STEMI-58

Published: April 12th, 2016

Category: STEMI

Pre-hospital ECG

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Emergency Department ECG

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Right side ECG

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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

Teaching

Inferior MI

  • 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

ECG-Anatomy-LITFL