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It turns out that the conventional algorithm was also worried, and because of that, the patient was brought to the criticalcare area. There is akinesis of the distal septum, anterior, apex, and distal inferior wall consistent with LAD territory ischemia or infarction. How large is the infarct?
He was rushed by residents into our criticalcare room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded.
If you put the inferior and posterior findings together, it is diagnostic of OMI This was read as "inferior ischemia" without any other information by Dr. Richard Gray and as probable reperfused inferior-posterior OMI much later by both me and Pendell Meyers, also without any clinical information.
This EKG was recorded as part of a standing order for criticalcare. 2 days later This is a typical LVH pattern, without ischemia Patient underwent 4 vessel CABG. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. He denied any CP or SOB.
This was interpreted by the treating clinicians as not showing any evidence of ischemia. Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing criticalcare. Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function.
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