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EKG with paced complexes shown below shows much narrower QRS complex and echocardiogram showed improved LV systolic function primarily due to improvement in LV dyssynchrony. In this specific case, Left Bundle Branch (LBB) area pacing was pursued to achieve cardiac resynchronization.
An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. An echocardiogram showed an EF of 20-25%. At this point, there was no improvement in LV function and he was out of the convalescent phase of his MI, so the decision was made to install an ICD for arrhythmia prophylaxis.
Hopefully a repeat echocardiogram will be performed outpatient. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). NOTE: Prediction of cardiac contusion "severity" on the basis of cardiac arrhythmias and ECG findings — is an imperfect science. QTc prolongation.
The echocardiogram showed a normal EF without any abnormalities. She was discharged with plan for outpatient cardiac MRI for further evalution. The "good news" ( from an arrhythmia interpretation perspective ) — is that we now see P waves much better than we did in the initial ECG. Troponins were all negative.
The emergent echocardiogram showed normal EF, no WMA, and normal valve function. Hopefully his outpatient EP appointment will understand and correct that. Unfortunately, this fooled the Emergency Physician and Cardiologist into an emergent angiogram for perceived "inferior STEMI." No use of drugs, stimulants, etc. was discovered.
It is relevant to note here that as a physician active clinically in both the inpatient and outpatient arenas, I am an eyewitness to the severe toll COVID19 took on my patients in the Spring or 2020. His cardiac testing completed to date consist of an electrocardiogram and an echocardiogram performed Feb 16th, 2023 that were both normal.
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