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And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis.
This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. CardiomyopathyCardiomyopathy is a condition that affects the heart muscle, causing it to become enlarged, thick, or rigid. This condition often leads to heart failure, as the heart cannot effectively pump blood.
My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." BOTTOM LINE: ECG changes of LV "strain" and/or ischemia that we see on today's initial ECG — were not present 9 years earlier. Cardiac cath showed normal coronary arteries.
There is ST elevation in V2 and V3 There are inverted T-waves in V2 and V3 There are prominent U-waves in V2 and V3 Many responders were worried about ischemia or hypertrophic cardiomyopathy. This short QT at least makes ischemia all but impossible. It is only to say that the ischemia is not represented on this ECG.
However, an echocardiogram is a different test, also conducted for heart activity. Electrocardiogram, echocardiogram, and some other tests are done for patients with cardiac arrest. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test.
So cardiomyopathies, valve problems, myocarditis and previous heart attacks all cause a problem with the pumping function of the heart. Overall though a normal cardiac MRI is even more reassuring than a normal echocardiogram. These are therefore not looking for coronary disease but instead ischemia heart disease.
by making it clear to everyone that this is NOT an EKG that one sees with takotsubo cardiomyopathy. Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy.
Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. It they are static, then they are not due to ischemia.
I have ordered an echocardiogram which will be done today, after that patient can be discharged to home with follow-up in 2 to 3 months." NOTE #3: In the context of a long QTc or ischemia — the finding of ST segment and/or T wave alternans may predict the occurrence of malignant ventricular arrhythmias. The echo was normal.
There is no evidence of infarction or ischemia. Later, he underwent a formal echocardiogram: Very severe left ventricular enlargement (LVED diameter 7.4 The absence of any wall motion abnormality makes ischemic cardiomyopathy very unlikely. There are nonspecific ST-T abnormalities. Mild to moderate mitral regurgitation.
Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. Therefore A different approach is needed.
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