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A CT Coronaryangiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD No signs for aortic dissection or pulmonary embolus. --"Results were discussed with the ordering physician. A repeat troponin returned at 0.45 ng/mL, consistent with reperfused OMI, or Non-OMI.
CT of the chest showed no pulmonaryembolism but bibasilar infiltrates. Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. Dobutamine is an acceptable alternative.
She had idiopathic ventricular fibrillation in 1992, treated with an EPD (Picture 1A), later replaced by a transvenous ICD.She was diagnosed with left femoral deep venous thrombosis and bilateral pulmonaryembolism and started on therapeutic anticoagulation. Despite empiric bronchial artery embolization, hemoptysis persisted.
On his physical examination, cardiac and pulmonary auscultation was completely normal. Bi-phasic scan showed no dissection or pulmonaryembolism. Coronary arteries cannot be assessed because the scan was not gated, but proximal segments of the coronary arteries seem to be open with some contrast.
CT angiogram chest: no aortic dissection or pulmonaryembolism. Serial chest xrays: progressive bilateral pulmonary edema. Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. No further troponins were measured.
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