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.