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More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. I sent it to 5 of my OMI friends without any clinical information or outcome and all 5 independently responded with exactly the same diagnosis: "reperfused inferior OMI".
Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival. Known obstructive coronary artery disease or known coronary stent. Known cardiac defibrillator. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival. Pre-existing DNR order.
It shows a proximal LAD occlusion, in conjunction with a subtotally occluded LMCA ( Left Main Coronary Artery ). Upon contrast injection of the LMCA, the patient deteriorated, as the LMCA was severely diseased and flow to all coronary arteries ( LAD, LCx and RCA ) was compromised. He was taken immediately to the cath lab.
I sent the top ECG to Dr Smith with no information and without the baseline ECG. She spontaneously converted (Defibrillation was not performed). Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. A repeat magnesium level was not drawn prior to coronary angiography.
He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. The next day, and angiogram showed normal coronary arteries.
She was defibrillated and resuscitated. Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. One need not have obstructive coronary disease to have occlusive thrombus!
Remember that the ECG reports what is happening to the myocytes , then you must use that information to make inferences about what the patient needs. Acute coronary occlusion is the most common and most treatable cause of this pattern, but it is not the only cause. This ECG can never be a baseline ECG.
I sent this ECG with no clinical information to Dr. Smith. The assay at my institution, for example, is frequently negative until 4-6 hours after acute coronary occlusion. After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations.
I sent the first ECG to Dr. Meyers without any information, and he replied, “good one. Accuracy of OMI findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. DIagnostic accuracy oF electrocardiogram for acute coronary OCClusion resulTing in myocardial infarction (DIFOCCULT study).
After reviewing the available information, cardiology did not feel that the patient warranted emergent PCI and recommended heparin infusion and cardiac catheterization the following morning. When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully.
It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I CPR was initiated immediately.
The arterial pressure waveform is transduced using the coronary catheter. Normally, the diameter of the coronary artery ostium is much greater than the diameter of the catheter so that catheter engagement does not significantly impair antegrade coronary perfusion. She was defibrillated perhaps 25 times.
The submitter started the patient on amiodarone and arranged implantation of a defibrillator. == MY Comment , by K EN G RAUER, MD ( 12/27 /2024 ): == Superb discussion by Dr. Frick in today's case, that highlights a series of important points regarding the ECG recognition of stable VT ( V entricular T achycardia ).
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