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EM Quick Hits 59 Traumatic Coronary Artery Dissection, Proper Use of Insulin, Mesenteric Ischemia, Exercise Associated Hyponatremia, AI for OMI

ECG Cases

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"A patient just arrived as a transfer for NSTEMI."

Dr. Smith's ECG Blog

The final diagnosis was spontaneous coronary artery dissection (SCAD) starting in the mid LAD and continuing distally where it wraps around the apex. SCAD wasn't on my differential per se , but in retrospect it should have been. Most patients presenting with SCAD report a preceding emotional or physical stressor.

SCAD 105
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A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

This strongly suggests reperfusing RCA ischemia. Troponins, echocardiogram An echocardiogram showed inferobasilar hypokinesis, further supporting a diagnosis of regional ischemia , likely of the area supplied by the RCA. In the absence of these factors it is termed spontaneous coronary artery dissection ( SCAD ).

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50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.

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An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. What is Spontaneous Coronary Artery Dissection (SCAD)?

SCAD 52
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Rise of the Lysenkoist Cardiologists

Dr. Anish Koka

The diagnosis typically requires classic clinical features, with no evidence of obstructive coronary disease, and typical findings of ischemia on functional studies. MINOCA now encompasses Spontaneous Coronary Artery Dissection (SCAD), a rare condition that is known to manifest primarily in women and affects the epicardial coronary artery.