STEMI-57

Pre-hospital ECG

Emergency Department ECG

• Patient experienced V-fib arrest in ED requiring defibrillation

Cardiac Cath Report

1. LMCA: Large, widely patent, gives rise to the LAD and LCX.

2. LAD: Large, transapical, proximal 100% thrombotic occlusion.   

3. LCX: Normal caliber, nondominant, widely patent.

4. RCA: Large, dominant, patent, PDA and PL are patent.

 Successful stent placement to 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.