Emergency Department ECG
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
- 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