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Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Clin Cardiol 2022 4. Herman, Meyers, Smith et al. Eur Heart J Digital Health 2024 5. McLaren and Smith.
Electrocardiogram (ECG) showed a prominent S wave in the left-sided leads and a prominent R wave in the right-sided chest leads, suggesting dextrocardia. After guidewire crossing, balloon angioplasty was performed, and a drug-eluting stent was deployed. His vital signs were normal, and the physical examination was unremarkable.
An open 90% LAD was stented. A 51 year old male with h/o stent presented with 30 minutes of chest pain: Obvious anterolateral very acute STEMI with hyperacute T-waves He went for immediate PCI, with successful reperfusion of a 100% occluded proximal LAD, and a door to balloon time of 35 minutes. The LAD has reperfused early.
The OM-1 was opened and stented, then the LAD was stented 3 days later. New electrocardiographic criteria for posterior wall acute myocardial ischemia validated by a percutaneous transluminal coronary angioplasty model of acute myocardial infarction. So there was 3-vessel disease, but with an acute posterior STEMI.
These tests may include: Electrocardiogram (ECG) : Records the electrical activity of your heart. A heart check-up is a comprehensive evaluation of your cardiovascular health. It typically includes a physical examination, medical history review and diagnostic tests. Echocardiogram : Uses sound waves to create images of your heart.
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 Myocardial Infarction in the Emergency Department Case 1. Updates on the Electrocardiogram in Acute Coronary Syndromes.
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