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In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, researchers examined the risk of ischemic events in patients with stable coronaryartery disease. years, with 57.1% occurring within 30 days after CABG. Original article: Redfors B et al.
Myocardialinfarction is among the top causes of mortality worldwide. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardialinfarction, coronaryarterybypassgraft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications.
DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. Author continued : STE in aVR is often due to left main coronaryartery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).
Angiography done after initial stabilization showed severe stenosis of distal left main coronaryartery. In addition, there were multiple lesions in all three vessels, making a standard indication for an urgent coronaryarterybypassgrafting. There is minimal ST segment elevation in aVR as well.
This is diagnostic of myocardialinfarction. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point.
In most cases, rather, the culprit is gross ischemia due to myocardialinfarction, cardiomyopathy, or advanced coronaryartery disease. Unfortunately, today’s case is lacking any such diagnostics, thus I cannot say with certainty that the QT interval is, or is not, culpable in arrhythmogenesis. [1]
Watch what happends as the heart recovers from its episode of ischemia. This is the c ulprit for the patient's non-ST elevation myocardialinfarction AV groove circumflex, proximal LPDA, and mid LAD stenoses may also be hemodynamically significant Occlusion of the proximal nondominant RCA is not likely clinically relevant.
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