Percutaneous Coronary Intervention in the face of the STEMI

First, we need to understand the normal coronary anatomy. The Right Coronary Artery, (RCA) is basically shaped like the letter "C"

The STEMI usually presents with 100% occlusion of a coronary artery.

This angiogram reveals a vessel which is stumped off, or a nub, (in cath lab lingo).  You can faintly see the lower half of the "C".

A special wire is advanced through a catheter & into the artery.  It is then advanced through the blockage.

The catheter is the solid dark line coming from the top middle of the image. This image also shows a balloon, (bigger section of darkness in middle of the wire), inflated using contrast.  Contrast is used to inflate balloons.  This makes them easier to see, the size they are becoming, as well as preventing an air embolus, should the balloon rupture on calcified plaque.

A stent is usually placed to help hold the vessel open at the formerly stenotic area.  

Many people describe the stent as being similar to the spring in a ballpoint pen.  Imagine this stent  being tightly wrapped around a balloon, which is wrapped around a small catheter.  This balloon/stent delivery system is advanced to the stenotic, or maybe thrombosed area.  The balloon is inflated, thereby delivering, or deploying the stent.  The stent then stays and the balloon is removed. (Obviously, this stent is magnified)

Turn up your volume and enjoy the music as this video gives a beginning to ending show of an intervention for the Inferior STEMI

Did you notice how much myocardium is now getting blood...and therefore, oxygen supply...that was missing
at the beginning?  

GI symptoms are common with the inferior STEMI, and many times, it being cardiac related is dismissed because the patient thinks it is just really bad heartburn.  The familiar saying in the cath lab, "Time is muscle," is very true.  Check out this left ventriculogram, (LV gram),which helps demonstrate the normal versus the diseased heart, which is unable to pump efficiently.  Contrast, or dye, is injected into the LV via the catheter. (The curly ended catheter in the middle of the LV is a pigtail catheter. How's that for imaginative?)

Have you been able to tell the difference in activity tolerance between patients with a normal versus a poor ejection fraction?  What differences do you see?  Have you noticed it is not limited to physical activity?  What CNS symptoms do you see?  What about GI? Renal?  What about right sided failure compare to left?

Just another reminder...

Time is Muscle!

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