Young Hearts go Ischemic too.

Conclusions: Very young
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research

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In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina.  If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI.  If that is a result of plaque rupture, then it is a type I MI.  The clinical presentat...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion The cost savings associated with a CCTA first strategy to evaluate chest pain were ~$1 200 244.10. For a self-insured health system such as the Chickasaw Nation, these are very important cost savings.
Source: Coronary Artery Disease - Category: Cardiology Tags: CT Angiography for CAD Source Type: research
ConclusionIn patients with suspected AMI timely applying of MDCT, angiography, endovascular revascularization and ICG quality control of perfusion after revascularization are expedient to improve the results of treatment. These patients should be treated by a multidisciplinary team consisting of a cardiologist, a cardiovascular and endovascular surgeon, a general surgeon with experience in working with such patients.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
In conclusion, the CADC model was more effective at predicting obstructive CAD compared to the HEART score. The HEART score and CADC model were equally effective to safely identify low-risk patients by achieving
Source: Critical Pathways in Cardiology - Category: Cardiology Tags: Original Articles Source Type: research
These 2 serial ECGs were texted to me recently.  They were recorded 12 minutes apart:" Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up. " :What do you think?QTc's were 330 ms and 373 msThis is what I texted back:These look like they are a very pronounced case ofBenign T-wave Inversion.  I do not think this is acute occlusion myocardial infarction (OMI).  Get an emergent contrast echocardiogram.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica}These are reasons why it does not look like OMI: 1. flat ST segment in V42. huge R-wave ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Recent evidence suggests plaque morphology evaluated on coronary computed tomography angiography (CTA) has prognostic implications. East Asians have a lower prevalence of myocardial infarction and cardiovascular mortality compared with European-origin Caucasians. We aimed to compare coronary atherosclerotic burden and plaque composition in a matched cohort of Caucasian and East Asians patients with stable chest pain who underwent CTA. Two-hundred symptomatic patients (age 58.8 ±7.9, male 51%) were matched for age, gender, body mass index (BMI) and diabetes (100 each ethnic group).
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
A 64 year-old man (155 cm, 56 kg) presented to hospital with an ST-elevation myocardial infarction after experiencing 6 hours of chest pain. He was taken to the cardiac catheterization laboratory where he suffered a ventricular tachycardia cardiac arrest requiring 2 minutes of cardiopulmonary resuscitation, endotracheal intubation, mechanical ventilation, and placement of an intraaortic balloon pump. Coronary angiography demonstrated severe multivessel coronary artery disease with acutely occluded left anterior descending and right coronary arteries and a large post-infarction ventricular septal defect (VSD).
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Case submitted by Dr. James AlvaA middle aged male called EMS for chest pain. EMS arrived and confirmed that the patient was complaining of chest pain and shortness of breath.They recorded this prehospital ECG:What do you think?Normal QRS complex rhythm with hyperacute T-waves in V2-V6, I and aVL. Slight STE in V2 only, with significant STD and thus de-Winter pattern in V4-V6. Leads II and III show reciprocal depression of the ST segment (II) and T-wave (III). This is diagnostic of acute myocardial infarction of the anterolateral walls, with the most likely etiology being Occlusion of the LAD. In other words, this ECG show...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
DiscussionWhich subacute STEMI should go to the cath lab?Simplified:IF there is subacute STEMI by ECG or other criteria AND:1. Symptoms onset is within 48 hours AND2. There are persistent symptoms OR persistent ST ElevationThen the patient should go for emergent angiogram/PCI.I think it makes sense to extend this beyond 48 hours because ischemia can be so intermittent.Schomig et al. randomized patients with:STEMI12-48 hours of symptomsNo persistent symptomsPersistent ST ElevationNo hemodynamic or electrical instability, no pulmonary edemaThe patients who received emergent PCI had significantly smaller median left ventricul...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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