Okluzija u dominantnom levom koronarnom sistemu – ekg dilema u radu lekara hitne pomoći

Stefan Đorđević

doi:10.5937/halo29-46282

Stefan Đorđević Zavod za urgentnu medicinu Beograd

DOI: https://doi.org/10.5937/halo29-46282

Ključne reči: Inferoposterolateralni infarkt miokarda, STEMI ekvivalenti

Sažetak

Uvod/cilj: Bol u grudima predstavlja glavnu kliničku manifestaciju aks-a. Posteriorni infarkt se najčešće javlja kao ekstenzija inferiornog infarkta. Prikazujemo pacijenta sa blagim simptomima čiji ekg nije korealirao sa devastirajućim infarktom koji je imao i koristimo algoritme za procenu mesta okluzije.

Prikaz slučaja: Ekipa SHP upućena je na intervenciju kod pacijenta zbog bola u grudima. Ekg: sinusni ritam, horizontalna ST depresija V1-V3 1 do 2mm, ST elevacija ≤1mm u odvodu V6, suptilna ST depresija D1 i aVL <1mm, ST elevacija D3 i aVF <1mm, ST elevacije V7-V9 1 do 2mm. Koronarografija: Sistem LCA je dominantan. RCA je minorna sa stenozom 70-80%, okluzija u OM1. Korišćenjem algoritama procene okluzije LCx/RCA ekg sugeriše na okluziju u desnom dominantnom koronarnom sistemu što ne korelira sa izveštajem koronarografije.

Zaključak: Preporuka je standardizovanje upotrebe posteriornih i desnih odvoda kod svakog inferiornog infarkta i sumnje na posteriorni kao i uključivanje STEMI ekvivalenata u STEMI mrežu.

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