Remove Cardiogenic Shock Remove Coronary Artery Disease Remove Ultrasound
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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

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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

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Incidence of an acute coronary occlusion. 3-vessel disease? An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Studies of patients with coronary artery disease who developed arrhythmic storm with episodes of PMVT following MI — show arrhythmias indistinguishable from those reported in this case.

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Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Dr. Smith's ECG Blog

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Or I suspect that there is OMI simultaneous with another pathology.