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By Smith, peer-reviewed by Interventional Cardiologist Emre Aslanger Submitted by anonymous A 53 y.o. male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. The pain radiated to both shoulders.
He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). She arrives in the emergency department (ED) with decreased level of consciousness and shock.
This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey. A recent angiogram report indicated a totally occluded left anterior descending artery (LAD) and right coronary artery (RCA), with 30-40% narrowings in the left circumflex artery (LCx).
The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Below is the first ED ECG, labeled LBBB by the machine. In this case, cardiology noted “old LBBB, negative Sgarbossa”, so they kept the patient in the ED for repeat ECGs and troponin levels. Vitals were HR 58 BP 167/70 R20 sat 96%.
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. Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries). It can only be seen by IVUS.
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