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36 year old with chest pain after chest wall surgery

Dr. Smith's ECG Blog

Abstract 4141318: AI-Powered Smartphone Application for Detection of Left Ventricular Systolic Dysfunction using 12-Lead ECG Here is the explainability heat map : The angiogram showed no coronary disease. Diffuse pericardial enhancement noted, consider pericarditis. Her respiratory failure has improved with diuresis.

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Chest pain, followed by syncope, and cardiogenic shock with right side weakness

Dr. Smith's ECG Blog

I was called by Dr. YYYY from the Cath Lab - we reviewed the coronary anatomy. The patient had evidence of significant three-vessel disease, but an occluded right coronary artery. This has been similar in the MICU as well. MICU team considering bicarb infusion. Oliguric AKI with hypokalemia: Hypokalemia unexplained.

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Something Winter This Way Comes

EMS 12-Lead

A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis. Here the ST segments are not so deep, nor are the T waves so wide and bulky, because of improved coronary flow at the level of the occlusion. MICU transport was unremarkable. But the lesion is still active!

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Don’t stress, it’s just an ECG…

Core EM

Acute coronary syndrome (ACS), cardiomyopathy, cardiogenic shock, aortic dissection, pulmonary embolism, myocarditis/pericarditis, cardiac tamponade, coronary artery dissection, coronary vasospasm, ventricular aneurysm What are your next steps in management for this patient?