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She arrived comatose and in cardiogenicshock and the following ECG was recorded. Pressors were required, and the patient was transported to the cath lab with a door to balloon time of 60 minutes, where a proximal dominant RCA occlusion was opened and stented. She was intubated.
About 45 minutes after the second EKG, the patient was found in cardiacarrest. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenicshock. She could not be resuscitated.
About an hour later, he was then found on the floor in cardiacarrest in the ED. He underwent CPR and then was shocked out of VF. He was taken to the cath lab where he was found to have acute total occlusion of his saphenous vein graft to his RCA, which was stented. No further troponins were measured.
The patient was referred immediately for cath which revealed RCA occlusion that was stented. The patient died of cardiogenicshock within 24 hours despite mechanical circulatory support. Smith: This bizarre ECG looks like a post cardiacarrest ECG with probable acidosis or hyperkalemia in addition to OMI.
But the lack of traditional Sgarbossa criteria is not reassuring enough for such high pretest probability (elderly patient with chest pain, out of hospital cardiacarrest and LBBB), and the Modified Sgarbossa Criteria confirms Occlusion MI in this case. So the RCA was stented. Any indications for cath lab activation?
He had undergone stenting of the LAD several weeks ago (unclear whether elective for stable symptoms, or in response to acute coronary syndrome). Plus recommendations from a 5-member panel on cardiacarrest. Written by Pendell Meyers An adult man presented with acute chest pain. He appeared critically ill.
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