Remove Aortic Remove Coronary Angiogram Remove Myocardial Infarction
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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

ng/mL This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction. A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD Her initial cTnI returned at 0.25 CAD-RADS category 1. --No

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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

The Queen of Hearts disagrees, diagnosing OMI with high confidence: Case Continued: The EKG was not immediately recognized by the emergency provider, who ordered a CT scan to rule out aortic dissection at 1419. Diagnosis of Type I vs. Type II Myocardial Infarction in Emergency Department patients with Ischemic Symptoms (abstract 102).

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Look at the aortic outflow tract. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection. What do you see? Answer below in the still shot.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. As his pain was very severe, emergency physicians concerned of aortic dissection and ordered a thoracic CT scan. References 1. Aslanger EK, Meyers HP, Smith SW.

STEMI 52
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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

Hgb 11g/dL (110g/L) and leukocytosis, and a mildly elevated troponin (36 ng/L, with normal 1mm STE in aVR due to ACS will require coronary artery bypass surgery for revascularization, the infarct artery is often not the LM, but rather the LAD or severe 3-vessel disease. Incidence of an Acute Coronary Occlusion. Left main?

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Hypertrophic Cardiomyopathy

EMS 12-Lead

As a brief review, HCM is a genetically inherited disorder that produces structural disarray in the myocardial cells. There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. 40; 1234-1241.

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Which patient needs a CT scan?

Dr. Smith's ECG Blog

Angiogram Door to balloon time was 120 minutes (much too long) because of time taken for a CT. Coronary angiogram showed 100% mid LAD occlusion for which she received a DES with excellent angiographic result. It was not SCAD (coronary dissection) Highest troponin I was 37,000 ng/L, but it was not measured to peak. (if