Patient handout

Inferior wall STEMI (RCA / LCx culprit)

PRODUCTION

1. Your condition

This handout is for inferior wall stemi (rca / lcx culprit). Your care team identified this based on: st elevation ii/iii/avf + reciprocal st↓ i/avl (inferior stemi).

Other reasons your team may use this plan: ischemic chest pain + inferior stemi ecg → emergent cath within 90 min; inferior stemi on standard ecg → mandatory v4r lead to screen for rv extension.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed	PO	load + 81 mg daily	ACC/AHA 2025 ACS Class I; same as parent
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo default DAPT	PLATO PMID 19717846; same as parent
atropine	0.5 mg IV q3-5 min, max 3 mg	IV	PRN	Vagal-mediated bradycardia (Bezold-Jarisch reflex) common in inferior MI; first-line per Kusumoto 2018 PMID 30412709
metoprolol	12.5-25 mg PO BID — DEFER until rhythm stable	PO	deferred	BB normally Class I post-MI, but AVOID/defer in acute inferior MI if HR <60, 2°-3° AV block, or hypotension; reintroduce after 48h once rhythm stable — encoded as contraindication_substitute (avoid in this phenotype, restart in chronic management arm)

Plan: Inferior STEMI complication phenotype — adds to parent cardio.stemi.core.v1 reperfusion regimen

3. When to call your provider

Contact your care team if any of the following happen:

EF declining despite the four foundational heart-failure medications → advanced HF eval
Recurrent angina → cath re-eval

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

2°-3° AV block in inferior MI; usually transient (resolves <48h with reperfusion) but can be symptomatic — Mobitz I with hypotension or complete heart block
V4R ST↑ ≥1 mm in inferior STEMI = RV extension (proximal RCA) — preload-dependent
New harsh apical/axillary holosystolic murmur post-inferior-MI + acute pulmonary edema → posteromedial papillary rupture (single-vessel blood supply from PDA, more vulnerable than anterolateral)(life-threatening)
Inferior STEMI + SBP <90 not responsive to atropine + fluids — assess for RV extension, mechanical complication, or evolving cardiogenic shock
Mobitz II or 3° AV block persisting >5d post-inferior-MI despite reperfusion

5. Follow-up

Cardiology follow-up; echo at 40 d for heart pumping strength (LVEF) reassessment; cardiac rehab; lower ICD-eligibility rate than anterior (smaller infarct typically)

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + ESC 2023 ACS + 2018 ACC/AHA/HRS Bradycardia Guideline