STEMI-7

Published: June 26th, 2015

Category: STEMI

00029459-1

 

Cath Report:

Left Main Trunk: Normal caliber, patent

Left Anterior Descending Artery: 100% acute occlusion of mid LAD

Left Circumflex Artery: Moderate stenosis in mid LCx. OMB1 is large and patent. OMB2 is large and has moderate proximal disease.

Right Coronary Artery: Dominant. Mid RCA has long diseased segment with upto 80% stenosis. Distal RCA has mild luminal irregularities.

CONCLUSIONS:

1. Acute 100% occlusion of mid LAD (culprit vessel)

2. Moderate stenosis of mid LCx and proximal OMB2

3. Severe mid RCA stenosis.

PROCEDURES

1. Successful PCI of mid LAD acute occlusion

Teaching:

  • Anteroseptal MI
    • ECG findings in V1-V3
      • ST segment elevation with Q wave formation in the precordial leads (V1-6) ± the high lateral leads (I and aVL)
      • Precordial leads
        • Septal leads = V1-2
        • Anterior leads = V3-4
        • Lateral leads = V5-6
    • Site of LAD occlusion (proximal versus distal) predicts both infarct size and prognosis.
    • Proximal LAD / LMCA occlusion has a significantly worse prognosis due to larger infarct size and more severe hemodynamic disturbance.

ECG-Anatomy-LITFL