How does acute left main occlusion present on the ECG?

Post by Smith and MeyersSam Ghali ( 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.  In these cases, STE in aVR is always reciprocal to the ST depression of subendocardial ischemia elsewhere (ST depression vector towards II and V5).Total LM occlusion can present withSTEorSTDin aVR. When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI.  The pattern seen may, or may not, be unique to left main occlusion.  Some total LAD occlusion manifest on the ECG similarly to some left main occlusions.  All are, however, clearly massive STEMI.To reiterate the most important part relevant to your question:LM occlusion does not present withisolatedSTE in aVR.  Depending on where the STE vector of the LM occlusion shows up on the ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

Related Links:

We present the case of a male diagnosed with a giant hepatic artery aneurysm, which first presented with pain and hemorrhage due to a partial rupture of the aneurysm. After discarding treatment with a stent or surgery due to the wide extension, we chose to embolize the hepatic artery with coils. However, the progress was unfavorable after the procedure, with the appearance of liver failure that was resolved by an urgent liver transplantation. Giant hepatic artery pseudoaneurysms are an infrequent entity and their management is a great challenge. The diagnosis is usually delayed due to non-specific clinical signs and the li...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Authors: Rovira Argelagués M, Calvet Medina EJ, Pierres Mir M, Navarro Sanahuja J Abstract Radiological images of a patient consulting the emergency room for pain in the right hypochondrium and hypercalcified images in the right-medial area of ​​the upper hemiabdomen, which correspond to the floating gallbladder. PMID: 31526007 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors. PMID: 31528244 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Authors: Nagamura N, Higuchi H Abstract A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmenta...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
Conclusions: Prescription of opioids after low acuity urology procedures is significantly associated with increased opioid use at 1 yr after surgery; efforts should be made to reduce postoperative opioids, especially for urologic procedures that do not typically require opioids.Patient summary: Filling an opioid prescription after minor urologic surgeries is associated with an increased risk of persistent long-term use of opioid medications and a higher risk of serious long-term complications such as hospital visits for an opioid overdose.’
Source: European Urology - Category: Urology & Nephrology Source Type: research
A 41-year-old female patient from Afghanistan was referred to our hospital because of multiple cysts in both liver and kidneys accompanied by recurrent left flank pain and hematuria. Despite inconclusive family history, the patient was suspected of suffering from autosomal dominant polycystic kidney disease (ADPKD) on the basis of a medical history of adult-onset polycystic kidneys. Abdominal ultrasound revealed multicystic liver and kidneys with many typical cysts, but also an atypical, echogenic, and partially calcified lesion in liver segment VI as well as an atypical, septated, and partially calcified lesion in the spl...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
Chronic kidney disease (CKD) is a major risk factor for valvular heart disease (VHD). Mitral annular and aortic valve calcifications are highly prevalent in CKD patients and commonly lead to valvular stenosis and regurgitation, as well as complications including conduction system abnormalities and endocarditis. VHD, especially mitral regurgitation and aortic stenosis, is associated with significantly reduced survival among CKD patients. Knowledge related to VHD in the general population is not always applicable to CKD patients because the pathophysiology may be different, and CKD patients have a high prevalence of comorbid...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: KDIGO Executive Conclusions Source Type: research
A 44-year-old woman developed acute anuric renal failure in the context of septic shock after hysteroscopy and intrauterine device placement for abnormal uterine bleeding. Aminoglycoside and nonsteroidal anti-inflammatory drug use were likely contributing factors. In the past, she had had a deep venous thrombosis episode on oral contraception that led to a diagnosis of Factor V Leiden heterozygosity. Computed tomography with contrast of the abdomen and pelvis showed abnormal enhancement of the renal medulla, and the renal cortex did not take on contrast (Figure  1).
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Nephrology Image Source Type: research
Early Life Trauma (ELT), trauma before the age of 18, often has a negative psychological impact, even into adulthood. ELT has been linked to a variety of psychopathologies in adulthood including anxiety, depression, substance abuse, and PTSD (e.g., Bremner...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
This study utilized qualitative methodology to provide a rich description and a deeper understanding of the professional experiences and practices of twelve school counselors who work with adolescent students who self-harm. Four themes included: suicidal o...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
More News: Angiography | Angioplasty | Aortic Stenosis | Appendicitis | Blogging | Canada Health | Cardiogenic Shock | Cardiology | Chemistry | Coronary Angioplasty | Coronary Artery Bypass Graft | Depression | Electrocardiogram | Emergency Medicine | France Health | Heart | Heart Attack | Israel Health | Middle East Health | Pain | Pain Management | Percutaneous Coronary Intervention | Pulmonary Thromboembolism | Residencies | Respiratory Medicine | Study | Teaching | Thrombolytic Therapy | Thrombosis | UK Health | Universities & Medical Training