Abstract 13690: Complex Clinical Course of Unsuccessfully Revascularized Right Coronary Artery
Bibliographic record
Abstract
Objective: Since onset of reperfusion era, ventricular aneurysms have become a rare complication of acute myocardial infarction, with incidence of LV inferior wall aneurysm around 5%. Guidelines recommend an ICD placement for sustained V tach after 48 hours of MI, however management of persistent V tach associated with ventricular aneurysm is uncertain. Case: The patient is a 60 year old male who presents with persistent palpitations, occurring after a mechanical fall. EKG demonstrated slow persistent V tach with HR of 121.Two and a half months prior, the patient suffered from inferior wall STEMI, unsuccessfully reperfused at another institution, secondary to iatrogenically dissected RCA. He presented at our institution 3 weeks after complaining of chest pain and diagnosed with moderate pericardial effusion, as well as large LV inferior wall aneurysm. Pericardial fluid was not large enough to drain. He represented two weeks later, with worsening SOB and tamponade physiology by TTE. A total of 2.5 L of pericardial fluid was drained over several days. CT surgery was consulted, coronary angiography was performed and demonstrated multivessel coronary artery disease. Plan was to follow up as an outpatient for surgery. Medical Decision Making: During his most recent presentation with V tach, the patient did not respond to Amiodarone infusion but underwent successful synchronized cardioversion with 30 J.He underwent CABGX2 and inferior LV endoaneurysmorrhaphy with 4x6 cm bovine pericardial patch. An ICD was implanted before his discharge. Conclusion: This patient’s V tach was likely secondary to LV aneurysm. Per our hypothesis, he would still be prone to develop V tach around the suture lines.Therefore the patient underwent an ICD implantation.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 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".