STEMI-51

Published: March 22nd, 2016

Category: STEMI

Pre-hospital ECG

ECG1Emergency Department ECG

ECG2Cardiac Cath Report

LM– Short, large, no angiographic stenosis

LAD– Large, transapical, proximal patent, mid hazy with 40-50% stenosis, distal patent. D1 medium, patent

LCx– Large, dorminant, proximal 75% hazy lesion, mid patent, distal 95% stenosis. OM 1 medium, patent. PDA/PLV branches are patent

RCA– Small, non-dorminant, patent

Plan: Successful stent to proximal and distal LCx

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

ECG-Anatomy-LITFL