Coronary Artery Disease

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Coronary Artery Disease by Module Four – Myocardial Disease Case Studies November, 2011 Abstract: It is important to assess the prescence of regional wall motion abnormalities (RWMA) and thrombus following an ST elevated myocardial infarction. Echocardiography is often the preffered tool when assessing these patients. It is non- invassive and can detect both RWMA and thrombus reliably. Echocardiography was used in the following case after an ST elevated myocardial infarction. The echocardiogram demonstated both RWMA and apical thrombus. Case Presentation A 61 – year – old male suffered an out of hospital cardiac arrest. The arrest was witnessed by his wife and basic life support was initiated in less than 6 minutes, with advanced life support being initiated with in 20 minutes. Epinephrine and amiodarone was given in route to the emergency department. An external defibrillator was used to shock the patient into sinus rhythm, a total of 10 shocks was administered and cooling measures were also started. The patient arrived with an IV access and intubated. Physical exam upon arrival to emergency department reported the patient to be tachycardic, normal blood pressure and unresponsive. Patient was then transferred emergently to cardiac catheterization lab for Artic sun and cardiac stenting. An echocardiogram was performed prior to the patient being sent to the cardiac catheterization lab. The echocardiogram showed an ejection fraction of 15 – 20% with multiple regional wall motion abnormalities. The coronary catheterization demonstrated that coronary artery dominance was right, with a normal left main coronary artery and left circumflex artery. The left main coronary artery was 40% obstructed by a single discrete lesion and the proximal left anterior descending artery was 100% occluded with intracoronary thrombus present. The

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