Comments to Post AVR STEMI

    • Very sick looking EKG! NSR, LVH. ST elevation in AVR and V1 and ST depression in inferior and lateral leads. Suspicious for LM coronary artery lesion Vs. multi-vessel dz.

      Pt needs urgent cath.

      • Case underwent emergent catheterization (radial approach) and found to have severe ostial LM lesion (image) which was subtotally occluded with large thrombus burden. The rest of. her coronaries were clean. 

        That LM lesion was successfully stented and Impella inserted for hemodynamic support. 

        Initially, Echo showed severe hypoknesis with EF 30-35%; however, Impella removed 48h later after patient was stabilized. Repeat Echo D6 post-MI showed EF: 50-55%. 

        Pt was discharged home on D7 in good stable condition. 

        The questions remains, what is the nature of this lesion (the patient had a clean cath 8 mo earlier before her AVR!)?

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