LMCA occlusion: High incidence of cardiogenic shock, need immediate PCI +/- CABG, not tPA.
LAD-D1 occlusion pattern: Highly predictive (89% PPV) of anterior wall MI.
Posterior wall MI: True STEMI, can be easily missed if isolated (ECG #3). May get leads V7,8,9 for confirmation. Inferior wall STEMI also noted in ECG #1 and #2.
Wellens' syndrome: Subacute critical occlusion of proximal LAD or mid-LAD. Avoid excercise stress test.
De Winter's T: Anterior STEMI equivalent due to acute proximal LAD occlusion.
Transjugular intrahepatic portosystemic shunt (TIPS)
TIPS is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is often due to liver cirrhosis) which frequently leads to intestinal bleeding, life-threatening esophageal bleeding (esophageal varices) and the buildup of fluid within the abdomen (ascites). An interventional radiologist creates the shunt using an image-guided endovascular (via the blood vessels) approach, with the jugular vein as the usual entry site.
Esophageal stenting followed by TIPS may be a reasonable choice for patients with variceal bleeding and perforation induced by balloon tamponade.