STEMI-15

Published: August 5th, 2015

Category: STEMI

Pre-Hospital ECG

ECG-3

Emergency Dept ECG 1

ECG-1

Cardiac Cath Report

LM: Large caliber vessel. Patent. 15-20% mid stenosis.
LAD: Large caliber vessel. Transapical. No significant focal stenosis proximaly. Moderate diffuse disease in its mid portion up to 60%. Acute 100% thrombotic occlusion of the distal LAD
Ramus: Large caliber, long. Proximal 80% stenosis.
LCx: Small caliber vessel. Mild intraluminal irregularities. No significant focal stenosis.
RCA: Medium sized. Dominant. 100% chronic total occlusion at its mid portion. Filling via L to R collaterals from the LAD.

Procedure: 1 stent placed to distal LAD

Teaching

Anterior MI

  • Carries the worst prognosis of all infarct locations, mostly due to larger infarct size
  • 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