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A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. Aortic angiogram did not reveal aortic dissection.
Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. It they are static, then they are not due to ischemia.
which would suggest reduced rates of major adverse cardiac events with coronaryarterybypassgrafting." 2 days later This is a typical LVH pattern, without ischemia Patient underwent 4 vessel CABG. On the other hand, stable EKG over an hour in the setting of ongoing acute coronary syndrome is again unusual.
Watch what happends as the heart recovers from its episode of ischemia. Case continued Troponins over 26 hours, from right to left : Echocardiogram: Mild concentric left ventricular wall thickening, normal cavity size, and normal systolic function. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute?
The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.) The EKGs from the ED presentation were felt by cardiology to represent "subendocardial ischemia." Smith : these ECGs do NOT show subendocardial ischemia.
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