STEMI-48

Pre-hospital ECG

Emergency Department ECG

Cardiac Cath Report

LM– Normal caliber, no angiographic stenosis

LAD– Normal caliber, transapical, no angiographic stenosis in proximal, mid and distal vessel. D1 is large, patent

LCx– Normal caliber, proximal vessel is patent, OM 1 has 55% stenosis, OM 2 is patent.  

RCA- 100% proximal occlusion

Plan: Successful stent placement 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