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Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. Prog- nostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pecto- ris-Myocardial Infarction Multicenter Investigators in Japan.
If you don't know what the dysrhythmia is, then try procainamide. Episodes of angina over past couple of months had been progressive. Pads were placed with ultrasound guidance, so they were in the correct position. What to do now? If you believe it is SVT, then try adenosine. So I would give procainamide.
This is mainly seen in patients who were taking the beta blocker for angina due to significant coronary disease and in a few of these patients, stopping the beta blocker was associated with more angina and even development of heart attacks. This is termed as ‘Acute beta blocker withdrawal syndrome’.
Firstly the plaque may continue to build up and cause actually restrict blood from getting to the heart muscle and this often presents with symptoms of chest tightness on exertion or angina. If the plaque gets so restrictive that no blood gets through then that leads to a heart attack which then damages the heart as a pump.
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