Published: September 6th, 2015

Category: STEMI

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)



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