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Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. This usually done by a pacer lead placed through the coronary sinus (LV venous system). Use Lidocaine instead (lidocaine prevents the PVCs which cause R on T, and does not prolong the QT.)
The diagnostic coronaryangiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection. The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED.
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