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Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The patient was transferred to CCU to consider surgical options. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.
An open 90% LAD was stented. Here is the ECG the next AM: There was so little infarction that there are lateral, but no anterior reperfusion T-waves (normally, there would be Wellens' type waves after LAD reperfusion). Here is some older but very interesting literature on TIMI myocardial perfusion grade and ST resolution : 1.
The OM-1 was opened and stented, then the LAD was stented 3 days later. The acute infarct-related artery was off the circumflex and the affected wall was posterior (STEMI). The LAD had a 75% proximal lesion that by fractional flow reserve was hemodynamically significant. The posterior leads were falsely negative.
He was found to have a 100% circumflex lesion for which a bare metal stent was placed. Laurence Katz and Jonathan Jones Safety of Computer Interpretation of Normal Triage Electrocardiograms (pages 120–124). It is not subtle any more. Interventional cardiology was consulted and patient was taken to the cath lab. References : 1.
Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. Literature cited In inferior myocardialinfarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction Johanna E. Such an escape would have a wider complex.
Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardialinfarction presented to a family clinic with two days of epigastric pain that started after consuming a meal. The attending provider wrote “Agree with electrocardiogram interpretation”. Normal EKG”. Normal ECG.
Consequences of reocclusion after successful reperfusion therapy in acute myocardialinfarction. It is important to recognize that coronary thrombosis is dynamic , with spontaneous opening and lysing of the thrombus in the infarct-related artery (we all have endogenous tPA and plasmin to lyse thrombi). It was stented.
LAD and D1 were stented, but flow unfortunately could not be well restored despite efforts (they list the post intervention TIMI flow still as 0). Serial tracings following stent placement confirmed the large extent of myocardial injury. LCX and RCA were described as "normal" in the cath report. Am J Emerg Med. 2021.11.023.
The patient was then taken to the cath lab an found to have a proximal RCA 100% thrombotic occlusion which was successfully stented. Diagnostic and prognostic value of the QRS-T-angle, an ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarc tion.
Angiogram found a totally occluded first diagonal artery, consistent with all the ECGs, which reperfused after stenting. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardialinfarction. Am J Emerg Med 2023 2. Herman, Meyers, Smith et al.
A mid-LAD culprit lesion was identified and stented. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardialinfarction in the emergency department. Type II MI), however decided to pursue coronary angiogram out of an abundance of caution. Pacing Clin Electrophysiol. 40; 1234-1241.
They were stented. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Available from: [link] Excerpt: "To illustrate the limitations imposed by sample size, recent data from our institution reveal that we identify approximately 225 type I myocardialinfarctions (MI) in a typical year.
Diagnosis of Acute MyocardialInfarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. Electrocardiographic Diagnosis of Acute Coronary Occlusion MyocardialInfarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria.
At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute MyocardialInfarction in the Emergency Department Case 1. Widimsky P et al.
LAD 80% mid LCx occluded mid (acute infarct lesion) RCA 80% mid. distal stent patent. PCI mid LCx So this is an OMI (Occlusion MyocardialInfarction), but not a STEMI Echo: Decreased left ventricular systolic performance, mild/moderate. Repeat ECG shows modest ST elevation in I and aVL and depression in inferior leads."
Appearance of abnormal Q waves early in the course of acute myocardialinfarction: implications for efficacy of thrombolytic therapy. It was treated with and dual "kissing balloons" and drug eluting stents. Midlateral wall rupture secondary to infero-postero-lateral infarction from circumflex occlusion was most common (34%).
Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardialinfarction. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. The lesion was successfully stented. No reciprocal ST-segment depression (STD). --QT
His father and brother both died of myocardialinfarction at ages 61 and 45, respectively. Advanced multi-vessel disease was found with stents deployed to the mid-LCx (80% stenosis), D1 (90% stensosis), and the pLAD (95% stenosis). A new electrocardiographic pattern indicating inferior myocardialinfarction.
The de Winter electrocardiogram pattern is an infrequent presentation, reported to occur in 2% to 3.4% of patients with anterior myocardialinfarction ( 1 ). At cath there was a 100% proximal LAD occlusion, which was opened and stented. If you have seen this pattern once the diagnosis is obvious to you.
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