STEMI-50

Pre-hospital ECG

 

Cardiac Cath Report

LM– Normal caliber, no angiographis stenosis

LAD– Normal caliber, transapical, ostial mild disease up to 20%, mid filling defect likely thrombus with 99% stenosis, distal vessel patent. D1 normal caliber, patent

LCx– Normal caliber, proximal vessel has no angiographic stenosis, OM 1 is branching vessel, large and patent. Ramus is large and patent

RCA– Normal caliber, dorminant, no angiographic stenosis in proximal, mid and distal vessel

Successful stent placement to mid LAD

Teaching

Anterolateral 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.