GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. Sgarbossa EB, Pinski SL, Barbagelata A, et al. Evolving considerations in the management of patients with left bundle branch block and suspected myocardial infarction. Smith’s ECG Blog,, tp:///2015/06/unstable-angina-still-exists-beware.html?m=1 Stephen Smith, “Unstable Angina Still Exists”, Dr. Scott Weingart, “Who Needs and Acute PCI with Dr. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. O'gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. If their pain can be medically managed and are HDS then it may be appropriate to cath the next day. But be sure to discuss with your interventionalist.Ĭase 1 - Elderly man presenting with chest pain and cardiogenic shock who has a brief episode of VF while on cath table.Two mechanisms proposed: Diffuse sub-endocardial ischemia with ST-depression in lateral leads producing reciprocal ST-elevation in aVR, or infarction of the basal septum producing aVR STEMI.The article they reference (11), defines “occlusion” as any stenosis greater than 50%.The 2013 AHA/ACC STEMI guidelines list aVR ST-elevation as an indication for thrombolytics when PCI cannot be obtained within 2 hours.If the left main was truly occluded the patient would probably be in profound cardiogenic shock or dead. Often quoted as indicating left main occlusion, but this may not be accurate. In the setting of ischemic chest pain this may indicate left main insufficiency (high grade stenosis) or diffuse multi vessel disease. Ultrasound Welcome Policies Scanning School Machines Machine Care Ultrasound of the Month Faculty Credentialing Resources QpathE Workflow Jewish Hospital Ultrasound ContactĤ.Procedures Procedural Education Arterial Line Central Line Chest Tube Cricothyrotomy Lumbar Puncture Procedural Sedation Regional Anesthesia Transvenous Pacemaker IC Cordes / Airway.Operations Logistics SPAMs UC Policies WCMC Operations WCMC Consults.Resident Education Grand Rounds Bread & Butter EM Electives Global Health Journal Club Social Media Primer Wellness.Prehospital EMS Air Care Orientation Air Care Education Air Care Equipment Air Care Medications Air Care Procedures Air Care Quick Reference Air Care Nuts & Bolts Air Care Safety Air Care Secure.Emergency KT EmergencyKT CC Evaluation Guidelines Clinical Practice Guidelines Common Forms Observation Protocols Outpatient Follow Up/Resources Antibiograms.Who Needs the Cath Lab Now! - Taming the SRU Top Taming the SRU
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