STEMI-13

Pre-Hospital ECG

Cath Report

LAD: Normal

LCx: Proximal 40% stenosis, gives rise to OM1 which has no angiogrpahic stenosis

RCA: thrombotic lesion in the proximal vessel with 80% stenosis, mid vessel has 2 sequential 50% stenoses, distal RCA at the PDA bifurcation has a thrombotic lesion with 80% stenosis.

Intervention:  stent placement to proximal RCA amd PDA.

 

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