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Case Report: Kounis syndrome due to cryptopteran bite

Frontiers in Cardiovascular Medicine

Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Outside the hospital, electrocardiogram(ECG) showed sinus rhythm, ST-segment elevation in leads V1–V3, high-sensitivity troponin 2.54 ng/ml(0–0.5 ng/ml). ng/ml(0–0.5 ng/ml).

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See how bad the outcome can be if you don't know OMI findings on the ECG, and don't use the Queen of Hearts

Dr. Smith's ECG Blog

The attending provider wrote “Agree with electrocardiogram interpretation”. The red arrow shows a roughly 80% stenosis of the proximal LAD. The blue arrow shows another stenosis of the LAD distal to the first diagonal branch of about 99%. The green arrow shows a 95% stenosis of the ostium of the first diagonal branch.

Outcomes 113
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What if your system adopted the recommendation that a computer "normal" ECG need not be shown to the doctor?

Dr. Smith's ECG Blog

Angiogram findings included: 95% mid RCA stenosis with occluded distal right PDA secondary to thrombus (peristent OMI). Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Below the limit of detection. And literature: McLaren, Meyers, Smith and Chartier.

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Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

Circulation

Electrocardiogram (ECG) showed a prominent S wave in the left-sided leads and a prominent R wave in the right-sided chest leads, suggesting dextrocardia. The left circumflex had 80% proximal stenosis with minimal luminal irregularities in the mid to distal portion.

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Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Dr. Smith's ECG Blog

It was stented. Also, anterior MI could result from 1) ACS, but also from 2) severe ischemia due to combination of a hemodynamically significant LAD stenosis + severe hypotension during cardiac arrest. Updates on the Electrocardiogram in Acute Coronary Syndromes. The troponin I peaked at 8.1. References : 1. Nikus KC, Eskola MJ.

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How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

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 Myocardial Infarction in the Emergency Department Case 1. Updates on the Electrocardiogram in Acute Coronary Syndromes.

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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"! 3 , 4 Q-waves defined the diagnosis of myocardial infarction before modern cardiac imaging was widely available.