STEMI-73

Pre-hospital ECG

Emergency Department ECG

Cardiac Cath Report

LM- Short, patent

LAD- Normal caliber, transapical, proximal 65-70% stenosis, mid 75% stenosis, distal 90% stenosis. D1 small- 90% mid, D2 small to medium, 70% ostial, D3 small to medium 80% proximal. Left to right collaterals

LCx- Normal caliber, mid 30% stenosis, AV groove after giving rise to major OMB has 70% stenosis. Major OM branch, large, 30-40% stenosis. Ramus- small- subtotal occlusion

RCA- 100% mid occlusion

Successful stent placement to 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