Emergency Department ECG
Right side ECG
Cardiac Cath Report
LM– Normal caliber, patent
LAD– Normal caliber, transapical, proximal vessel is patent, mid mild disease up to 30% stenosis, distal patent. D1 is small, patent
LCx– Normal caliber, patent gives rise to small OM 1 which is patent, OM 2 is large, patent
RCA– Large, dominant, patent proximal, mid and distal vessel. PLV has 99% proximal stenosis (culprit lesion), PDA 75% ostial stenosis
Successful stent placement
- 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