STEMI-36

Published: January 8th, 2016

Category: STEMI

Emergency Department ECG:

STEMI1

Cardiac Cath Report

1. LMCA: Large, patent.

2. LAD: Normal in caliber, transapical, patent.  Patent small diagonals.

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

4. RCA: Large, dominant, 100% proximal occlusion with thrombus.

Intervention: Stent placed to RCA

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