STEMI-126

Published: July 1st, 2017

Category: STEMI

Pre-hospital ECG

Cardiac Cath Report

1. LMCA: Large, widely patent, gives rise to the LAD and LCX.

2. LAD: Normal in caliber, Mid 99% thrombus occlusion after 1st septal and diagonal with TIMI 0.

3. LCX: Normal in caliber, nondominant, widely patent OMB1 with MLI, patent OMB2 with MLI. Vessel terminates as AV groove LCx.

4. RCA: Normal in caliber, dominant, widely patent.  Patent right PDA

Successful stent placement to LAD lesion

 

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.