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Well, most commonly we’re going to see ACS. Pregnancy itself with its bump in plasma volume, reduced Hb and increased cardiac output is like one long exercise stress test. Some unique features to consider in pregnancy is spontaneous coronary artery dissections.
I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? But in this case the clinical scenario is not right for acute ACS with OMI, and there is very high voltage, and the patient is very young, (though beware of young patients , even 29 year olds!! I was not worried for a coronary etiology.
Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). See this case for an in-depth discussion of AC and an example of VT and ECG changes associated with this disorder. CT coronary angiogram showed a hypoplastic RCA and dominant LCx.
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