Emergency Department ECG:
Cardiac Cath Report:
LM-Normal Caliber vessel with distal tapering
LAD-Normal Caliber transapical vessel, proximal vessel has luminal iregularities, mid vessel has 60% stenosis, just distal to this there is a stent which is patent, distal vessel has luminal irregularities. D1 has no angiographic stenosis
LCx- Normal caliber vessel, proxiaml vessel has no angiographic stenosis, mid LCX gives rise to medium sized OM1 which has 20-30% ostial stenosis, OM 2 is a large branching vesel with 70% hazy proximal stenosis, mid OM2 has an area of filling defect which may represent thrombus versus calcification. AV groove LCX is a small vessel
RCA- Large caliber dorminant cesel with 40% proximal stenosis, mid 99% stenosis, distal 30% stenosis, PDA and PLV branches no angiographic stenosis
Intervention: Stents to mid RCA and OM2
- 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