STEMI-19

Published: September 6th, 2015

Category: STEMI

Emergency Department ECG

ECG1

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)

 

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