Acute inferior STEMI – RCA or LCX?

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  • I do think that right-sided EKGs are rapidly gaining acceptance in the pre-hospital setting. Do you think the major pre-hospital Monitor companies are going to come up with a 14 lead or 16 lead EKG attachment or an option on the 12-lead acquisition to get a right sided 12 lead? I know such systems exist for the hospital 12-leads, but I've never heard anything on the pre-hospital monitors.

  • Tom B says:

    MIFL – I agree that right sided and posterior chest leads are rapidly gaining acceptance in the pre-hospital setting.I'm not sure what the "Big 3" are going to do, but a simple setting that allows the paramedic to select right sided or posterior chest leads (or both) would be an interesting feature.I personally don't want any additional wires. I just don't think it's necessary.Tom

  • But 12 leads are so yesterday! Why not do a pre-hospital 80 lead EKG? :D day we see this on the rigs…I think there will probably be a cath lab in there as well.

  • Tom B says:

    MIFL – I take it back! I want my 80 lead ECG! :)Tom

  • Shaggy says:

    While searching for something else a while back, the 80 lead EKG popped up in my search results. It looked like something foreign and experimental, so I only gave it a glance with a shrug of the shoulders.Anyway, Tom, how often are there rules in diagnosing a culprit artery from EKG analysis that are 100% accurate? As you said, the treatment and actions of the medic crew were appropriate for the condition of the patient anyway.

  • Tom B says:

    True, Shaggy! I don't know how often they're accurate. I was completely shocked this was the LCX! Tom

  • Lee says:

    Big inferior STEMI with Sinus brady (30's) with hypotension, if there is ST elevation in V4R would you suspect that the SB is due to SA node ischemia and thus the treatment would only include increasing the preload and reperfusion therapy and not Atropine?

  • The Jarvik 7 says:

    Tom- Outstanding analysis and case presentation. This has been an area of interest for me and you have assembled an unmatched wealth of insight here– very, very helpful. Thank you! 

  • steve says:

    If I identify an inferior MI, I always place V4 on opposite position on chest then repeat ECG making sure to mark it V4R!! To see what side is being effected.

  • Eleazar Daet says:

    Under the Eskola criteria, about the dimensions of artery which states that ST elevation at leads II, III, aVF accompanied with ST depression in leads I and aVL involves a non dominant RCA. In that case, i would rather have additional V7, V8 and V9, since ECG also shows a possible posterior wall STEMI (mirror image in V1 to V3). This findings would lead to support that the STEMI involves the dominant LCx rather than the RCA.

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