STEMI-69

Published: May 31st, 2016

Category: STEMI

Emergency Department ECG

ECG2Cardiac Cath Report

1. LMCA: Large, widely patent, gives rise to the LAD and LCX.

2. LAD: Large, transapical vessel, mid 100% acute thrombotic occlusion after takeoff of large D1. Large D1 showed a 40% proximal stenosis. There was a heavily diseased medium sized 1st septal with ostial 90% stenosis.

3. LCX: Medium-sized, nondominant, mid LCX with 80% stenosis. There is a high OMB1 is medium sized and angiographically normal.

4. RCA: Large, dominant, mid 35% stenosis, patent right PDA.

Successful stent placement to mid LAD and D1 (intra-procedural spontaneous plaque rupture)

 

Teaching

Anterior MI

  • Carries the worst prognosis of all infarct locations, mostly due to larger infarct size
  • ECG findings in V1-V3
    • ST segment elevation with Q wave formation in the precordial leads (V1-6) ± the high lateral leads (I and aVL)
    • Precordial leads
      • Septal leads = V1-2
      • Anterior leads = V3-4
      • Lateral leads = V5-6
  • Site of LAD occlusion (proximal versus distal) predicts both infarct size and prognosis.
  • Proximal LAD / LMCA occlusion has a significantly worse prognosis due to larger infarct size and more severe hemodynamic disturbance.

ECG-Anatomy-LITFL