STEMI-79

Published: July 1st, 2016

Category: STEMI

Pre-hospital ECG

IMG_5064

Emergency Department ECG

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Patient with bradycardia, although BP and mentation were normal and stable

Atropine in Emergency Department had no affect on bradycardia

Trans-venous pacer placed in cath lab

Cardiac Cath Report

LMCA: Long and normal caliber vessel which is angiographically normal.

LAD: Large-sized, transapical vessel with proximal 30% stenosis followed by mid 60-70% stenosis. The LAD gives off a small-sized D1 vessel with moderate diffuse disease.

LCX: Small-sized, nondominant vessel. The LCx gives off a high, large-sized OM1 vessel which bifurcates and has moderate diffuse disease. The LCx also gives off a small-sized atrial branch.

RCA: Large-sized, dominant vessel with mid-segment occlusion (culprit)

Successful stent placement to mid 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