Emergency Department ECG
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
- 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