Anteroseptal STEMI

Today we looked at an ECG showing an Anteroseptal STEMI. We looked at the features of this ECG and the management within the department.

 

ECG Example:

 

ECG roundup: 
– ST elevation is biggest in the anteroseptal leads (V1-4). 
– There is some subtle ST elevation in I, aVL and V5, with reciprocal ST depression in lead III.
– There are peaked T waves in V2-4.
– These features indicate a acute anteroseptal STEMI 

Management: 
– Transfer to Resus 
– Bloods including Troponin 
– Monitor 
– Follow ACS drug protocol 
– Analgesia,  Analgesia and Analgesia!! Get this group of patients as comfortable and relaxed as possible!
– Refer to Cardiology Reg for PCI

ECG Lead Map:

Use this ECG lead map to help understand, and describe which part of an ECG that you can see changes to the ST segment. With this example, if you overlay this map to the ECG leads you will see that ST elevation is biggest in V1-4 which means an Anteroseptal STEMI.

Clinical Relevance of Anterior STEMIs

Anterior STEMI results from occlusion of the left anterior descending artery (LAD). Anterior myocardial infarction carries the worst prognosis of all infarct locations, mostly due to larger infarct size.

A study comparing outcomes from anterior and inferior infarctions (STEMI + NSTEMI) found that on average, patients with anterior MI had higher incidences of in-hospital mortality (11.9 vs 2.8%), total mortality (27 vs 11%) and heart failure (41 vs 15%)  compared to patients with inferior MI (https://litfl.com/)H

How to recognise an Anterior STEMI

– ST segment elevation with Q wave formation in the precordial leads (V1-6) the high lateral leads (I and aVL).

– Reciprocal ST depression in the inferior leads (mainly III and aVF).

– ST segment elevation, unlike depression, will localise to the ECG lead of the affected area of the heart (see Lead map)

– 1mm of ST elevationin 2 consecutive leads is required to diagnose a STEMI, with the exception of an anterior STEMI where 2mm of ST elevation in V2 and V3 are required in men, and 1.5mm in women. 

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