Published: October 28th, 2015

Category: STEMI

Pre-hospital ECG:


Emergency Department ECG


Right Side ECG:


Cardiac Cath Report:

1. LMCA: Large, widely patent. Gives rise to the LAD and LCX.

2. LAD: Normal in caliber, transapical vessel, mid LAD stent patent with 40% stenosis distal to the patent stent, there is a small D1 with ostial 90% lesion and a large branching D2 that is widely patent.

3. LCX: Normal in caliber, nondominant, widely patent.

4. RCA: Normal in caliber, dominant, 95% mid stenosis with plaque rupture and thrombus.

Intervention: stent placed to RCA


  • Right side MI
    • Complicates 40% of inferior MIs
    • Right ventricle is preload dependent which may lead to hypotension if Nitroglycerin is administered.  Treat with IV fluids and rapid transport.
  • Right side ECG
    • A complete set of right-sided leads is obtained by placing leads V1-6 in a mirror-image position on the right side of the chest (see diagram, below).
    • It may be simpler to leave V1 and V2 in their usual positions and just transfer leads V3-6 to the right side of the chest (i.e. V3R to V6R).
    • The most useful lead is V4R, which is obtained by placing the V4 electrode in the 5th right intercostal space in the midclavicular line. ST elevation in V4R has a sensitivity of 88%, specificity of 78% and diagnostic accuracy of 83% in the diagnosis of RV MI.
  • 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