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American College of Cardiology Announces Care of the Athletic Heart

DAIC

High profile cases of sudden cardiac arrest in elite athletes in recent years has reminded the cardiology community of the challenging questions posed to cardiologists in these settings. Questions like: How do we prevent cardiac arrest in athletes? Can an athlete return to play after cardiac arrest?

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). He had multiple cardiac arrests with ROSC regained each time.

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Abstract 4139677: A rare case of ventriculobronchial fistula caused by an epicardial defibrillator patch

Circulation

This case highlights such a scenario.Case:A 75-year-old female with a history of cardiac arrest 30 years ago presented with shortness of breath and left leg swelling. She experienced massive hemoptysis, leading to respiratory and cardiac arrest, but was resuscitated. Bronchoscopy revealed clots in the left lower lobe.

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Abstract 022: Acute Kidney Injury in Subarachnoid Hemorrhage: Exploring its Clinical Significance and Prognostic Implications

Stroke: Vascular and Interventional Neurology

However, AKI patients had higher rates of deep vein thrombosis (6.36% vs. 3.54%, p < 0.01), pulmonary embolism (4.22% vs. 1.42%, p < 0.01), pneumonia (21.39% vs. 8.84%, p < 0.01), urinary tract infection (19.07% vs. 13.32%, p < 0.01), sepsis (20.27% vs. 4.18%, p < 0.01), acute myocardial infarction (12.14% vs. 3.21%, (..)

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1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. pulmonary embolism, sepsis, etc.), Coronary thrombosis or embolism can result in MINOCA, either with or without a hypercoagulable state. In non-arrest situations — escape beats and escape rhythms tend to be at least fairly regular.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. The degree of stenosis is not a great predictor of thrombosis, and culprits may not be visible.

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