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Out-of-hospital cardiacarrest (OHCA) mostly occurs in crowded public places outside hospitals, such as public sports facilities, airports, railway stations, subway stations, and shopping malls. Fortunately, there was no obvious stenosis in the right coronary artery.
A patient had a cardiacarrest with ventricular fibrillation and was successfully defibrillated. This is FAR LESS than all other studies of shockable arrest. Coronary Angiography after CardiacArrest without ST-Segment Elevation. The proof of this is that only 5% of patients enrolled had acute coronary occlusion.
years and was admitted after an out-of-hospital cardiacarrest due to ventricular fibrillation. After successful cardiopulmonary resuscitation, the initial diagnostic work-up showed elevated cardiac enzymes and a limited left-ventricular ejection fraction, while coronary angiography did not show relevant stenosis.
ST depression is common BOTH after resuscitation from cardiacarrest and during atrial fib with RVR. Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiacarrest, after defibrillation, and after cardioversion. The patient was cardioverted. This was done.
Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiacarrest. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiacarrest. (
Cardiacarrest can cause diffuse subendocardial ischemia, usually transient (it often resolves as time goes by after ROSC). Also, anterior MI could result from 1) ACS, but also from 2) severe ischemia due to combination of a hemodynamically significant LAD stenosis + severe hypotension during cardiacarrest.
A 66-year-old man was transferred to a hospital after a cardiacarrest. Coronary angiography (shown in a video) revealed 50% stenosis in the middle LAD coronary artery during diastole with complete occlusion during systole.
(MedPage Today) -- Not all defibrillator pad positions may work equally well for patients with shockable out-of-hospital cardiacarrest. JAMA Network Open) Medical therapy for aortic stenosis? Early clinical data on evogliptin were disappointing.
An echocardiogram confirmed aortic stenosis with a large pressure gradient. Now there is much less ST segment deviation, less elevation and less depression. The troponin returned positive, and the maximum troponin was 3.8 The next day, and angiogram showed normal coronary arteries. He awoke and did well.
Although one may have all kinds of ischemic findings as a result of cardiacarrest (rather than cause of cardiacarrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion. This prompted cath lab activation. On arrival to the ED, this ECG was recorded: What do you think?
Angiography revealed a very tight LAD stenosis with some flow (confirming the reperfusion that we see on the ECG). Were it not for this prehospital ECG and the cardiacarrest, the diagnosis may have been significantly delayed. A stent was placed, and the patient had an excellent outcome with no wall motion abnormality.
This patient is actively dying from a left main coronary artery OMI and cardiacarrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiacarrest. Below is a still image with the red arrow indicating the subtotal LMCA stenosis.
Angiography : LMCA — 90-99% osteal stenosis. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. Cath findings shown above in Dr. Nossen's discussion confirm multi-vessel disease , including 90-99% osteal stenosis of the LMCA. The image shows the impella device in place.
Category 2 : An increase in myocardial oxygen demand due to tachycardia, elevated ventricular afterload (BP or aortic stenosis), or increased wall stretch (admittedly this latter is more complicated) or a decrease in oxygen supply due to hypotension, anemia, hypoxia, or a combination of all of the above. Aortic Stenosis f.
It showed reduced LV function — significant concentric LVH — a dilated left atrium — severe aortic stenosis ( seemingly in need of prompt valve replacement ) — and at least moderate pulmonary hypertension , with resultant moderate pulmonary regurgitation. The plan was to proceed as soon as possible with aortic valve replacement.
I suspect this is Type 2 MI due to prolonged severe hypotension from cardiacarrest. distal stenosis or occluded small branches), and 3) nonischemic causes for myocyte injury (e.g., In non-arrest situations — escape beats and escape rhythms tend to be at least fairly regular. pulmonary embolism, sepsis, etc.),
It is apparently fortunate that she had a cardiacarrest; 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. She was defibrillated and resuscitated. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.
History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Thirty-six patients (36%) presented with cardiacarrest, and 78% (28/36) underwent emergent angiography.
He had a previous MI with cardiacarrest 2 years prior. LM: No significant stenosis. LAD: luminal irregularities with a 40% stenosis at the take-off of a D3. D3 has a 95% tubular ostial stenosis. LCX: Luminal irregularities, no significant stenosis. Two OM branches without significant stenosis.
Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiacarrest with unrecognized STEMI, died. 30 minutes later, this ECG was recorded: There is less high lateral ST elevation And another 3.5
They found an acute lesion of the LAD at the site of the prior stents, including 70% proximal LAD lesion and 95% mid-LAD stenosis with TIMI 3 flow at the time of cath. They took him almost immediately for catheterization. There was also a chronic total occlusion of the RCA. The LAD lesion was acute and required 3 stents to restore flow.
The patient was subsequently given 5000 units of heparin, 180 mg of ticagrelor, and defib pads were placed on the patient in the event that he should have a cardiacarrest. Angiogram Culprit Lesion: 90% mid LAD stenosis with evidence of plaque rupture, TIMI III flow on angiography.
If a patient presents with chest pain and a normal heart rate, or with shockable cardiacarrest, then ischemic appearing ST elevation is STEMI until proven otherwise. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI.
Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research at Cedars-Sinai, investigates the causes of and potential treatments for abnormal heart rhythms, including sudden cardiacarrest. Experts Available The following experts also are available for interviews throughout ACC.24: 24: Christine M.
We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiacarrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. of invasive‐assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001).
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