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A CT Coronaryangiogram 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."
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 coronaryangiogram. Supply-demand mismatch (non-occlusive coronary disease, or exacerbation of preexisting flow insufficiency) a.
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.
We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multi-lead ST depression. All electrocardiograms (ECGs) and coronaryangiograms were blindly analyzed by experienced cardiologists. A slightly prolonged QTc ( although this is difficult to assess given the tachycardia ).
During observation in the ED the patient had multiple self-terminating runs of Non-Sustained monomorphic Ventricular Tachycardia (NSVT). CT coronaryangiogram showed a hypoplastic RCA and dominant LCx. There were no plaques or stenoses. This patient very likely has some form of idiopathic ventricular tachycardia.
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.
Angiogram Door to balloon time was 120 minutes (much too long) because of time taken for a CT. Coronaryangiogram showed 100% mid LAD occlusion for which she received a DES with excellent angiographic result. This was ruptured plaque with thrombus.
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