STEMI case examples

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Case # 1

EKG

74 year old male with an acute anterolateral ST elevation MI. EKG at admission: Left axis deviation,
(EKG courtesy of C. Michael Gibson MS MD, and copylefted)

Coronary angiography

Left Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo>3504592606144648008</googlevideo>

Right Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo>-5496965035450742211</googlevideo>

Case # 2

EKG

A 63 year old male with an acute anterior ST elevation MI. EKG on admission: left axis deviation and right bundle branch block
(EKG courtesy of C. Michael Gibson MS MD, and copylefted)

Coronary angiography

Left Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo></googlevideo>

Right Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo></googlevideo>

Case # 3

EKG

72 year old male with anterosptal ST elevation MI. EKG on admission: Normal sinus rhythm with sinus arrhythmia and right bundle branch block.
(EKG courtesy of C. Michael Gibson MS MD, and copylefted)

Coronary angiography

Left Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo></googlevideo>

Right Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo></googlevideo>

Case # 4

EKG

48 year old female with an acute anterolateral ST elevation MI. EKG on admission: Accelerated junctional rhythm and old inferior MI.
(EKG courtesy of C. Michael Gibson MS MD, and copylefted)

Coronary angiography

Left Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo>3666349766716149098</googlevideo>

<googlevideo>3819638227461161537</googlevideo>

Right Coronary Artery

(Angiographic image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo>6513361842828023628</googlevideo>

Left Ventriculography

(Image courtesy of C. Michael Gibson MS MD, and copylefted)

<googlevideo>-7170279204277936411</googlevideo>

v t e ST Elevation Myocardial Infarction
Background	Overview • Epidemiology and Demographics • Classification
Risk factors and Triggers	Risk Factors • Triggers
Pathophysiology	Pathophysiology of Vessel Occlusion • Pathophysiology of Reperfusion• Gross Pathology • Histopathology
Diagnosis	Diagnosis • Symptoms • Differential Diagnosis of Chest Pain • Physical Examination • Electrocardiogram • Right ventricular myocardial infarction • Atrial Infarction • Cardiac Markers • Coronary Angiography
Treatment	Pre-Hospital Care Pre-Hospital Care Initial Care Initial Care • Oxygen • Nitrates • Analgesics • Aspirin • Beta Blockers Pharmacologic Reperfusion • Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) • Fibrinolysis Mechanical Reperfusion • The Importance of Reducing Door-to-Balloon Times • Primary PCI • Adjunctive and Rescue PCI • Rescue PCI • Facilitated PCI • Adjunctive PCI • CABG • Management of Patients Who Were Not Reperfused • Assessing Success of Reperfusion Antithrombin Therapy • Antithrombin therapy • Unfractionated heparin • Low Molecular Weight Heparinoid Therapy • Direct Thrombin Inhibitor Therapy • Factor Xa Inhibition Antiplatelet Agents • Aspirin • Thienopyridine Therapy • Glycoprotein IIbIIIa Inhibition Inhibition of the Renin-Angiotensin-Aldosterone System • Inhibition of the Renin-Angiotensin-Aldosterone System Other Adjunctive Therapies • Magnesium Therapy • Glucose Control • Calcium Channel Blocker Therapy
Monitoring	Arrhythmia Monitoring
Complications	Complications
Discharge Care	Secondary Prevention • Cardiac Rehabilitation • Prognosis

v t e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

Cardiovascular disease (heart)

Coronary disease	Coronary artery disease (CAD) Coronary artery aneurysm Spontaneous coronary artery dissection (SCAD) Coronary thrombosis Coronary vasospasm Myocardial bridge
Active ischemia	Angina pectoris Prinzmetal's angina Stable angina Acute coronary syndrome Myocardial infarction Unstable angina
Sequelae	hours Hibernating myocardium Myocardial stunning days Myocardial rupture weeks Aneurysm of heart / Ventricular aneurysm Dressler syndrome

Layers

Endocardium /
valves

Endocarditis	infective endocarditis Subacute bacterial endocarditis non-infective endocarditis Libman–Sacks endocarditis Nonbacterial thrombotic endocarditis
Valves	mitral regurgitation prolapse stenosis aortic stenosis insufficiency tricuspid stenosis insufficiency pulmonary stenosis insufficiency

Conduction /
arrhythmia

Tachycardia
(paroxysmal and sinus)

Supraventricular	Atrial Multifocal Junctional AV nodal reentrant Junctional ectopic
Ventricular	Accelerated idioventricular rhythm Catecholaminergic polymorphic Torsades de pointes

Premature contraction

Pre-excitation syndrome

Flutter / fibrillation

Long QT syndrome

Other / ungrouped

Other

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