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cardio.stemi.inferior.v1

Inferior wall STEMI (RCA / LCx culprit)

cardiologyacuteadultacuteinpatienttransitionoutpatient
Start encounter →Print handoutPRODUCTION

Phase E variant of cardio.stemi.core.v1 — narrowed to inferior wall (RCA most common, LCx less common). Inherits reperfusion + antiplatelet + statin + BB regimen from parent via routing; specializes complication profile (bradyarrhythmia, transient AV block, RV extension surveillance via mandatory V4R, posteromedial papillary rupture). Manifest pointer reuses cardio.stemi.core.v1 manifest. Design-brief pointer reuses parent (inferior-specific differences documented inline). Status INTEGRATED until terminology + RxNav-validated drug codes are reconciled. Authored 2026-05-14 by shard-06-cardio-acute as part of Phase E variant batch (inferior/RV/posterior/LMCA).

Entry points (3)

  • imaging
    ST elevation II/III/aVF + reciprocal ST↓ I/aVL (inferior STEMI)
    ecg_inferior_st_elevation
  • symptom
    Ischemic chest pain + inferior STEMI ECG → emergent cath within 90 min
    ischemic_chest_pain_with_inferior_ecg
  • imaging
    Inferior STEMI on standard ECG → mandatory V4R lead to screen for RV extension
    inferior_stemi_with_v4r_check

Required inputs (9)

  • agerequired
    demographic • used at CONTEXT
    Older patients have higher AV-block risk after inferior MI
  • sbprequired
    vital • used at RED_FLAGS
    Hypotension in inferior MI — distinguish vagal (responds to atropine + fluids) from RV extension (preload-dependent)
  • hrrequired
    vital • used at RED_FLAGS
    Bradyarrhythmia common in inferior MI (Berger PMID 1735156); transient AV block in 12-20%
  • ecgrequired
    imaging • used at INITIAL_WORKUP
    II/III/aVF ST↑ defines inferior; ST↑ III > II suggests RCA, ST↑ II > III + I/aVL ST↑ suggests LCx; ALWAYS obtain V4R for RV-extension screening
  • ecg_v4rrequired
    imaging • used at INITIAL_WORKUP
    V4R ST↑ ≥1 mm = RV extension → route to cardio.stemi.right-ventricular.v1; Class I obligatory in inferior STEMI per AHA 2025
  • troponinrequired
    lab • used at INITIAL_WORKUP
    Confirms infarct; smaller absolute peak vs anterior MI (smaller territory typically)
  • creatininerequired
    lab • used at CONTEXT
    Contrast nephropathy + DOAC dosing if AF post-MI
  • echo_post_pcirequired
    imaging • used at MONITORING
    LV + RV function, inferior wall motion, mitral apparatus (papillary rupture more often posteromedial in inferior MI)
  • cor_angiorequired
    imaging • used at TREATMENT
    RCA vs LCx culprit confirmation; complete revasc decision per COMPLETE PMID 31475795

12-phase flow (10)

  1. 1FRAME
    Inferior STEMI = RCA (most common, ≈80%) or LCx culprit; smaller territory than anterior typically; characteristic bradyarrhythmia + AV-block + RV-extension complication profile; route to cardio.stemi.core.v1 for the reperfusion arc
    inputs: ecg
    advance: inferior STEMI confirmed on ECG
  2. 2ENTRY
    Cath lab within 90 min; mandatory V4R lead capture; bedside echo for RV strain + tamponade exclusion + papillary apparatus
    inputs: age, hr
    advance: cath lab activated + V4R captured
  3. 3CONTEXT
    Allergies, bleed risk, recent surgery, antithrombotic regimen — same as parent
    inputs: sbp, creatinine
    advance: context complete
  4. 4RED_FLAGS
    Bradyarrhythmia / 2°-3° AV block (12-20% transient — usually resolves <48h with reperfusion); RV extension on V4R (preload-dependent — distinct hemodynamic profile, see right-ventricular.v1); papillary muscle rupture (posteromedial more common after inferior MI than anterior)
    inputs: sbp, hr
    actions: cardiogenic_shock
    advance: red flag screen complete
  5. 5INITIAL_WORKUP
    ECG + V4R + troponin + BMP + CBC + CXR + bedside echo (LV, RV, mitral apparatus)
    inputs: ecg, ecg_v4r, troponin, creatinine, echo_post_pci
    actions: acs_pathway, panel.cardiac, panel.renal
    advance: workup documented
  6. 6BRANCHING_WORKUP
    Primary PCI of RCA or LCx; complete revasc per COMPLETE if multivessel; if V4R+ → branch to cardio.stemi.right-ventricular.v1 for hemodynamic management
    inputs: cor_angio
    advance: reperfusion delivered
  7. 7TREATMENT
    Standard ACS regimen (ASA + ticagrelor + UFH + statin + BB if EF↓) per cardio.stemi.core.v1; AVOID/withhold BB in acute phase if HR <60 or 2°-3° AV block (relative contraindication until rhythm stable); atropine ready at bedside; transcutaneous pacing if symptomatic high-grade AV block
    inputs: sbp, hr, creatinine
    actions: protocol.stemi
    advance: reperfusion + secondary-prevention bundle started
  8. 8DISPOSITION
    CICU post-PCI; telemetry vigilance for transient AV block
    advance: unit assigned + rhythm-monitoring plan documented
  9. 9MONITORING
    Telemetry continuous; daily exam for new murmur (papillary); rhythm follow-up — most AV block resolves <48h with reperfusion; if persistent >5d consider permanent pacing per Kusumoto 2018
    inputs: echo_post_pci
    actions: panel.cardiac
    advance: rhythm stable + murmur absent
  10. 10FOLLOWUP
    Cardiology follow-up; echo at 40 d for LVEF reassessment; cardiac rehab; lower ICD-eligibility rate than anterior (smaller infarct typically)
    advance: cardiac rehab booked + EF re-assessed