Remove Coronary Angiogram Remove Plaque Remove Tachycardia
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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD LAD plaque with 0-25 percent stenosis. Although a lesion is not visible anatomically on this CT scan, coronary catheter angiography could be considered based on Cardiology evaluation."

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Critical Left Main

EMS 12-Lead

Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. It’s judicious, then, to arrange for coronary angiogram. Supply-demand mismatch (non-occlusive coronary disease, or exacerbation of preexisting flow insufficiency) a.

Angina 52
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What Lies Beneath

EMS 12-Lead

From afar, there is gross tachycardia, cadence irregularities, and narrow QRS complexes that may, or may not, be Sinus in origin; and finally – a cacophony of wide complexes that might very well be ventricular in origin. McLaren : We’ve answered the first question – Sinus Tachycardia with episodic runs of wide QRS (RBBB morphology) and PVC’s.

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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multi-lead ST depression. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists. A slightly prolonged QTc ( although this is difficult to assess given the tachycardia ).

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Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

During observation in the ED the patient had multiple self-terminating runs of Non-Sustained monomorphic Ventricular Tachycardia (NSVT). CT coronary angiogram showed a hypoplastic RCA and dominant LCx. There were no plaques or stenoses. This patient very likely has some form of idiopathic ventricular tachycardia.

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Trust the coronaries : There are benign forms of ACS too !

Dr. S. Venkatesan MD

One big chunk of ACS-UA is secondary UA where there is increased demand as in stable angina with tachycardia*. In these patients there is no plaque triggered ACS. we can witness menacingly deep resting ST depression with absolutely no thrombotic process going on in the coronary.

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Which patient needs a CT scan?

Dr. Smith's ECG Blog

Angiogram Door to balloon time was 120 minutes (much too long) because of time taken for a CT. Coronary angiogram showed 100% mid LAD occlusion for which she received a DES with excellent angiographic result. This was ruptured plaque with thrombus.