![]() ![]() Wide QRS changes were observed on ECG during the shocks ( Fig. 2c, e and g), he did not recover from the cardiogenic shock, and the PEA arrest continued ( Fig. However, despite the administration of adrenaline/etilefrine as well as nitroglycerine ( Fig. e: Normal coronary arteriogram in the right coronary artery.Ĭardiac massage was promptly performed. ![]() d: No fixed stenosis was found after the insertion of a drug-eluting stent. c: Severe coronary artery spasm was relieved after 15 minutes’ cardiopulmonary support. b: Contrast medium was observed at the proximal left coronary artery. a: Total and subtotal spasm were observed at the proximal left anterior descending artery or proximal left circumflex artery. 2b and c) were observed after the insertion of a diagnostic catheter (5-Fr Terumo outlook™ JL 3.5, Terumo, Tokyo, Japan) into the ascending aorta.Ĭoronary arteriograms during cardiogenic shock. 1b) leads and a decreased blood pressure (60/40 mmHg) ( Fig. ST-segment elevation in the V1-6, I, II, and aVF ( Fig. His blood pressure was 140/80 mmHg, and his heart rate was 80/min ( Fig. His electrocardiogram (ECG) had no significant ST-T changes, and chest symptom were not recognized ( Fig. We used the same local anesthetic drug (xylocaine injection polyamp 1% AstraZeneca, Osaka, Japan) on the four previous occasions. We started coronary angiography at 9:00 AM without premedication. Cardiac thallium scintigraphy showed slight partial redistribution on the anterior lesion. He was medicated with antiplatelets (ticlopidine 200 mg), aspirin (100 mg), angiotensin-receptor blockers (telmisartan 20 mg), statins (atrovastatin 10 mg) and beta-blockers (carvedilol 2.5 mg). He had ventricular fibrillation treated with direct current possibly due to a catheter wedge in the right coronary artery during follow-up coronary angiography nine years earlier. He had not been using sublingual nitrates when he complained of atypical chest discomfort. ![]() He had no typical chest pain but some atypical chest discomfort at rest during daily life. He had quit smoking 10 years earlier and had hypertension, dyslipidemia and diabetes mellitus. He had undergone coronary angiography four times, including coronary intervention three times, before this admission. No commercial use is permitted unless otherwise expressly granted.A 75-year-old man was admitted to our hospital for follow-up coronary angiography after the implantation of a drug-eluting stent (Ultimaster 3.0×38 mm & Xience Alpine 2.5×23 mm) into the left anterior descending artery approximately 1 year earlier. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. ![]() Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.Ĭlinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.Īuscultation electrocardiography heart rate neonatal resuscitation newborn. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope. The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets. However, a recent case report raised concerns about this technique in the delivery room. The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant's heart rate (HR) when determining the need for resuscitation at birth. ![]()
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