What is the infarct artery????? And have you ever seen a troponin this high?
An elderly woman with h/o stroke and aphasia seemed different to her daughter, and was pointing all over her body as if in pain.They called 911.She had a history of PCI to the circumflex and also of severe mitral regurgitation, status post bioprosthetic valve replacement. Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. On arrival, the BP was 60/30.Here is the initial ECG:There is atrial pacing and Right Bundle Branch Block (RBBB)There is STE in I and aVL, V5, V6, with reciprocal STD in II, III, aVFThere is appropriately discordant ST depression in V1-V3 (appropriate to RBBB) TheRBBB is newand the previous ECG had no ST elevation What is the infarct artery?The cath lab was activated.Here is the bedside echo (POCUS): Short AxisExtremely poor LV function and massive wall motion abnormalityLong AxisExtremely poor LV function and massive wall motion abnormalityAt 20 minutes, just before cath, another ECG was recorded:More (worsening) STEHer initial troponin I returned at 0.341 ng/mL (URL = 0.030 ng/mL) (not per L, not high sensitivity)Lactate was 3.7 mEq/LHer BP with pressors came up to 80, then 100.Angiogramshowed a 99% left main thrombotic occlusion with TIMI-1 flow (this is considered " occlusion " even though there is some flow. It was opened and stented with resulting TIMI-3 (normal) flow.The stent to LCX is patent. OM1 is occluded and OM2 has 60% stenosis. Her RCA is a mediu...
We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION: PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries. PMID: 33034214 [PubMed - as supplied by publisher]
Authors: Sabet Sarvestani F, Azarpira N Abstract Heart and cerebral infarctions, as two important ischemic diseases, lead to the death of tissues due to inadequate blood supply and high mortality worldwide. These statuses are started via blockage of vessels and depletion of oxygen and nutrients which affected these areas. After reperfusion and restoration of oxygen supply, more severe injury was mediated by multifaceted cascades of inflammation and oxidative stress. microRNAs (miRNAs) as the regulator of biological and pathological pathways can adjust these conditions by interaction with their targets. Also, miRNAs...
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Currently in fellowship doing bread/butter procedures (MBB, epidurals, PNB, few SCS/PNS trials, etc.) and just interviewed at a private practice spot where they do a lot of procedures that I will have not done any training in prior to graduating (e.g. IT pump, SI fusion, Vertiflex, Kypho, MILD, Discectomy, lots of SCS/PNS trials etc) and significant amount of "OR pain procedures" at a very busy practice seeing 30-40 pts/day - how many of you are commonly performing these procedures and are... private practice concern
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