STEMI-62

Published: May 6th, 2016

Category: STEMI

Emergency Department ECG

A

  • 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

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