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Left ventricular free wall rupture caused by myocardial ischemia without treatable atherosclerotic coronary disease: a case series

Journal of Cardiothoracic Surgery

Under ICU surveillance, LVFWR occurred 24 h later and was treated by pericardiocentesis and ECMO support followed by immediate uncomplicated surgical repair. Postoperative therapy-refractory vasoplegia and electromechanical dissociation caused fulminant deterioration and the early death of the patient.

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A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course.

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Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. She had an uneventful ICU course and was extubated for ongoing care with the inpatient psychiatric service.

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Abstract 114: LACROSSE Trial: Lumbar Drainage Compared to External Ventricular Drainage in Aneurysmal Subarachnoid Hemorrhage, a Randomized Control Trial

Stroke Journal

Introduction:Delayed cerebral ischemia (DCI) is a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Secondary outcomes were ICU measures and functional outcomes.Results:52 patients were enrolled. Stroke, Volume 55, Issue Suppl_1 , Page A114-A114, February 1, 2024.

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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

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 critical care. He was intubated in the field and sedated upon arrival at the hospital. Two subsequent troponins were down trending.

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Abstract 254: Imaging Findings of Stroke Following Treatment of Ruptured Cerebral Aneurysm Increases Risk of Postoperative Delirium

Stroke: Vascular and Interventional Neurology

IntroductionDelirium is an acute cognitive or perceptual disturbance that is associated with prolonged hospital and ICU length of stay, therefore, extending recovery time. This is secondary to delayed postoperative cerebral ischemia and infarction caused by vasospasm.7

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A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU.