See this: Occlusion/Reperfusion/Re-occlusion/Reperfusion/Re-occlusion/Reperfusion

A 60-something y.o. male presented with intermittent left-sided chest and shoulder pain that is achy in nature and lasted a few minutes or sometimes just a few seconds. " The symptoms come and go, not associated with any exertion or history of trauma. Patient does have a history of hypertension and has been taking his medications.  Prehospital EKGs appeared consistent with anterior tombstone ST elevation with pain. " Prior to arrival the patient was given full dose aspirin, as well as nitroglycerin, which relieved his pain, after which T wave inversions were noted in the anterior precordial leads.  These 2 prehospital ECGs are not available.On arrival, the patient had recurrent chest discomfort and had this ECG recorded:LAD STEMIHis pain quickly resolved and 6 minutes later, this was recorded:Reperfusion " Wellens ' " wavesHis pain quickly recurred and another ECG was recorded at 12 minutes (6 minutes after the 2nd one)Re-occlusionThe patient ' s pain resolved again and this was recorded 19 minutes after the 3rd one (t = 31 minutes)Reperfusion againHe went to the cath lab and the angiogram showed a thrombotic LAD culprit with normal (TIMI-3) flow.The lesion was stented.The initial high sensitivity troponin I returned at  96 ng/L.The patient did well.Comment:This is a nice illustration of what occurs with occlusion and reperfusion, and a demonstration of how thrombus can lyse and propagate, lyse and propagate. This can occur with or...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs