STEMI-35

Published: January 3rd, 2016

Category: STEMI

Emergency Department ECG

STEMI1

Cardiac Cath Report

LM– Normal caliber, no angiographic stenosis

LAD-Normal caliber, transapical, proximal vessel has no angiographic stenosis, mid 60% stenosis

LCx– Normal caliber, proximal vessel has no angiographic stenosis,continues as large OM 1 with no angiographic stenosis

RCA– Normal caliber, dorminant, proximal vessel has no angiographic stenosis, mid 99% thrombotic stenosis, distal vessel is patent

Intervention: RCA Stent placed

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