R84

Published: June 25th, 2016

Category: Uncategorized

Pre-hospital ECG

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  • Pre-hospital ECG did not meet criteria for field activation

Emergency Department ECG

ECG1

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

 

Teaching

Anterolateral 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.

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.