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There are multiple possible clinical situations that could account for diffuse subendocardial ischemia that is not due to ACS and plaque rupture. On arrival in the emergency department, invasive blood pressure was 35/15mmHg and the patient was in profound cardiogenicshock with severe confusion secondary to brain hypoperfusion.
The notes now refer to the patient being in cardiogenicshock, on pressors. hours from presentation, where he was found to have an acute thrombotic LAD occlusion which was stented with resulting TIMI 3 flow, but still the patient was in severe cardiogenicshock. Time = 3 hours: the next troponin returns at 60 ng/L.
ET Main Tent (Hall B1) Self-expanding Versus Balloon-expandable Transcatheter Aortic Valve Replacement in Patients with Small Aortic Annuli: Primary Outcomes from the Randomized Smart Trial Effect of Edetate Disodium Based Chelation Infusions on Cardiovascular Events in Post-MI Patients with Diabetes: The TACT2 Trial Long-term Beta-blocker Treatment (..)
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.
Clinical and Investigative Horizons The Clinical and Investigative Horizons is a new type of late-breaker session that was added for ACC23 and is back by popular demand.
Why is the patient in shock? He was in profound cardiogenicshock. He was taken to the cath lab and underwent emergent intervention: Thrombotic stenosis of the proximal RCA (95% with evidence of plaque rupture) is the culprit for the patient's inferoposterior STEMI. There is an obvious inferior STEMI, but what else?
Here’s the angiogram of the RCA : No thrombus or plaque rupture in the RCA (or any coronary artery) was found. This MI wasn’t caused by a ruptured plaque of CAD - it was a coronary artery dissection of the RCA. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenicshock. Lobo et al.
Tachycardia is unusual for OMI, unless the patient is in cardiogenicshock (or getting close). As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion). We can see enough to make out that the rhythm is sinus tachycardia.
An elderly man with sudden cardiogenicshock, diffuse ST depressions, and STE in aVR Literature 1. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? Knotts et al.
Top 10 Clinical Trials Preventive PCI on Stenosis With Functionally Insignificant Vulnerable Plaque PREVENT (ACC.24) 24) Microaxial Flow Pump in Infarct-Related CardiogenicShock DanGer Shock (ACC.24) It is asking for stenting all non-flow limiting lesion , if found, to carry high risk plaques by intracoronary Imaging.
A 2017 trial named CULPRIT SHOCK found that in patients with cardiogenicshock, a strategy of culprit vessel PCI only was associated with better outcomes than immediate multivessel PCI. After CULPRIT SHOCK, many shied away from multivessel PCI in the acute setting. In fact, in this elegant study by Heitner et al.
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