STEMI-65

Published: May 23rd, 2016

Category: STEMI

Emergency Department ECGECG1

Cardiac Cath Report

1. LMCA: Patent. Gives rise to the LAD and LCX.

2. LAD: Normal caliber, non-transapical, proximal stent is patent, mid LAD 50% stenosis stable from prior cath, Large D1 is patent.

3. LCX: Normal caliber, non-dominant, proximal 50% diffuse, mid vessel stent is patent. OMB1,2,3 are small and patent. LCX terminates as an OMB4 which is patent.

4. RCA: Large, dominant, proximal tandem lesions 75% and 95%, right PDA stent is patent. PDA supplies the entire apex.

Successful single vessel PCI with DES to proximal RCA tandem lesions

 

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