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RCA-dependent LAD circulation through collaterals 3. True bifurcation STEMI with static thrombus (Carinal trapping of thrombus ,Coronary Lerish sydrome ) 4. Embolic STEMI with showers of emboli into both LCX and LAD Simultaneous or sequential Anterior and Inferior STEMI 5. Wrap around LAD true Global MI 2.
Thus, this is both an anterior and inferior STEMI. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Armstrong et al.)], the presence of such well developed anterior Q-wave suggests completed transmural STEMI. Circulation 1993;88(3):896-904.
Thus, this is BOTH an anterior and inferior STEMI in the setting of RBBB. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. Could it be acute (vs.
This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes.
Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Circulation , 130 (25). St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis.
cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. of AMI patients and is often preceded by postinfarction regional pericarditis (PIRP).
Of course this depends on many factors: 1) duration of occlusion, 2) whether full or near occlusion with zero flow or some flow -- the flow in the artery is the critical factor, measured by "TIMI" flow, 3) presence of collateral circulation and others. Pericarditis would be even more unlikely in someone without chest pain.
.: 50% of LAD STEMI have Q-waves by one hour. The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves. So it is not necessarily subacute.
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