STEMI-9

Published: July 5th, 2015

Category: STEMI

Emergency Department ECG:

18127225-1

Cath Report

LMCA: Normal

LAD: Sub-total occlusion, mid to distal

LCx: moderate disease

RCA: Acute 100% thrombotic occlusion

Intervention: 2 stents placed to mid and proximal RCA

Teaching

  • Inferior MI
    • 40-50% of all myocardial infarctions.
    • more favorable prognosis than anterior myocardial infarction
    • Up to 40% of patients with an inferior STEMI will have a concomitant right ventricular infarction. These patients may develop severe hypotension in response to nitrates and generally have a worse prognosis.
      • Confirmed with Right sided ECG, Elevation in V4R
    • Up to 20% of patients with inferior STEMI will develop significant bradycardia due to second- or third-degree AV block. These patients have an increased in-hospital mortality (>20%).
    • ECG findings
      • ST elevation in leads II, III and aVF
      • Reciprocal ST depression in aVL (± lead I)
      • RCA (80%): Elevation in III > II, Reciprocal depression in I
      • LCx (20%): Elevation in III = II, No reciprocal depression in I

ECG-Anatomy-LITFL