article thumbnail

An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. Invasive therapies, such as percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) should be reserved for patients with ongoing ischemia, left main artery dissection, or hemodynamic instability 6.

SCAD 52
article thumbnail

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). 2 The astute paramedic recognized this possibility and announced a CODE STEMI.