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Kawasaki disease (KD), an acute self-limited febrile illness that primarily affects children <5 years old, is the leading cause of acquired heart disease in developed countries, with the potential of leading to coronary artery dilation and coronary artery aneurysms in 25% of untreated patients.
The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). This is "Persistent ST elevation after previous MI" or "LV aneurysm morphology". LV aneurysm is very different for inferior vs. anterior MI. The patient had a critical LAD stenosis.
T-wave inversion in V2 is inconsistent with early repol, and is typical of posterior ischemia. In addition, there is ST depression, diagnostic of ischemia, in V3-V6. It showed a 99% stenosis in the RCA, and proximal to a posterolateral branch. A coronary aneurysm was found. mm of ST elevation in inferior leads.
Prior ECG available on file from 2 months before: We do not know the clinical events happening during this ECG, but there is borderline tachycardia, PVCs, and likely some evidence of subendocardial ischemia with small STDs maximal in V5-6/II, slight reciprocal STE in aVR. QS waves from V2-V5 consistent with LV aneurysm morphology.
The EKG is diagnostic of acute inferior, posterior, and lateral OMI superimposed on “LV aneurysm” morphology. Whether these EKGs show myocarditis, a normal variant, or something else, they are overall not typical of transmural ischemia of the anterior or high lateral walls. Patient 2 , EKG 1: What do you think?
An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was What do you think?
Repeat ECG at 1624 (shortly before cath): QS waves now present in V2-V3, with slight STE, showing the pattern of left ventricular aneurysm morphology. Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia." Upon arrival to the PCI center, the repeat troponin returned at 13,962 ng/L.
Meschia’s lecture, “Asymptomatic Carotid Stenosis: Current and Future Considerations,” will be presented Feb. Globus New Investigator Award in Stroke awardee, is a postdoctoral fellow at Barrow Aneurysm & AVM Research Center (BARRC) at the Barrow Neurological Institute in Phoenix. Chimowitz, M.B., Ch.B. , the recipient of the Ralph L.
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Evidence of acute ischemia (may be subtle) vii. Left BBB vi. LVH or RV d.
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