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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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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.

Plaque 52
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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. 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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Critical Left Main

EMS 12-Lead

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.

Angina 52
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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography. Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock/profound hypotension; GI bleeding; anemia; "sick patient"; etc. ).

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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.