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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.
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.
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.
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.
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.
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.
Advanced multi-vessel disease was found with stents deployed to the mid-LCx (80% stenosis), D1 (90% stensosis), and the pLAD (95% stenosis). New insights into the use of the 12 Lead Electrocardiogram for diagnosing Acute Myocardial Infarction in the emergency department. link] [1] Mirand, D. 2] Aslanger, E.,
There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. A mid-LAD culprit lesion was identified and stented. Pacing Clin Electrophysiol. 40; 1234-1241.
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