STEMI-59

Published: April 15th, 2016

Category: STEMI

Pre-hospital ECG

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Emergency Department ECG

ECG1

  • 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

Teaching

  • 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

Click here to watch video lecture covering multiple causes of “STEMI Mimics”