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Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT CoronaryAngiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.
The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). Smith comment : Is the ACS (rupture plaque) with occlusion that is now reperfusing?
Given the consistency of the clinical profile with typical angina, associated riskfactors, and abnormal ECG findings, a cardiology consult was promptly requested. Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates.
Riskfactors such as high blood pressure, smoking, and inactivity are important because the longer you are exposed to them, the higher the odds you will develop coronary artery disease sooner in life. And, by extension, have a higher risk of a heart attack. But not everyone with riskfactors develops early heart disease.
A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. CT Coronary Artery Calcium Score Scan CT Coronary Artery Calcium Score CT CoronaryAngiogram As you can see from the above images, the CTCA provides far more anatomical detail.
Smith Major Learning Point: The worst riskfactor for a bad outcome in OMI is young age because cardiologists cannot believe that a young person can have an OMI. 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.
Heart disease, the build-up of plaque in the coronary arteries, typically starts years, if not decades, prior to an event. In many cases, you can see the risk coming years in advance. This doesn't apply to everyone, but on average, you can see the risk coming. CT CoronaryAngiogram. Here’s why.
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