STEMI-49

Emergency Department ECG

Cardiac Cath Report

LM-Normal caliber, no angiographic stenosis

LAD– Ostial 30% stenosis, just after S1 there is 40% stenosis followed by aneurysmal segment, distal to major Diagonal branch there is 100% occlusion.  

LCx– Normal caliber, proximal 80% stenosis, mid to distal 80% stenosis. Ramus is large and patent

RCA– Dorminant, proximal vessel has mild diffuse disease, mid 100% instent restenosis, PDA fills via left to right collaterals

Successful stent placement LAD.  RCA in-stent restenosis chronic. Plan for staged PCI of LCx

Education

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.