STEMI-94

Published: September 14th, 2016

Category: STEMI

Pre-hospital ECG

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Cardiac Cath Report

LMCA: Short with distal 30% stenosis.

LAD: Large-sized, transapical vessel with mid 35% stenosis followed by MLI. The LAD gives off a small-sized, patent D1 vessel.

LCX: Large-sized, dominant vessel occluded at mid-segment, followed by ectatic segment, and then a distal stent which is widely patent. The LCx gives off a small-sized, patent OM1 and large-sized, patent OM2 vessel. The PDA has mild disease.

RCA: Small-sized, non-dominant vessel with proximal 50% stenosis followed by MLI.

Occlusion of mid-LCx with successful stent placement

 

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

ECG-Anatomy-LITFL