STEMI-40

Published: January 21st, 2016

Category: STEMI

Pre-hospital ECG:

inf4

*** This is not the actual patient ECG.  Actual ECG low quality copy, but similar to above***

 

Cardiac Cath Report

1. LMCA: Large, patent.

2. LAD: Large, transapical, patent.  Medium sized high D1 with ostial 60% stenosis and mid 40% stenosis.

3. LCX: Large, nondominant, patent.

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

Plan: Stent placed in 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