STEMI-37

Published: January 10th, 2016

Category: STEMI

* No field-activation.  Medic alerted staff of clinical concern on arrival and repeat ECG done which showed STEMI.

Pre-hospital ECG:

IMG_3992

Emergency Department ECG:

Untitled1

Cardiac Cath Report:

1. LMCA: Large, widely patent, gives rise to the LAD and LCX.
2. LAD: Normal in caliber, transapical vessel, mid 40% stenosis, multiple
small diagonals, apical segment gives a very faint/small left-to-left
collateral to distal LCX territory.
3. LCX: Normal in caliber, nondominant, mid 100% heavily calcified occlusion.
4. RCA: Normal in caliber, dominant, calcified w mid and distal severe disease
up to 85%. Nonculprit.

Intervention: Stent placed to LCx with plan for future stent 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