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
- 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.