STEMI-57

Published: April 8th, 2016

Category: STEMI

Pre-hospital ECG

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Emergency Department ECG

Untitled

  • 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.

ECG-Anatomy-LITFL