Registered: 4 months, 1 week ago
Most cases we have on this blog show evolution to obvious ST elevation, or you see the predictable progression of reperfusion and reocclusion with hyperacute T-waves in both directions. He is at risk of mismanagement in both directions. The internal rate of return is the expected return on stocks, and netting out the risk free rate today will yield an implied equity risk premium. Conversely, we all know there is an unacceptably high rate of false positives using the STEMI criteria, which distracts the clinician from a patients actual dangerous pathology, causes premature closure, puts the patient at risk of unnecessary procedures and their complications, as well as unnecessary mobilization of scarce resources. The patient recovered and did well. Yet on exam the patient had full range of motion without any change in his constant severe shoulder pain. Echo was completely normal, no evidence of LVH or any wall motion abnormalities. My fellow resident performed a bedside US showing a very dense anterior and apical wall motion abnormality, further confirming the diagnosis. Should he suffer another acute coronary occlusion, diagnosis may be missed or delayed because his ST segments are not appreciated as different from his baseline ECG which will now have STE forever. Answer: Very very high, because despite the angiographic result the ECG shows complete infarction. They may even represent complete occlusion with ongoing necrosis (infarction)! This is a large and long LAD that wraps around the apex of the heart, supplying the apex and sometimes even parts of the inferior wall. There are thousands more out there that can help you get organized, stay entertained on the go, or even learn new skills and knowledge, right from your smartphone. The best answer is that you simply have to see thousands of ECGs and correlate which ones turn out to be ACO and which are false positives. 3) Hyperacute T-waves and/or de Winter morphology may be present for hours without obvious evolution, but in most cases you can find evidence of progression with serial ECGs. But the ECGs did not change - hyperacute T-waves were present non-stop for approximately 45 minutes (from EMS ECG to my ...
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