STEMI-73

Published: June 8th, 2016

Category: STEMI

Pre-hospital ECG

ECG1Emergency Department ECG

ECG2Cardiac 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