CASE PRESENTATION
The patient is a 40 yo male reporting a 9/10 pressure in the center of his chest. The patient appears pale and diaphoretic.
Family history is significant for early coronary artery disease. The patient felt well prior to experiencing the "pressure in his chest."
What does the 12 lead ECG show ?
Where is this patient's occlusion ?
Where is this patient's occlusion ?
12 LEAD ECG INTERPRETATION
Sinus rhtyhm, rate of 60, anterior lateral STEMI
A baseline sinus rhythm is present. ST segment elevation is seen in leads V1-V5. Leads I and aVL also reveal significant > 1 mm elevation of the ST segment. Reciprocal changes in the form of ST segment depression are best visualized in the inferior limb leads III and aVF.
The distribution of ST elevation across most of the precordium suggests obstruction of the left main or left anterior descending artery. The LAD supplies blood to the left ventricule. Diagnonal branches of the left coronary artery supply the lateral wall of the left ventricle. Occlusion of a diagnoal branch corresponds to ST elevation in leads I and aVL.
EMS PEARLS
Complications related to a massive anterior myocardial infarction include:
1. Dysrhythmia (VT/VF)
2. Congestive heart failure
Congestive heart failure may occur when approximately 40% of the LV muscle mass is lost to infarction.
