Remove ACS Remove CAD Remove Defibrillator
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Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?

Dr. Smith's ECG Blog

He had a history of CAD with CABG. Does this patient have ACS? Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. He did not have ACS. The remainder were due to other etiologies, (including NonSTEMI ACS).

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. She was defibrillated and resuscitated. Just because you don't see hemodynamically significant CAD on angiogram does not mean it is not OMI.

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Fascinating case of dynamic shark fin morphology - what is going on?

Dr. Smith's ECG Blog

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. That said, ACS is by far the most common and treatable cause.

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. If this is ACS with Aslanger's pattern , the ST depression vector of subendocardial ischemia (due to simultaneous 3 vessel or left main ACS) is directed toward lead II (inferior and lateral). CPR was initiated immediately.

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Management of STEMI (ST-Elevation Acute Myocardial Infarction)

ECG & Echo Learning

I B ECG monitoring should start immediately and a defibrillator must be ready. I C Glucose-lowering therapy should be considered in ACS patients with glucose levels >10 mmol/L (>180 mg/dL), while episodes of hypoglycaemia (defined as glucose levels <_3.9 STEMI , ST-segment elevation acute myocardial infarction ).

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OMI? Subendocardial ischemia? Does it matter in this clinical context?

Dr. Smith's ECG Blog

But thankfully, when the clinical context is clearly and highly concerning for ongoing ischemia from ACS, this distinction doesn't matter much. Soon after the witnessed occlusion, the patient suffered ventricular fibrillation arrest, from which he was immediately resuscitated with 1 defibrillation.

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(Q1/2025) ESO Updates: Quarterly Product Enhancements

ESO

Here are some key features to look out for: CAD & Cardiac Monitor Integration: The application supports integration with cardiac monitors and CAD systems, enhancing your ability to swiftly monitor and respond to patient needs. Integration with ACS to facilitate real-time encounter submissions.

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