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Pulse was 115, BP 140/65, and afebrile He was found to have cellulitis and to be in diabetic ketoacidosis, with bicarb of 14, pH of 2.27, glucose of 381, anion gap of 18, and lactate of 2.2 Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present.
His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. The initial troponin T level was measured at 30 ng/L.
A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia.
Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. His response: “subendocardial ischemia.
This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Also see this incredible case of the use of 12-lead ST Segment monitoring.
A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. Does this mean that the ST depression in V3 represents "anterior" subendocardial ischemia, and not posterior OMI? non-occlusive ischemia) 2. Thus, they have much less voltage.
This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Echocardiogram An echocardiogram uses sound waves to produce a detailed image of the heart, allowing doctors to see the size of the heart chambers and how well the heart is pumping blood.
The clinical significance of ARCA-LCS lies in its potential to cause myocardial ischemia or sudden cardiac death, particularly under physical exertion. No previous history of hypertension or diabetes. Transthoracic echocardiogram, bilateral carotid Doppler ultrasound, and electrocardiogram were normal.
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