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The timely detection of myocardial fibrosis is crucial for intervention and improved outcomes. 68 Ga-FAPI-04 PET/CT shows promise in assessing fibroblast activation in patients with early myocardialinfarction characterized by prolonged myocardial ischemia. The results demonstrated tracer-specific uptake (SUVmax = 4.6)
Cardiovascular consultation had been requested for all of the patients based on their primary clinical examination, vital signs, and electrocardiogram (ECG). Additionally, 2D transthoracic echocardiography (TTE), and myocardial injury serum biomarkers assays (creatine phosphokinase-MB [CPK-MB] and cardiac troponins [cTn]) were measured once.
Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] 1] European guidelines add "regardless of biomarkers". But only 6.4% Clin Cardiol 2022 4. Herman, Meyers, Smith et al. McLaren and Smith.
As hours go by, these T inversions always evolve , [unless 1) there is re-occlusion, in which case they go upright and become hyperacute, with or without additional ST elevation, ("pseudonormalize") or 2) no infarction at all (negative troponin, true unstable angina with dynamic T-waves, in which they may normalize). Jernberg T, et al.
A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.
This patient had reported with recent onset angina. They can present with anterior wall infarction. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardialinfarction. ST elevation was 2 mm in aVR and 1 mm in V1. J Am Coll Cardiol.
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 Appearance of abnormal Q waves early in the course of acute myocardialinfarction: implications for efficacy of thrombolytic therapy. hours when she called 911. These do NOT indicate late, subacute MI. Raitt MH, et al.
At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute MyocardialInfarction in the Emergency Department Case 1. Widimsky P et al. This was a 100% acute LM occlusion.
This is surprisingly common, and several studies of continuous 12-lead ECG monitoring in the setting of admitted unstable angina report high rates (15%) of silent transient myocardial ischemia (ST elevation), and that these findings were strong independent predictors of MI or death during hospitalization. Patel et al., Krucoff et al.)
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