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By Smith, peer-reviewed by Interventional Cardiologist Emre Aslanger Submitted by anonymous A 53 y.o. Compensatory enlargement was defined as being present when the total coronary arterial cross-sectional area at the stenotic site was greater than that at the proximal nonstenotic site. 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). Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.
by Emre Aslanger Dr. Aslanger is our newest editorial member. Dr. Aslanger is also the author of the DIFFOCULT study: Emre K. Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. He is an interventional cardiologist in Turkey.
Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The finding of dynamic ST-T wave changes on serial tracings in association with a change in chest pain symptoms ( SEE My Comment in the July 21, 2020 post ).
Written by Emre Aslanger. Emre is a new Editor of the Blog. Take home messages: Any coronary occlusion may present with vague symptoms, but when ECG is clear, there should not be any suspicion. PMID: 34523597. == MY Comment by K EN G RAUER, MD ( 11/13/2022 ): == Highly interesting case by Emre Aslanger. doi: 10.5543/tkda.2021.21026.
Furthermore, some ECGs may not meet the STEMI criteria but may still be diagnostic for acute coronary occlusion (ACO). Smith and Emre Aslanger, but we also thank external researchers for their demonstrative ECGs (thanks to Philip L. The majority of the ECGs are from Stephen W. Mar for atrial activity ECG).
But STEMI criteria has poor sensitivity for acute coronary occlusion. Like the initial hemoglobin level in acute hemorrhage, the initial troponin in acute coronary occlusion can be falsely reassuring. In the STEMI paradigm, patients with ischemic symptoms and ECGs that don’t meet STEMI criteria get serial ECGs.
This ALONE is very strong evidence of acute coronary occlusion. Any indications for cath lab activation? An initial level of 650 ng/L represents a too rapid rise to be attributable only to Type II MI from brief cardiac arrest. Which was the culprit lesion?
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).
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.
I published, and Emre Aslanger externally validated, the 4-Variable formula for differentiating the ST Elevation of LAD OMI from Normal ST Elevation. Knowing the patient has a history of coronary disease could be relevant to today's case — as it should add to our suspicion of a new acute event.
Written by Emre Aslanger (Emre is our newest editor. Although not striking, this is clearly a diagnostic ECG for infero"posterior" myocardial infarction due to coronary occlusion (OMI), most likely due to left circumflex (LCx) artery occlusion. Here are his publications.) He denies any illicit drug use. His ECG is shown below.
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