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Case 5

History

  • 68yo male
  • ED admission, C/O: left jaw + left arm pain x 5hrs
  • PMX: HTN, ↑ Choles, ++cigs,
  • O/E: diaphoretic, tachycardic
  • CVS: nil, RS: bibasal creps
  • Labs: + troponin
  • ECG: NSR, oST change
  • Echo: ↓ EF



Findings

  • Wall motion abnormality with corresponding oedema
  • Differential: Acute myocardial injury
    • Contusion: Trauma
    • Inflammation: Myocarditis
    • Ischaemia
    • Infarction
  • Differentiation: Pattern/location/scar

  • Dx: Acute MI circumflex territory with no reflow zone → non-viable infarcted myocardium
  • No Reflow: Obstruction to coronary microvasculature 2o tissue oedema, endothelial disruption, plugging of capillaries by neutrophils and microthrombi
  • Indicates dead myocardium
  • Assoc: poor prognosis, reduced EF, malignant arrhythmias, LV dilatation, LV rupture, ↑ risk cardiac death
  • No role for revascularization