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The patient was treated as possible NSTEMI and underwent coronary angiography about 4 hours after presentation. TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care.
They found non-obstructive CAD, with only a 20% stenosis of OM2 and 10% RCA. in the ICU but survived with excellent function. A repeat ECG was performed and cardiology was re-consulted: Roughly unchanged. With the troponin elevated and ongoing pain, cardiology now decided to take him to the lab. No acute culprit.
She also had non-acute CAD of the left main (50%) and LCX (75%). If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. They opened it. Blondheim et al.
Fortunately, he was extubated several days later in the ICU with intact baseline mental status and was discharged shortly thereafter to subacute rehab. In this study of dialysis patients with severe CAD, 77% had an abnormal resting EKG and the most common abnormality was LVH. His troponin I peaked at 97 ng/mL (very large MI!).
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