Cardiology Case Studies Students

Cardiology Case Studies Students-81
The patient initially reported sudden onset of chest pain described as "a brick on my chest" and collapsed a few minutes later. Upon arrival of emergency medical services, he was found to be in ventricular fibrillation.

The patient initially reported sudden onset of chest pain described as "a brick on my chest" and collapsed a few minutes later. Upon arrival of emergency medical services, he was found to be in ventricular fibrillation.

Although there is a Class I American College of Cardiology and American Heart Association recommendation for comatose patients who have experienced cardiac arrest due to underlying ST-segment elevation myocardial infarction to undergo emergent cardiac catheterization with the intent of primary PCI, there are no specific recommendations for comatose patients without ST-segment elevation myocardial infarction who survived a cardiac arrest.

An unwitnessed arrest, the presence of severe lactic acidosis, advanced age, end stage renal disease, traumatic etiology, and cardiopulmonary resuscitation greater than 30 minutes before return of spontaneous circulation are poor prognostic factors.

Coronary angiograms of his left and right coronary artery are shown in Videos 1 and 2, respectively.

Figure 1 Serial axial images of the computed tomography with intravenous contrast showing the dissection flap limited to the proximal ascending aorta and the aortic root.

The initial rhythm is usually pulseless electrical activity due to blood exsanguination or cardiac tamponade.

Ventricular fibrillation is less commonly seen and is probably secondary to ischemia from coronary obstruction or intermittent obstruction of the left main coronary ostium with a dissection flap, as probably is the case in this patient.

Note that the flap extends from the intramural hematoma of the posterior wall of the proximal ascending aorta just above the sinotubular junction leftwards and lower towards the left coronary cusp.

There is contrast extravasation into the left and right pleural spaces (more pronounced to the left) and pericardial effusion, probably hemopericardium.

A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency.

His mental status is clouded and there is disagreement as to whether he has decisional capacity.

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