Emergency Department ECG
- Patient with history of RCA, not compliant with meds
- Field ECG showed inferior STE, improved on arrival
Cardiac Cath Report
LMCA: Short and angiographically normal.
LAD: Large-sized vessel that terminates at the apex. The mid-LAD stent is widely patent followed by MLI.
LCX: Large-sized, co-dominant vessel which gives off small-sized, patent OM1/OM2 vessels and a large-sized, OM3 vessel with 80% proximal stenosis. Left-to-right collaterals are present.
RCA: Large-sized, co-dominant vessel with 100% occlusion prior to stent. The mid-RCA stent is widely patent.
Stent placed to proximal RCA
- 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