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mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant."
06:44 - T-waves in V2 are smaller now - Overall resolution of prior findings (which qualifies as a dynamic change) The initial note by the cardiologist states that the presentation is more consistent with pericarditis. Remember, pericarditis is the thing you say and write down when youre actively trying to miss an OMI.
His disease included 70% prox LAD, 80% distal LAD, 10% in-stent stenosis in the distal LCX, 70% OM1, 70% OM2, and 60% prox RCA. Triage ECG: It was interpreted as lateral STEMI, and he was sent to the cath lab, where the angiogram showed unchanged CAD from known prior, with no acute culprit. Three troponins were undetectable.
This rules out pericarditis, which essentially never has reciprocal ST depression. The patient had a critical LAD stenosis. This is not pericarditis because: a. Pericarditis does not have reciprocal depression. ST elevation of pericarditis is maximal in leads II and V5, V6. He underwent CABG. Conclusions: 1.
Aortography confirmed a normal course of coronary arteries, with adequate perfusion of essential branches and no evidence of stenosis or aneurysms. Additionally, a complication of pericarditis cannot be entirely ruled out. Cardiac magnetic resonance imaging revealed an akinetic aneurysm of the LV apex with a full-wall ischemic scar.
There were no incidences of adverse event fistula, diaphragmatic paralysis, MI, pericarditis, thromboembolism, PV stenosis, transient ischemic attack, or death. Eighty patients (98%) underwent remapping.
That occurs in right heart failure and constrictive pericarditis. Constrictive pericarditis is an important cause for Kussmaul sign or inspiratory increase in jugular venous pressure. The Y descent is shallow in tricuspid stenosis, and absent in cardiac tamponade. A prominent A wave can occur when the atrium is hypertrophied.
There is evidence that de Winter's T-waves really represent a tiny trickle of blood through the thrombotic stenosis. In patients with suspicion of acute MI who have any ST elevation, aVL is also a very useful lead to differentiate between pericarditis and MI. mm ST depression in aVL.
Then the patient's pain then resolved spontaneously after 2 sublingual nitroglycerine and another ECG was recorded ECG 2 at 16 minutes ST ELEVATION CONSISTENT WITH INJURY, PERICARDITIS, OR EARLY REPOLARIZATION Overread same Smith : The T-waves are now MUCH smaller. The S-wave is reconstituted. The inferior findings are much less pronounced.
Pericarditis? The cath lab was activated: Result: Thrombotic 95% stenosis at the ostium of a small LPL2 with 70% stenosis at the LPL2/LPDA bifurcation in the distal/AV groove Cx Tubular 70% stenosis in the mid-circumflex. (In Time zero What do you think? There is inferior ST elevation. Is it normal variant?
Assessment:" " Nonspecific ST elevation from V1-V4 , question of early repolarization versus pericarditis , question of acute current of injury and ? Pericarditis would be even more unlikely in someone without chest pain. Initial troponin came back negative." Sodium channel blockade effect from unidentified drug?" "In
Cath was done at around 9AM: Culprit lesion mid-LAD, 99% stenosis, pre-intervention TIMI flow not listed, PCI performed with TIMI 3 flow and 0% stenosis resulting. Normal RV, no significant valvular stenosis or regurgitation. It is critically important to recognize these T waves as hyperacute in the precordial leads!
The cardiologist called this 20% stenosis. You can easily imagine this patient getting one of several diagnoses -- vasospasm, MINOCA , pericarditis, or maybe even no diagnosis at all beyond "non-obstructive coronary artery disease." In a large proportion of cath labs, the operator would probably have ended the case at this point.
The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. In addition, the top left blue arrow indicates a section in the LAD with a severe stenosis, likely the culprit for the prior L A D occlusion which has since recanalized. The case continues.
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