A 70-year-old female comes to the with a Two-hour history of retrosternal chest pain, dyspnea, and sweating. The First ECG shows ST elevation in anterior chest leads. Lady proceeds immediately to coronary angiography where a 100% proximal LAD artery occlusion is seen. The lesion is successfully opened with the help of angioplasty followed by stent implantation, with resultant normal TIMI III flow. An echocardiogram reveals a LV EF of 30% with RWMA along the anterior and lateral walls. In ICU telemetry reveals frequent PVCs and infrequent episodes on nonsustained Ventricular Tachychardia (3–5 beats). What should be the next step in her case?
a. Conservative Treatment and implantation of an ICD
b. Conservative Treatment and implantation of an ICD if VT is induced
c. Conservative Treatment and implantation of an ICD if a signal averaged ECG is abnormal
d. Conservative Treatment and defer implantation of an ICD
e. Conservative Treatment and refer for radiofrequency ablation of the VT
Please Leave your comments and explanations in the box below
a. Conservative Treatment and implantation of an ICD
b. Conservative Treatment and implantation of an ICD if VT is induced
c. Conservative Treatment and implantation of an ICD if a signal averaged ECG is abnormal
d. Conservative Treatment and defer implantation of an ICD
e. Conservative Treatment and refer for radiofrequency ablation of the VT
Please Leave your comments and explanations in the box below
In theory - you've "corrected" the problem in her "culprit artery" by rapid PCI with restoration of flow (assuming as implied, that the rest of her cath is unremarkable). Initial EF is reduced (30%) - but the regional wall motion abnormality may improve with a tincture of time (as may her infrequent episodes of 3-5 beats of NSVT) - so I'd vote for D (Conservative Treatment & Defer Implantation of ICD)- Ken Grauer, MD (ekgpress@mac.com)
ReplyDeleteThanks for the answer and examination. By the WsyI have Joined Your Group. Great Groop !
ReplyDeleteThe answer is D
ReplyDeleteThe patient described had a large MI that was treated with percutaneous revascularization.
PVCs and nonsustained VT are common. This type of patient was studied in
DINAMIT. Although these patients are at relatively high risk of both sudden and
total mortality, implantation of an ICD did not improve outcomes. If the patient has
periods of sustained VT, an antiarrhythmic should be considered. Otherwise, medical
therapy alone is appropriate, with follow-up assessment of her EF to determine if any
functional recovery results from the revascularization.
lacoste polo shirts
ReplyDeleteray ban sunglasses
true religion outlet
michael kors handbags
cheap nfl jerseys
burberry outlet
michael kors handbags
canada goose jackets
ray ban sunglasses
nike air max 2015
chanyuan0930