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The algorithm uses deep learning to analyse routine ultrasound scans of the heart ( echocardiograms ) to detect disease that often goes undetected during standard assessments.
On arrival, lung ultrasound confirmed pulmonary edema (B lines). Mild Plaque no angiographically significant obstructive coronaryarterydisease. There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD. This is proximal LAD Occlusion until proven otherwise.
Patients usually have a normal life expectancy unless other structural heart diseases are present. An intravascular ultrasound was also performed, which was negative for vessel dissection. Introduction:Dextrocardia is a rare congenital condition where the heart's apex points to the right, with an incidence of about 0.01%.
The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex. Fortunately, this operator used intravascular ultrasound (IVUS). Initial hscTnI was 10 ng/L (ref. <14).
This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. This entire case is not consistent with takotsubo. It can only be seen by IVUS.
Given her risk factors (HTN, HLD, ESRD from diabetes) I decided to obtain a broad cardiac workup for the patient: serial ECGs, labs, serial troponins, CXR and bedside cardiac ultrasound. This appears to be new, as her last formal echocardiogram 2 years ago was relatively normal. Clinical presentation is important, but so is history.
See this case: what do you think the echocardiogram shows in this case? Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronaryarterydisease? Incidence of an acute coronary occlusion. A emergent cardiology consult can be helpful for equivocal cases.
Echocardiography – We can use ultrasound to visualize the heart and look at how well it pumps. With this test, an echocardiogram is done at rest to study the pumping ability of the heart. The best way to know if there is plaque in the heart arteries is by a test called CTCA (CT coronary angiography).
Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.
I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Anything that causes pulmonary edema: poor LV function, fluid overload, previous heart failure (HFrEF or HFpEF), valvular disease. Or I suspect that there is OMI simultaneous with another pathology.
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