Emergency Department ECG
- Patient had MI 1 week ago with stent placement
Cardiac Cath Report
Normal coronaries with patent stent
Echo: Akinetic inferior, lateral, anterior and septal LV wall
- There are a few causes of continued ST elevation after an MI that need to be thought of:
- Another MI
- Stent thrombosis (usually patient will not be compliant with anti-platelets they were discharged on)
- Left ventricular aneurysm
- Factors suggesting MI/stent thrombosis
- New ST changes compared with previous ECGs.
- Dynamic / progressive ECG changes — the degree of ST elevation increases on serial ECGs.
- Reciprocal ST depression.
- High clinical suspicion of STEMI — ongoing ischemic chest pain, sick-looking patient (e.g. pale, sweaty), hemodynamic instability.
- LV Aneurysm
- Can occur in up to 60% of Anterior MI
- Infarcted LV wall balloons out
- ECG criteria: Persistent ST elevation 1-2 weeks after MI + well formed Q waves
- More information HERE