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So we activated the Cath Lab Angiogram: Impression and Recommendations: Culprit for the patient's anterior ST segment myocardial infarction and out of hospital V-fib cardiac arrest is a thrombotic occlusion of the mid LAD The first troponin returned barely elevated at 36 ng/L (URL = 35) In our study of initial troponin in STEMI, 26.8%
The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrialflutter with regular conduction. There are no P waves preceding the QRS complexes, and no clear flutter waves. She had an echocardiogram which was normal. SVT is by far the most likely rhythm in this case.
The patient was given furosemide and admitted to the hospital. Later, he underwent a formal echocardiogram: Very severe left ventricular enlargement (LVED diameter 7.4 There is atrial activity before every QRS, but that activity has negative polarity, so it is not sinus rhythm. The other atrialflutter types are: 1.
Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score. Background: Syncope is a common, potentially serious condition accounting for many hospital admissions. Other studies 1) EGSYS score (full text link). Del Rosso A, et al. Heart 2008;94(12):1620–6.
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