Emergency Department ECG
Cardiac 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
- 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