Abstract 13657: Malignant Multivessel Coronary Spasm
Bibliographic record
Abstract
Objective: Management of multivessel coronary spasm is challenging. Case: A 59-year-old female with a medical history of CAD status post coronary stents presented with atypical chest pain.The following morning the patient suffered a PEA arrest, from which she was resuscitated. Retrospective review of telemetry revealed frequent episodes of transient ST segment elevations in inferior leads, lasting minutes, eventually followed by sinus bradycardia and episodes of high-degree AV block with pauses up to 20 seconds.Two weeks earlier the patient presented at another institution with similar complaints. Inferior STEMI was diagnosed, she received 2 DES, in proximal OM1 and Mid LAD. She represented 6 days later with continued symptoms and repeat catheterization revealed patent stents. She was reassured and discharged on Isosorbide Mononitrate in addition to Carvedilol. Management and Decision Making: Coronary angiography at our facility demonstrated 90% stenosis of proximal LCX and 60-70% of proximal LAD. These stenosis resolved with intracoronary nitroglycerin. The stents were patent. Therefore, she was diagnosed with coronary spasm. During her hospital stay, the patient did have four more episodes of ST elevations associated with complete heart block. Since she developed high degree AV block after a coronary spasm, a temporary pacemaker was placed. Norvasc as well as nitroglycerin drip were used to treat her coronary vasospasm. Pure B-blocker medications were avoided to prevent unbalanced alpha effect.The patient was extubated 4 days later and fully recovered neurologically. A permanent pacemaker was placed and discharged home. Conclusion: High suspicion is important for diagnosis of coronary vasospasm. Treatment with coronary vasodilators is cornerstone of management. We also avoided pure alpha agonists during resuscitation measures, as well as pure B-blocker medications after recovery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".