SSmith-DRAFT- 30yof with Pulmonary Edema (4-3.31-2023)-ME_TO_DO

XXXXXXXX

==================================

My Comment by KEN GRAUER, MD (2/11/2023):

==================================

XXXX

• XXXXX
• 
  
• 
  

==================================

 

XXXXXXX

• 
  

Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio).

====================

============

SSmith DRAFT as of 12-14.1-2022:

============

XXXX

1911513

A 49 year old woman presented with sudden dyspnea.  She had pulmonary edema on exam.  Her 

Prehospital

Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI

Transformed ECG by PM Cardio:

PM Cardio AI Bot interpretation:

OMI with High Confidence

ED ECG 1:

Conventional algorithm interpretation:

SINUS TACHYCARDIA

ABNORMAL RHYTHM ECG

confirmed by overreading physician

Transformed ECG by PM Cardio:

PM Cardio interpretation:

OMI with Low Confidence

Dr. Rob Reardon did a bedside echo using Speckle tracking.  Speckle Tracking tracks the endocardium for excellent visualization of wall motion abnormalities, and graphs the wall motion for each major segment. (see graphs)  

Speckle Tracking Video

 This shows apical ballooning, which can be due to an LAD Occlusion or to Takotsubo.  Thus, the diagnosis of takotsubo can only be made by combining all this information with a negative cath.  Moreover, in takotsubo, the peak troponin I does not often go above about 5000 ng/L

ECG 2 was recorded while waiting for the cath team in the middle of the night:

Conventional algorithm

SINUS TACHYCARDIA

NONSPECIFIC T-WAVE ABNORMALITY

ABNORMAL RHYTHM ECG

Confirmed by overreading physician

PM Cardio AI Bot:

Not OMI with high confidence

>Mild Plaque no angiographically significant obstructive coronary artery

disease .

LVEDP 23 mmhg, no gradient across Ao valve.

This is most likely stress induced cardiomyopathy, formal TTE today

Medical Rx. Aggressive risk factor modification.

Normal left ventricular size with moderately reduced systolic function.

The estimated ejection fraction is 38%.

Regional wall motion abnormality-apex, anterior akinesis.

Left ventricular diastolic pattern suggest elevated left ventricular

filling pressure .

Left atrial enlargement moderate.

Fibrocalcific process of the mitral valve annulus . Mitral valve

insufficiency mild.

No tricuspid regurgitation was present, so it was not possible to estimate

PA systolic pressure.

 

ADDITIONAL REMARKS

 

In comparison to the previous study, 11/11/2020, there has been a

significant interval deterioration of left ventricular systolic function

(previous EF 80%), and there is a new large apical wall motion

abnormality.

 

Stress induced cardiomyopathy (Takot-Tsubo like LV dysfunction) possible.

trops: 41, 1871 at 2 hours, 2094 at 6 hours