- Pre-hospital ECG did not meet criteria for field activation
Emergency Department ECG
Cardiac Cath Report
LMCA: Normal caliber vessel that is angiographically normal.
LAD: Large-sized, transapical vessel with ostial 30% stenosis, proximal 30% stenosis followed by MLI. The LAD gives off a large-sized D1 vessel with ostial 30% stenosis followed by 80% proximal stenosis and then mid-segment occlusion.
LCX: Small-sized, patent, nondominant vessel
RCA: Large-sized, dominant vessel with diffuse disease but up to 50% mid-segment stenosis.
Successful stent placement to D1
- 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.
High Lateral STEMI: (From www.lifeinthefastlane.com)
- ST elevation is present in the high lateral leads (I and aVL).
- There is also subtle ST elevation with hyperacute T waves in V5-6.
- There is reciprocal ST depression in the inferior leads (III and aVF) with associated ST depression in V1-3 (which could represent anterior ischaemia or reciprocal change).
- This pattern is consistent with an acute infarction localised to the superior portion of the lateral wall of the left ventricle (high lateral STEMI).
- The culprit vessel in this case was an occluded first diagonal branch of the LAD.