Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of retrosternal chest pressure radiating to the left scapula and jaw, associated with diaphoresis and nausea. Symptoms are persistent, non-positional, and unresponsive to sublingual nitroglycerin. Clinical suspicion for LCx-related STEMI is high given the absence of classic ST-elevation in anterior leads, with potential subtle ST-segment depression in V1-V3 and ST-elevation in lateral leads (I, aVL, V5, V6).
Clinical Examination Findings
Patient appears in acute distress, diaphoretic, and tachypneic. Cardiovascular exam reveals S1/S2 with no murmurs, rubs, or gallops. Lungs are clear to auscultation bilaterally. Peripheral pulses are symmetric, though potentially diminished if cardiogenic shock is evolving. ECG demonstrates ST-segment elevation in lateral leads (I, aVL, V5, V6) and reciprocal ST-depression in V1-V3, consistent with LCx territory ischemia.
Treatment Protocol
Immediate activation of the Cardiac Catheterization Lab for primary PCI. Administered loading dose of DAPT (Aspirin 325mg and P2Y12 inhibitor), anticoagulation with unfractionated heparin, and high-intensity statin therapy. Initiated IV nitroglycerin for pain management and beta-blockers if hemodynamically stable. Continuous cardiac monitoring and serial ECGs to assess for dynamic changes.