STEMI-47

Published: March 8th, 2016

Category: STEMI

Pre-Hospital ECG:

IMG_4239

Emergency Department ECG:

Untitled

Cardiac Cath Report:

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

2. LAD:  Large, transapical, proximal 95% stenosis with mild thrombus.  D1 small and patent, D2 very small and patent.

3. LCX:  Large, nondominant, large OMB1 and OMB2 are patent, patent ongoing LCX in AV groove.

4. RCA:  Large, dominant, widely patent, patent right PDA.

PLAN: Successful stent placement in proximal LAD

Teaching

Anterior MI

  • Carries the worst prognosis of all infarct locations, mostly due to larger infarct size
  • ECG findings in V1-V3
    • ST segment elevation with Q wave formation in the precordial leads (V1-6) ± the high lateral leads (I and aVL)
    • Precordial leads
      • Septal leads = V1-2
      • Anterior leads = V3-4
      • Lateral leads = V5-6
  • Site of LAD occlusion (proximal versus distal) predicts both infarct size and prognosis.
  • Proximal LAD / LMCA occlusion has a significantly worse prognosis due to larger infarct size and more severe hemodynamic disturbance.

ECG-Anatomy-LITFL