RESUMO
Anterior and inferior ST elevation on electrocardiography (ECG) in patients with acute myocardial infarction is uncommon. ST-segment elevation due to right ventricular infarction induced by right coronary occlusion may extend from V1 to V3/V4, resembling the pattern of transmural ischemia of the anterior wall of the left ventricle. In addition, a wraparound left anterior descending (LAD) artery can produce ischemia manifesting as ST-segment elevation in the anterior and inferior leads. Our case report reveals dynamic ST-segment changes in acute inferior myocardial infarction, including the appearance of the shark fin ECG pattern, unlike what has been reported before.
Assuntos
Eletrocardiografia , Humanos , Masculino , Infarto Miocárdico de Parede Inferior/fisiopatologia , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/complicações , Diagnóstico Diferencial , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To assess electrocardiogram (ECG) for risk stratification in inferior ST-elevation myocardial infarction (STEMI) patients within 24 h. METHODS: Three hundred thirty-four patients were divided into four ECG-based groups: Group A: R V1 <0.3 mV with ST-segment elevation (ST↑) V7-V9, Group B: R V1 <0.3 mV without ST↑ V7-V9, Group C: R V1 ≥0.3 mV with ST↑ V7-V9, and Group D: R V1 ≥0.3 mV without ST↑ V7-V9. RESULTS: Group A demonstrated the longest QRS duration, followed by Groups B, C, and D. ECG signs for right ventricle (RV) infarction were more common in Groups A and B (p < .01). ST elevation in V6, indicative of left ventricle (LV) lateral injury, was more higher in Group C than in Group A, while the ∑ST↑ V3R + V4R + V5R, representing RV infarction, showed the opposite trend (p < .05). The estimated LV infarct size from ECG was similar between Groups A and C, yet Group A had higher creatine kinase MB isoform (CK-MB; p < .05). Cardiac troponin I (cTNI) was higher in Groups A and C than in B and D (p < .05 and p = .16, respectively). NT-proBNP decreased across groups (p = .20), with the highest left ventricular ejection fraction (LVEF) observed in Group D (p < .05). Group A notably demonstrated more cardiac dysfunction within 4 h post-onset. CONCLUSIONS: For inferior STEMI patients, concurrent R V1 <0.3 mV with ST↑ V7-V9 suggests prolonged ventricular activation and notable myocardial damage. RV infarction's dominance over LV lateral injury might explain these observations.
Assuntos
Infarto Miocárdico de Parede Inferior , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Eletrocardiografia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Relevância Clínica , Volume Sistólico , Função Ventricular Esquerda , Arritmias CardíacasAssuntos
Eosinofilia , Infarto Miocárdico de Parede Inferior , Miocardite , Humanos , Masculino , Doença Aguda , Biópsia , Diagnóstico Diferencial , Eletrocardiografia , Eosinofilia/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Síndrome Hipereosinofílica/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/etiologia , Miocardite/diagnóstico , Valor Preditivo dos Testes , AdultoRESUMO
AIM: To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. MATERIAL AND METHODS: This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. RESULTS: The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. CONCLUSION: Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.
Assuntos
Trombose Coronária , Infarto Miocárdico de Parede Inferior , Síndrome Metabólica , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Pessoa de Meia-Idade , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Angiografia Coronária , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Eletrocardiografia , Arritmias CardíacasRESUMO
BACKGROUND: Identifying the culprit during inferior myocardial infarction (MI) is still challenging. We determined the diagnostic effect of electrocardiographic (ECG) indices in identifying the culprit vessel of acute MI and the impact of coronary artery dominance on it. METHODS: This cross-sectional study included patients with acute inferior MI who presented to Imam Khomeini Hospital and Tehran Heart Center and underwent primary PCI within 12 h of the onset of symptoms. A standard 12lead ECG was recorded and interpreted by two cardiologists. Based on the coronary angiography, the patients were divided into two groups of LCX or RCA involvement and were compared for general variables and ECG indices. The diagnostic values of the ECG indices for predicting the culprit vessel were then calculated. RESULTS: We evaluated 411 patients with inferior STEMI (321 [77.5%] male, age 58.1 ± 11.1 years). RCA was the culprit vessel in 286 patients (69.1%) and LCX in 128 patients (30.9%). 321 patients (77.5%) were right dominant, 40 (9.7%) patients were left dominant, and 53 patients (12.8%), were codominant. Coronary dominance had minimal impact on the ECG indices regarding culprit identification even after adjustment for confounders. STE in lead III > lead II had the highest sensitivity for detecting RCA as the culprit (sensitivity: 89.2% and specificity: 57.8%). STE ≥0.1 mV in V5 or V6 leads had the highest sensitivity for detecting LCX as the culprit (sensitivity: 51.6, specificity: 93.7%). CONCLUSION: In inferior STEMI, ECG indices can predict the culprit vessel with acceptable sensitivity and specificity independent of coronary artery dominance.
Assuntos
Infarto Miocárdico de Parede Inferior , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Infarto Miocárdico de Parede Inferior/diagnóstico , Eletrocardiografia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Estudos Transversais , Irã (Geográfico) , Infarto do Miocárdio/diagnóstico , Angiografia Coronária , Sensibilidade e Especificidade , Vasos CoronáriosRESUMO
Complications following acute myocardial infarction (MI) such as ventricular septal rupture (VSR) and left ventricular (LV) aneurysm are rare and can be dreadful. Their simultaneous presence in the same patient is extremely rare. We aimed to present a rare case of concomitant association of ventricular aneurysm and VSR complicating an inferior myocardial infarction. We report the unusual case of Mr. A. D, a 63-year-old, active smoker, with a history of diabetes mellitus and hypertension, admitted for the management of inferior MI within 6 days. The MI was complicated by an LV aneurysm in the inferoposterior and the inferoseptal walls associated with a VSR in the inferoseptal wall. The patient had only signs of right heart failure on admission. This observation illustrates on the one hand the rarity of the association of VSR and LV aneurysm after an inferior myocardial infarction, and on the other hand the possibility of founding them at an early stage of MI without any signs of cardiogenic shock.
Assuntos
Aneurisma Cardíaco , Infarto Miocárdico de Parede Inferior , Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Pessoa de Meia-Idade , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Choque Cardiogênico , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologiaAssuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Infarto Miocárdico de Parede Inferior , Intervenção Coronária Percutânea , Calcificação Vascular , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Resultado do Tratamento , Tomografia de Coerência Óptica , Angiografia CoronáriaRESUMO
BACKGROUND: Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized. AIMS: The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG. METHODS: We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. RESULTS: Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods. CONCLUSIONS: Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.
Assuntos
Vasos Coronários , Infarto Miocárdico de Parede Inferior , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia/métodos , Infarto Miocárdico de Parede Inferior/diagnóstico , Sensibilidade e Especificidade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnósticoRESUMO
The ST-segment elevation myocardial infarction (STEMI) paradigm requires ST-segment elevation (STE) in contiguous leads on electrocardiography (ECG). STEMI criteria overlook numerous patients with acute coronary occlusion (ACO). The Aslanger pattern describes an ECG without contiguous STE, indicating acute inferior occlusion myocardial infarction (OMI) with concomitant multi-vessel disease. We describe one case of inferior OMI with one STE in lead III on initial ECG; however acute inferior STEMI was later identified. Coronary angiography showed thrombosis in the proximal right coronary artery and severe stenosis in non-infarct-related arteries. Awareness of the limitations of current STEMI criteria is crucial for timely intervention.
Assuntos
Oclusão Coronária , Infarto Miocárdico de Parede Inferior , Infarto do Miocárdio com Supradesnível do Segmento ST , Arritmias Cardíacas/complicações , Angiografia Coronária/efeitos adversos , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico , Eletrocardiografia , Humanos , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnósticoRESUMO
BACKGROUND: The de Winter electrocardiography (ECG) pattern is associated with acute total or subtotal occlusion of the left anterior descending coronary artery (LAD) characterized by upsloping ST-segment depression at the J point in leads V1-V6 without ST-segment elevation. CASE PRESENTATION: We report an atypical style case of the de Winter ECG pattern accompanied by ST elevation in inferior leads. The patient underwent emergency coronary angiography, which revealed total occlusion of the proximal LAD with no observable stenosis in the right coronary artery. CONCLUSION: ECG-related changes in acute total LAD occlusion can present with the de Winter pattern and ST elevation in inferior leads. Recognizing this atypical ECG pattern is critical for immediate reperfusion therapy.
Assuntos
Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Eletrocardiografia , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Potenciais de Ação , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Diagnóstico Diferencial , Stents Farmacológicos , Frequência Cardíaca , Humanos , Infarto Miocárdico de Parede Inferior/fisiopatologia , Infarto Miocárdico de Parede Inferior/terapia , Masculino , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Síndrome , Resultado do TratamentoRESUMO
A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.
Assuntos
Infarto Miocárdico de Parede Inferior , Intervenção Coronária Percutânea , Ruptura do Septo Ventricular , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Pessoa de Meia-IdadeAssuntos
Ruptura Cardíaca Pós-Infarto , Ruptura Cardíaca , Infarto Miocárdico de Parede Inferior , Insuficiência da Valva Mitral , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/etiologia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/etiologia , Infarto Miocárdico de Parede Inferior/terapia , Músculos Papilares/diagnóstico por imagemRESUMO
A 62-year-old white patient presents with markedly ischemic electrocardiogram, notable for Tombstone sign.
Assuntos
Eletrocardiografia , Infarto Miocárdico de Parede Inferior/diagnóstico , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/fisiopatologia , Pessoa de Meia-IdadeRESUMO
An infarction in the right coronary artery affects the inferior wall of the heart and can also cause impedance to the cardiac conduction system. The right coronary artery perfuses the sinoatrial and atrioventricular nodes, and a loss of blood flow contributes to a breakdown in the communication system within the heart, causing associated bradycardias, heart blocks, and arrhythmias. This case report details the prehospital and emergency care of a middle-aged man who experienced an inferior myocardial infarction, concomitant third-degree heart block, and subsequent cardiogenic shock, with successful revascularization. This case is informative for emergency clinicians to review symptoms of acute coronary syndrome, rapid lifesaving diagnostics and intervention, and the unique treatment and monitoring considerations associated with right ventricular involvement and third-degree heart block.