醫學筆記匯整 ED Notes

• LAD occlusions
• The worst prognosis of all infarction ( Larger infarct size )
   
• 除了 Anterior STEMI, 
  Other high-risk presentations of anterior ischaemia :
   - Left main occlusion
   - Wellens' syndrome
   - De Winter's T
   - Anterior-inferior STEMI (Occlusion of a wraparound LAD)
   
• STE + Q over V1-6
  ± the high lateral leads (I and aVL)
  
  Reciprocal @下壁

• Different types of anterior MI :

          - Septal : V1-2
          - Anterior : V2-5
          - Anteroseptal :  V1-4
          ​​​​​​- Anterolateral : V3-6, I + aVL
          - Extensive anterior  / anterolateral : V1-6, I + aVL

Wraparound 

同時 ST elevation in the precordial and inferior leads
同時前壁 + 下壁梗塞
Due to occlusion of a variant“type III”LAD that wraps around the cardiac apex
to supply both the anterior and inferior walls of the left ventricle. 

Extensive anterior MI : Tombstoning pattern

Massive ST elevation with tombstone morphology
present throughout the precordial and high lateral leads (I, aVL)

This pattern is seen in proximal LAD occlusion
and indicates a large territory infarction with a poor LV ejection fraction
and high likelihood of cardiogenic shock and death.

wraparound LAD : 前 + 下