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High profile cases of sudden cardiacarrest 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 cardiacarrest in athletes? Can an athlete return to play after cardiacarrest?
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 cardiacarrests with ROSC regained each time.
Imge courtesy of Won-Young Kim from Chung-Ang University milla1cf Thu, 01/11/2024 - 08:30 January 11, 2024 — Acute cardiovascular manifestations of COVID-19 , such as heart failure, thrombosis, and dysrhythmia, are associated with increased mortality.
This case highlights such a scenario.Case:A 75-year-old female with a history of cardiacarrest 30 years ago presented with shortness of breath and left leg swelling. She experienced massive hemoptysis, leading to respiratory and cardiacarrest, but was resuscitated. Bronchoscopy revealed clots in the left lower lobe.
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. The degree of stenosis is not a great predictor of thrombosis, and culprits may not be visible.
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%, (..)
I suspect this is Type 2 MI due to prolonged severe hypotension from cardiacarrest. 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.
Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. elevated BP), but rather directly correlated with coronary obstruction (due to plaque rupture and thrombosis) and, potentially, stymied TIMI flow. This results in Type I MI.
It was thought to be an in stent restenosis and thrombosis from a DES placed in the same region 6 months prior. Dialysis patients had double the rate of cardiacarrest (11% vs 5%), were less likely to receive reperfusion therapy when eligible (47% vs. 75%), and had an increased odds ratio of death compared to nondialysis patients 1.5 (95%
Thirty-six patients (36%) presented with cardiacarrest, and 78% (28/36) underwent emergent angiography. Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiacarrest; shock/profound hypotension; GI bleeding; anemia; "sick patient"; etc. ).
12,16 In 2017, CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) provided proof-of-principle that inflammation inhibition in the absence of lipid lowering can significantly reduce cardiovascular event rates and helped to define the interleukin-1 (IL-1) to IL-6 to CRP pathway as a central target in CV disease.16
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