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Inferior-posterior Wall M.I. and AV Dissociation

At the ECG Guru website, our main goal is to provide quality teaching materials to those who teach ECG interpretation and other cardiac topics.  This ECG offers teaching opportunities for those who teach any level of student.

The patient:   This ECG was obtained in the Emergency Department from a 54-year-old man who was complaining of severe chest pain and nausea.  His BP was 130/68.

Non-dominant Right Coronary Artery In A Patient With A Dominant Circumflex Artery

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Non-dominant right coronary artery

This is an angiogram of a non-dominant right coronary artery in a patient with a dominant left circumflex artery.  The RCA is very small, compared to the usual.  This patient is one of about 15 - 18% of the population whose circumflex artery perfuses the posterior/nferior wall of the left ventricle.

Click HERE to view the dominant circumflex artery of this patient.

Dawn's picture

Inferior Wall M.I. With Angiogram and Ventriculogram

This ECG was taken from a 66-year-old woman who presented to the emergency department complaining of chest pain and shortness of breath.  She attributed her symptoms to her COPD, but stated that her aerosol treatment had not helped.  She waited for some time before deciding to go to the hospital, then drove herself. In the emergency department, she had blood drawn, an I.V. started, and an aerosol treatment of albuterol.  She was then taken to the radiology dept. for a chest xray.  When she returned, a 12-lead ECG was done.  45 minutes had passed since she first arrived at the hospital.  This ECG is shown here.  It shows ST elevation in the inferior leads:  II, III, and aVF.  The patient was taken immediately to the cath lab, where her right coronary artery was found to have a 100% occlusion. (See image accompanying this ECG).  Angioplasty was successful, and stents were placed in the artery.  The patient was found to have anemia, with a hemoglobin of 5.5, and she was given a blood transfusion.  During the cath procedure, a ventriculogram was performed, which showed a stunned and akinetic inferior wall.  Unfortunately, subsequent ventriculogram performed several weeks later showed the lack of motion of the inferior wall to be permanent.  The ventriculogram is also posted here, and at this YouTube link, so you will be able to show your students the mechanical effects on the heart of a delay to treatment in acute STEMI.  See our YouTube site for more ventriculograms and cath videos.

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