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Circulation: Cardiovascular Interventions, Ahead of Print. BACKGROUND:Prior clinical trials have demonstrated the efficacy of ultrasound-facilitated catheter-directed thrombolysis (USCDT) for the treatment of acute intermediate-risk pulmonary embolism (PE) using reduced thrombolytic doses and shorter infusion durations.
Circulation, Volume 151, Issue 12 , Page 835-846, March 25, 2025. The risk of stent thrombosis is particularly increased during the first 6 months after intervention. Key exclusion criteria included <18 or >75 years of age, contraindications to anticoagulant use, or acute venous thrombosis <3 months.
Bedside cardiac ultrasound with no obvious wall motion abnormalities. It is not small but rather large plaques, which may not be producing significant stenosis, that undergo rupture with acute occlusive thrombosis, resulting in myocardial infarction and other ischemic events. He was started on nitro gtt.
MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. This is in spite of the known proclivity of tighter stenoses to thrombose.
The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. The authors recommend using optical coherence tomography or intravascular ultrasound imaging in patients with evidence of nonobstructive CAD by angiogram.
This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Takotsubo is a sudden event, not one with crescendo angina.
Total loss of circulation can lead to gangrene and loss of a limb. Deep Vein Thrombosis (DVT) : A blood clot occurring in a deep vein. Causes include infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis (DVT), radiation or other cancer treatment. Damaged valves within the veins cause this.
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