STEMI-25

Published: October 28th, 2015

Category: STEMI

Pre-hospital ECG:

IMG_3427

Emergency Department ECG:

ECG-4

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

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