STEMI-22

Published: October 13th, 2015

Category: STEMI

Pre-hospital ECG:

IMG_3384

Emergency Department ECG:

CG 2-1

Right Side ECG:

ECG 2-2

 

Cardiac Cath Report:

LM large and patent
LAD proximal and mid 40% lesions. Diagonals are small
LCx large mid 80% lesion
RCA 100% mid thrombotic occlusion.
RCA dominant.

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
    • ECG-Anatomy-LITFL