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Such a pattern is consistent with significant left main coronaryarterystenosis. Angiography done after initial stabilization showed severe stenosis of distal left main coronaryartery. Clinical evaluation and X-Ray chest showed features of pulmonary edema.
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. If you see this, you should Doppler the valve.
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.
The patient was started on heparin for possible NSTEMI vs demand ischemia. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade. What "initiates" the aortic stenosis cascade? increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.)
Watch what happends as the heart recovers from its episode of ischemia. Angiogram: Severe two-vessel coronaryartery disease of a left dominant system including 70 to 80% stenosis involving the distal left main/bifurcation. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute? Hard to tell.
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