Emergency Department ECG
Pt with history of CABG
Cardiac arrest. Treated en route with CPR, ACLS meds, King Tube
ROSC before arrival, therapeutic hypothermia
Cardiac Cath Report
LM– 80% distal LM stenosis
LAD– Proximal vessel has mild disease, mid vessel 100% occlusion, no competitive flow seen
LCx– normal caliber vessel proximal vessel has 70% stenosis, distal vessel continues as OM 2 with no stenosis. AV groove LCx is a small to medium vessel. OM1 is a small cailber vessel
RCA- 100% proximal occlusion
SVG (CABG)- 100% proximal occlusion (Culprit vessel)
- 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