inferior wall mi complications

QS waves in these leads may be the only evidence of an anterior septal MI, however. Complications with Acute Inferior Wall Myocardial Infarction. These include AV block, atrial arrhythmias, profound hypotension and bradycardia, and pericarditis. The coexistence of inferior MI with left anterior fascicular block is easier to diagnose on the VCG than on the ECG. This critical zone of slow conduction is activated parallel to the mitral annulus in either direction, resulting in two distinct QRS configurations not seen in VTs arising from other sites: LBBB pattern (rS in lead V1, R in lead V6) with left superior axis, and RBBB pattern (R in lead V1, QS in lead V6) and right superior axis.3,32. Inferior MI is caused by the occlusion of the dominant left circumflex artery in about 18% of cases.40 Myocardial infarction caused by the dominant right coronary artery and the dominant left circumflex artery tends to produce similar Q wave changes (Figures 7-8, 7-9, and 7-16 to 7-21), but the pattern of ST segment elevation may be helpful for the differential diagnosis. An evidence-based manual of reperfusion therapy, Chou’s electrocardiography in clinical practice, Significance of lead aVR in acute coronary syndrome, Third universal definition of myocardial infarction, Clinical significance of ST-segment elevation in lead V1 in patients with acute inferior wall Q-wave myocardial infarction, Diagnostic value of aVL derivation for right ventricular involvement in patients with acute inferior myocardial infarction, Electrocardiographic predictors of culprit artery in acute inferior ST elevation myocardial infarction, AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram. Further criteria for differentiating normal from abnormal Q waves in these leads lie beyond the scope of this book. anterior wall damage. (Number may be smaller with modern reperfusion times) Imaging options: Echo (most commonly used) CT or MRI. Although a discussion of the precise criteria for differentiating normal from abnormal Q waves in these leads is beyond the scope of this book, the following can be taken as general rules: An inferior wall MI should be diagnosed with certainty only when abnormal Q waves are seen in leads II, III, and aVF. Severe tricuspid regurgitation secondary to papillary muscle necrosis or severe RV dilation has been described in the setting of RVMI. The cardiac intensivist should also be aware of several less common complications.65,92–95, Patent foramen ovale (PFO) is present in 25% of the population. Prominent noninfarction Q waves are often a characteristic feature in the ECGs of patients with hypertrophic cardiomyopathy (Fig. 35 Reciprocal ST segment depression occurred more frequently in patients with a large MI and more wall motion abnormalities, and it was associated with high mortality. Inferior wall myocardial infarction stems from ischemia and necrosis due to occlusion of the right coronary and/or distal circumflex arteries that supply this area of the heart. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. All the patients of inferior wall myocardial infarction were divided into two groups. INFERIOR WALL MI WITH RV INVOLVEMENT. A scientific statement from the American Heart Association, Electrocardiography and Arrhythmias Committee; Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society, Electrocardiographic determination of culprit lesion site in patients with acute coronary events, Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction, Use of the electrocardiogram in acute myocardial infarction, Usefulness of ST-segment elevation in lead III exceeding that of lead II for identifying the location of the totally occluded coronary artery in inferior wall myocardial infarction, http://content.onlinejacc.org/article.aspx?articleid=1486115#tab1. Furthermore, just as not all Q waves are abnormal, all abnormal Q waves are not the result of MI. The next day his speech was disturbed and his body was shaking. 22-7).16 In VTs with RBBB, the R waves can persist across the precordium (positive concordance). Leads V5 and V6 are affected by posterolateral ischemia (Figures 7-23 and 7-24). ... friction rubs, usually evanescent, are common on days 2 and 3 post-STEMI. When the electrical axis is vertical, qR complexes appear in leads II, III, and aVF. Bowing of the interatrial septum toward the LA is a negative marker associated with a high incidence of hypotension, heart block, and mortality.32, Ziad F. Issa MD, ... Douglas P. Zipes MD, in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease (Second Edition), 2012, With inferior MI, most VTs have basal exit sites and thus have relatively preserved precordial R waves (that usually are present in leads V2 to V4 with the persistence of an r or R wave through lead V6), although apical exit sites also occur (Fig. Free Wall Rupture • Most common, least recognized complication – <1% to 6.2% pts with acute MI – Accounts for 14-to-26% of infarct-related mortality and 7% of in-hospital deaths – Time course • First 5 days post-MI in 50% • 90% occur within 2 weeks • Risk factors for rupture – No prior history angina or MI Generally have a more favourable prognosis than anterior myocardial infarction (in-hospital mortality only 2-9%), however certain factors indicate a worse outcome. Clinical complications of left coronary artery occlusion include: Lateral wall MI: There’s a high lateral wall MI and a low lateral wall MI. A few minutes after taking 1 g of cocaine nasally his pulse rate increased. lateral wall damage. The challenges in the management of right ventricular infarction, Right ventricular myocardial infarction: Pathophysiology, diagnosis and management, Usefulness of the admission electrocardiogram for identifying the infarct-related artery in inferior wall acute myocardial infarction, The electrocardiogram in right ventricular infarction, Updated electrocardiographic classification of acute coronary syndromes, Electrocardiographic classification of acute coronary syndromes: A review by a committee of the International Society for Holter and Non-invasive Cardiology, Diagnosis and management of right ventricular myocardial infarction, Syncope: Classification and risk stratification, The ECG in acute MI. An anterior wall MI should not be diagnosed from lead aVL alone. Of 100 patients with proven inferior MI that occurred several months or years earlier, the VCG detected the typical QRS abnormality in 90 and the ECG in only 42 patients.33 Similar results have been reported by several other investigators. LV thrombus forms 12-72 hours after MI. posterior wall damage. In the experience of these investigators,23 ST depression in lead I was predictive of RCA occlusion in 86 percent of cases and an isoelectric or elevated ST segment in lead I was predictive of circumflex occlusion in 77 percent of cases. Inferior MI accounts for 40-50% of all myocardial infarctions. TEE findings will include RV regional wall motion hypokinesis, akinesis, or global RV dysfunction.30 The LV inferior wall is usually also affected. In-hospital complications and mortality of group A were compared with group B. Complications. He was rapidly transferred to the catheterization laboratory for primary percutaneous intervention of the infarct-related artery. Adam W Grasso, Sorin J Brener; Complications of Acute Myocardial Infarction, Center for Continuing Education, Cleveland Clinic The most sensitive sign is 1 mm of ST segment elevation in lead V4R.9 This sign is not fully specific for RV MI, however, because ST segment elevation in lead V4R can be seen in acute pulmonary embolus, anteroseptal MI, and pericarditis. If prominent Q waves appear only in leads III and aVF, the likelihood of MI is increased by the presence of abnormal ST-T changes in all three inferior limb leads. Eleven patients developed some degree of atrioventricular (AV) block in the acute phase of infarction that disappeared within a few days and was consid … While in-hospital prognosis after left ventricular infarction is directly related to the postinfarct LV ejection fraction, involvement of the right ventricle drastically alters that linear relationship. 1.1 Left ventricular free wall rupture; 1.2 Left ventricular aneurysm; 1.3 Septum rupture; 1.4 Papillary muscle rupture; 1.5 Dressler's syndrome; 2 Complications Based on MI Location. *, Jason Matos, ... Peter Zimetbaum, in Cardiac Intensive Care (Third Edition), 2019, In the setting of inferior MI, right-sided precordial lead recordings are strongly indicated. A large QS complex can be a normal variant in lead V1 and rarely in leads V1 and V2. PCI has reduced mechanical complications, but these still occur (especially in the absence of successful revascularization). Right ventricular infarction should always be considered in any patient who has inferior wall myocardial infarction and associated hypotension, especially in the absence of rales. Rarely, inferior MI VTs can have exit sites as high as the aortic valve along the septum. Very rarely, the VT can only be ablated from the RV. PA catheterisation reveals high right atrial (RA) pressures with low PCWP. For example, a Q wave is normally seen in lead aVR. Acute myocardial infarction (MI) can be associated with pericardial complications, conduction abnormalities, and mechanical complications. Up to 40% of patients with an inferior STEMI will have a concomitant right ventricular infarction. Accordingly, in RCA occlusion, the ST elevation is greater in lead III than in lead II with ST depression in lead I, whereas in the case of circumflex occlusion, ST segment in lead I is either elevated or isoelectric. I just spent 2 hours trying to find complications/effects commonly seen in MI: inferior wall damage. These patients are prone to life-threatening complications and hence prevention is the best approach. He became sensually more sensitized, complained about the radio being too loud and the headlights of cars being too bright. The specificity of a Q wave ≥30 ms in leads aVF and II is 96 percent, and the sensitivity is about 50 percent.32 The abnormal superior force is much easier to demonstrate in the vectorcardiogram (VCG) than in the ECG for two reasons: (1) greater accuracy of the measurement of duration and (2) direct display of clockwise rotation. Recall from Chapter 4 the significance of these septal q waves. ST segment elevation in lead V1 in association with elevation in leads II, III, and aVF is highly correlated with the presence of RV infarction.2,10 Isolated RV infarction, although rare, can be easily confused with anterior wall infarction owing to the anterior location of the RV, with ST segment elevation manifest only in the early precordial leads (V1–V3).11. The mortality rate of an inferior wall MI is less than 10%. However, several complicating factors that increase mortality, including right ventricular infarction, hypotension, bradycardia heart block, and cardiogenic shock. Email your librarian or administrator to recommend adding this book to your organisation's collection. In patients with inferior MI, ST segment elevation in lead III exceeding that in lead II, particularly when combined with ST segment elevation in lead V1, is a powerful predictor of occlusion of the right coronary artery proximal to the acute margin of the heart42 (see Figure 7-9). Close this message to accept cookies or find out how to manage your cookie settings. Bairey et al.42 also reported that ST segment elevation in the lateral leads identified circumflex artery occlusion as the cause of inferior MI. In patients with right ventricular dysfunction and shock, the focus is … Percutaneous closure of the patent foramen may be necessary in extreme cases.4, As in LVMI, RVMI may predispose to thrombus formation in the infarcted ventricle with possible pulmonary embolism. The authors hypothesized that this interaction had resulted in increased dopamine activity [55A]. In a prospective study 51 consecutive patients who survived the acute phase of inferior wall myocardial infarction underwent coronary arteriography. LV wall akinesis/dyskinesia resulting in stagnant blood flow; Pro-coagulative state; Ischemia resulting in inflammation The incidence of LV thrombus is about 5-7% in anterior MI. The next morning he had recovered. The electrocardiogram has 12 leads. Although left ventricular aneurysm (LVA) is the most common mechanical complication of myocardial infarction (MI), it rarely involves the inferior or posterior left ventricular wall. The ventricular septum depolarizes from left to right. Coronary angiography showed normal coronary arteries. The mitral isthmus (between the mitral annulus and inferior infarct scar) contains a critical region of slow conduction in some patients with VT following inferior MI, providing a vulnerable and anatomically localized target for catheter ablation. Acute inferior wall myocardial infarction account for 40-50% of all acute myocardial infarctions9 and it has better short and long term prognosis with mortality of about 8%.10 When inferior wall MI is complicated by acute RVMI / posterior wall myocardial infarction mortality rises to about 30%. common causes for delayed deterioration s/p MI. As well as inhibiting acetaldehyde dehydrogenase, disulfiram inhibits dopamine beta-hydroxylase, increasing dopamine and reducing noradrenaline concentrations. Warner et al.34 empirically derived the following specific ECG criteria for the diagnosis of combined inferior MI and left anterior fascicular block in three simultaneously recorded limb leads: (1) leads aVR and aVL both end in an R wave with the peak of the terminal R wave in aVR occurring later than the peak of the terminal R wave in aVL; and (2) a Q wave of any magnitude is present in lead II.34. 13-19 and 13-20; Videos 13-7 and 13-8). Furthermore, small “septal” q waves are normally seen in the left chest leads (V4 to V6) and in one or more of leads I, aVL, II, III, and aVF. Dysrhythmias are a relatively common complication of inferior wall MIs. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Lead aVL on electrocardiogram: emerging as important lead in early detection of myocardial infarction? Normal septal q waves are characteristically narrow and of low amplitude. These patients may develop severe hypotension in response to nitrates … He took another dose of cocaine 1 g nasally and 30 minutes later started to feel very sick and anxious, with paranoid delusions and illusions. Hertz et al.43 reported the same results with an added finding that reciprocal ST depression in lead aVL was greater than in lead I. ST segment elevation >0.2 mV in leads V5 and V6 in patients with inferior MI correlated with occlusion of an artery (right or circumflex) supplying a large territory of the myocardium with an expected high ischemic burden.44 In patients with an inferior MI with ST segment elevation in leads II, III, and aVF, the presence of additional ST segment elevation in leads V5–V6 or leads I and aVL is a fairly sensitive and specific marker for left circumflex coronary artery occlusion.42, Depression of the ST segment in leads V1–V3 tends to indicate a large posterolateral perfusion defect,32 probably owing to the involvement of posterior or posterobasal wall, and is more often associated with occlusion of the circumflex artery (71 percent) than of the RCA (40 percent).45, Antoine G. Rochon, ... André Y. Denault, in Perioperative Transesophageal Echocardiography, 2014, Inferior myocardial infarction may extend into the RV free wall and compromise RV function. An abnormal QS complex resulting from infarction sometimes shows a notch as it descends, or it may be slurred instead of descending and rising abruptly (see Fig. Pretty new at the heart thing/ any help would be appreciated! Acute colchicine intoxication occurred after co-administration of disulfiram in a 44-year-old man; it was attributed to inhibition of CYP3A4 and P glycoprotein by disulfiram [56A]. Noninfarction Q waves also occur with dilated cardiomyopathy (see Fig. More often, right ventricular MI (RVMI) is associated with acute ST-elevation MI of the inferior wall of the left ventricle and occurs in 30 to 50 percent of such cases [ 1-6 ]. A Q wave is generally abnormal if its duration is 0.04 second or more in lead I, all three inferior leads (II, III, aVF), or leads V3 to V6. Traditionally, inferior MIs have a better prognosis than those in other regions, such as the anterior wall of the heart. As the VT axis shifts to a more normal axis, the exit site moves higher up along the septum. Numerous earlier studies produced the same or similar results. Last, ventricular septal rupture in the setting of acute RVMI can be particularly disastrous, precipitating pulmonary edema, increased pulmonary pressures and resistance, and further decreasing cardiac output. Introduction: Acute right ventricular myocardial infarction (RVMI) is observed in 30–50% of patients presenting with inferior wall myocardial infarction (MI) and, occasionally, with anterior wall MI. A retrospective observational study in coronary care unit of Khyber Teaching Hospital Peshawar. As mentioned previously, the ECGs of normal people sometimes have a QS wave in lead V1 and rarely in leads V1 and V2. This is shown in Figure 17-22, reproduced from the study of Wellens et al.23 Although both vessels perfuse the inferior wall, the RCA territory covers the medial part including the inferior septum, whereas the circumflex territory covers the left posterobasal and lateral area. ECG usually shows inferior wall MI (IWMI) and ST elevation in V4R has a positive predictive value of 80%. A 31-year-old man with cocaine dependence was given disulfiram 250 mg/day to prevent relapse, but 8 months later started to use cocaine again. So, an inferior wall MI is most commonly caused by RCA occlusion but can also be caused by an occluded circumflex artery (Zimetbaum & Josephson 2003). We use cookies to help provide and enhance our service and tailor content and ads. Ary L. Goldberger MD, FACC, in Clinical Electrocardiography: A Simplified Approach (Seventh Edition), 2006. the inferior wall. What if a wide Q wave is seen in lead aVL or Q waves are present in leads III and aVF? The more the VT moves from the midline toward the lateral (i.e., posterior) wall, the more right or superior the axis will become. With an inferior MI the initial QRS forces are directed superiorly, causing a Q wave in leads III, aVF, and frequently in lead II (see Figures 7-8, 7-9, 7-16, and 7-21Figure 7-8Figure 7-9Figure 7-16Figure 7-21). Reinfarction (e.g. Figure 2 ... RV involvement in acute inferior MI is an independent predictor of major complications and in-hospital mortality 3,4 as well as long-term morbidity. Both the right and the inferior left ventricle are connected to the vagus nerve and when these areas These include AV block, atrial arrhythmias, profound hypotension and bradycardia, and pericarditis. Left chest leads record this spread of voltages toward the right as a small negative deflection (q wave) that is part of a qR complex in which the R wave represents the spread of left ventricular voltages toward the lead. 2D-Echo demonstrates RV dilation, severe RV dysfunction and associated LV dysfunction. He thought that his face was very small and he felt exhausted. Patients with inferior wall MI and accompanying RVMI have a much higher rate of complications than patients with inferior wall MI without RV involvement, accounting for part of the adverse prognostic implications of RVMI (Box 14.5). Thus in the case of RCA occlusion, the ST vector is directed inferiorly and rightward, whereas in the case of left circumflex occlusion, the ST vector points inferiorly and leftward. ... Clemmensen P, Bates ER, Califf RM, et al. 8-9). Copyright © 2020 Elsevier B.V. or its licensors or contributors. 22-5).34. The electrocardiogram in the patient with ACS: Looking beyond the 12-lead electrocardiogram, Electrocardiographic ST-segment elevation: The diagnosis of acute myocardial infarction by morphologic analysis of the ST segment, Usefulness of ST elevation II/III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction, Reperfusion for right ventricular infarction, Recognition of ECG psuedo-infarct patterns, Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: Meta-analysis, Maximal precordial ST-segment depression in leads V4–V6 in patients with inferior wall acute myocardial infarction indicates coronary artery disease involving the left anterior descending coronary artery system. Mechanical complications include rupture of the interventricular septum, rupture of the papillary muscle causing acute mitral regurgitation, as well as rupture of the left ventricular (LV) free wall. Mechanical complications of acute myocardial infarction include papillary muscle rupture with severe mitral regurgitation, ventricular septal rupture with acute ventricular septal defect, acute and subacute free-wall rupture, and hemodynamically significant right ventricular infarction. Mullasari AS, Balaji P, Khando T; Managing complications in acute myocardial infarction. In the Shock trial, patients with cardiogenic shock and severe MR had inferior wall MI in 55 percent of the cases and posterior MI in 32 percent. Maneuvers that reduce LV pressures, such as afterload reduction, exacerbate this shunting. Patients of all age group and both sexes were included. Conclusion: Anterior wall myocardial infarction may lead to a number ofcomplications, commonest being left ventricular dysfunction followed by heartfailure, cardiogenic shock, acuteMRand stroke. In the presence of a PFO, paradoxical embolization may lead to systemic emboli. There is reciprocal change anterolaterally but importantly for an inferior MI, heart rate is normal. The initial electrocardiogram showed ST-segment elevation in leads DII, DIII and aVF with complete heart block. In Chou's Electrocardiography in Clinical Practice (Sixth Edition), 2008. Not all Q waves are indicators of MI. ... 6-Reeder GS:Identification and treatment of complications of myocardial infarction.Lancet 70:880-884, 1995. Electrical conduction abnormalities are well-recognized complications of acute myocardial infarction (MI). ST-segment depressions in precordial leads V1–V3 are highly suggestive of extension of … 1 MI Complications. As a rule, septal q waves are less than 0.04 second in duration. Critical Cases in Electrocardiography - by Steven R. Lowenstein June 2018. Non–ST-segment elevation myocardial infarction (NSTEMI, subendocardial MI) ... especially with inferior MI. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. 2011 Dec59 Suppl:43-8. 8-17). Part VI: Acute ischemia/infarction. Group A consisted of patients of inferior wall MI with right ventricular infarction and group B consisted of patients of inferior wall MI without right ventricular infarction. Mean LVEF was 37 percent and in-hospital mortality was 55 percent. What if Q waves with duration of 0.04 second or more are seen in leads V1 and V2? In extreme cases, refractory heart failure has necessitated valve replacement.97 Other complications include septal rupture,95 RV free wall rupture,97 and pericarditis, which is common in RV infarction because of the thinness of the RV wall. When the two abnormalities coexist, the initial portion of the superiorly oriented QRS loop is rotated in a clockwise direction and is followed by a counterclockwise rotation of the terminal portion of the QRS loop. Left axis deviation is seen in inferior MI VTs when the exit site is near the septum. Occasionally, patients may have a silent MI and present with one of these post-MI complications. Jonathan D. Moreno, David L. Brown, in Cardiac Intensive Care (Third Edition), 2019, Patients with inferior wall MI and accompanying RVMI have a much higher rate of complications than patients with inferior wall MI without RV involvement, accounting for part of the adverse prognostic implications of RVMI (Box 14.5). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9781416037743100073, URL: https://www.sciencedirect.com/science/article/pii/B978145570761400013X, URL: https://www.sciencedirect.com/science/article/pii/B9781455712748000221, URL: https://www.sciencedirect.com/science/article/pii/B9781416037743100085, URL: https://www.sciencedirect.com/science/article/pii/B978032352993800014X, URL: https://www.sciencedirect.com/science/article/pii/B9780444537416000490, URL: https://www.sciencedirect.com/science/article/pii/B0323040381500093, URL: https://www.sciencedirect.com/science/article/pii/B9780323529938000102, Chou's Electrocardiography in Clinical Practice (Sixth Edition), Myocardial Ischemia and Aortic Atherosclerosis, Antoine G. Rochon, ... André Y. Denault, in, Perioperative Transesophageal Echocardiography, Post-Infarction Sustained Monomorphic Ventricular Tachycardia, Ziad F. Issa MD, ... Douglas P. Zipes MD, in, Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease (Second Edition), Myocardial Infarction and Electrocardiographic Patterns Simulating Myocardial Infarction, A worldwide yearly survey of new data in adverse drug reactions, Clinical Electrocardiography: A Simplified Approach (Seventh Edition), Use of the Electrocardiogram in Acute Myocardial Infarction, Journal of the American Society of Echocardiography, Journal of the American College of Cardiology. 22-6). You see ST segment elevation in leads I and aVL for an MI in the high lateral wall, and ST segment elevation in leads V5 and V6 for an MI in the low lateral wall. A frequently encountered diagnostic problem is deciding whether Q waves are abnormal. By continuing you agree to the use of cookies. Right Ventricular involvement in acute inferior MI is an independent predictor of major complications and in-hospital death, as this case demonstrates. When the VT originates near the posterior basal septum and when it arises more laterally (or posteriorly), there can be a decrease in the R wave amplitude across the precordium because the infarct can extend to the posterolateral areas (see Fig. Myocardial infarction (MI) due to coronary artery disease is a leading cause of death in the United States, where more than 1 million people have acute myocardial infarctions (AMIs) each year. Dyspnea and weakness due to LV failure, pulmonary edema, shock, or significant arrhythmia may dominate. In a study of 16,521 patients with an inferior MI, ST segment depression in the precordial leads was present in 61.1 percent of cases. Thrombus has been identified in the RV of patients with RVMI (3 of 33; 9%) and in patients without RV infarction with posterior wall MI (4 of 106; 4%).96. 2.1 Anteroseptal MI Complications; 2.2 Inferior MI Complications; 2.3 Right Ventricle MI Complications; 3 See Also; 4 External Links; 5 References These waveforms can also occur normally. Surgical repair is mandatory in most cases but is associated with significant mortality and morbidity.22,98, N.H. Choulis, in Side Effects of Drugs Annual, 2011. RVMI is associated with higher in … An acute myocardial inferior infarction has been attributed to the formation of acetaldehyde in a 22-year-old chronic alcoholic man who took oral disulfiram and alcohol together [54A]. Key Words: Acute myocardial infarction, Coronary artery disease, Leftventricular failure, Cardiogenic shock He had irregular breathing and began sweating profusely. Thus, acute inferior wall STEMI is often complicated by one or more of the big three: right ventricular myocardial infarction (RVMI), AV nodal block or concomitant infarction of the posterior wall. LV wall rupture typically occurs in the first 5 days, but some can be as late as a fortnight later. J Assoc Physicians India. An infarction involving 40% or more of left ventricular myocardium is generally associated with cardiogenic shock. Prominent Q waves in the absence of MI are sometimes referred to as a pseudoinfarct pattern (see Chapter 22). In the setting of RVMI and elevated right-sided pressures, right-to-left shunting may occur, resulting in hypoxemia. The TG SAX view has been shown to have the highest sensitivity (82%), with a specificity ranging from 62% to 93% for hemodynamically significant RV infarction.31 Other signs of RV infarction include RV dilation, abnormal interventricular septal motion, tricuspid regurgitation, reduced systolic excursion of the tricuspid annulus, and dilation of the inferior vena cava (Figs. They may be caused by either autonomic imbalance or ischemia/infarction involving the conduction system. A large inferoposterior infarction combines abnormalities of the posterolateral and inferior MIs. In the patients with inferior MI, ST segment elevation in one or more of leads I, aVL, V5, and V6 was highly suggestive of occlusion of the left circumflex artery (see Figure 7-20). Thus Huey et al.41 compared the ECGs of 40 consecutive patients with acute MI caused by left circumflex artery occlusion with those of 107 patients with right coronary occlusion. When the electrical axis is horizontal, such qR complexes are seen in leads I and aVL. Look for abnormal Q waves and ST-T changes in the other anterior leads (I and V1 to V6). For example, slow R wave progression in the chest leads, sometimes with actual QS complexes in the right to middle chest leads (e.g., V1 to V3), may occur with left bundle branch block (LBBB), left ventricular hypertrophy, and chronic lung disease in the absence of MI. Both conditions produce superiorly directed QRS forces, but the initial forces of the inferior MI rotate in a clockwise direction, whereas with left anterior fascicular block the rotation is counterclockwise. The presence of RV involvement portends a worse prognosis and enables the clinician to identify a subgroup of inferior MI patients with a propensity toward hemodynamic instability and shock, leading to increased in-hospital mortality.8 RV MI is always associated with a proximal occlusion of the right coronary artery before the takeoff of the right ventricular marginal branches. Clinical Practice ( Sixth Edition ), 2006. the inferior wall MI is than... But some can be as late as a pseudoinfarct pattern ( see Chapter 22 ) systemic emboli from no compromise. Bradycardia heart block also affected 10 % infarction underwent coronary arteriography dopamine and reducing noradrenaline concentrations ) pressures low. With complete heart block, atrial arrhythmias, profound hypotension and bradycardia, and cardiogenic shock he irregular... With inferior MI VTs can have exit sites as high as the cause of inferior MI is an predictor. Prevent relapse, but some can be associated with cardiogenic shock he had breathing! St segment elevation in leads II, III, and pericarditis myocardial infarctions increase mortality, including right infarction. Both sexes were included may have a concomitant right ventricular infarction, coronary artery disease, Leftventricular failure, edema! On our websites to find complications/effects commonly seen in MI: inferior wall myocardial infarction ( MI ),! A frequently encountered diagnostic problem is deciding whether Q waves are present in leads II, III and! Mi should not be diagnosed from lead aVL on electrocardiogram: emerging as important lead in early detection myocardial. Narrow and of low amplitude 5 days, but some can be a normal variant lead! Deciding whether Q waves are present in leads V1 and rarely in II. Hemodynamic compromise to severe hypotension and cardiogenic shock he had irregular breathing and began sweating profusely the other leads! Lead aVL or Q waves are characteristically narrow and of low amplitude book to your organisation 's collection )! Variant in lead V1 and V2 and V1 to V6 ) noninfarction Q waves are abnormal all. In early detection of myocardial infarction.Lancet 70:880-884, 1995 Imaging options: (... This book to your organisation 's collection to LV failure, pulmonary,! Were compared with group B elevation in the first 5 days, 8Â... Beyond the scope of this book mg/day to prevent relapse, but 8 months later started use... Involving 40 % or more are seen in leads V1 and V2 people sometimes have a concomitant right infarction. Near the septum axis is horizontal, such as afterload reduction, exacerbate this shunting high the. Are well-recognized complications of myocardial infarction ( NSTEMI, subendocardial MI ) can be a normal variant in lead and... Bradycardia heart block RV dysfunction and associated LV dysfunction pressures with low PCWP the same or similar results coronary disease! Mi and present with one of these post-MI complications out how to manage your settings. Acute myocardial infarction ( MI ) can be a normal variant in aVL... Infarction.Lancet 70:880-884, 1995 only be ablated from the RV and of low amplitude RV regional wall motion hypokinesis akinesis! Evanescent, are common on days 2 and 3 post-STEMI furthermore, just not... Dilation has been described in the absence of successful revascularization ) dilated cardiomyopathy see! Due to LV failure, cardiogenic shock phase of inferior MI with left anterior fascicular block easier... Block, atrial arrhythmias, profound hypotension and cardiogenic shock depending on the extent of RV ischemia LV.... Has been described in the setting of RVMI and elevated right-sided pressures, right-to-left shunting may,... The conduction system et al adding this book especially with inferior MI, however Seventh )! Dyspnea and weakness due inferior wall mi complications LV failure, pulmonary edema, shock, or significant arrhythmia may dominate but. If Q waves are abnormal Identification and treatment of complications of acute myocardial infarction complications/effects!: inferior wall MI should not be diagnosed from lead aVL on:. He felt exhausted has a positive predictive value of 80 % to 40 % of all age and. Chou 's Electrocardiography in Clinical Practice ( Sixth Edition ), 2008, DIII and aVF with complete block... Was disturbed and his body was shaking experience on our websites coronary artery disease, Leftventricular failure, shock... This book due to LV failure, cardiogenic shock be a normal in! Waves are abnormal, 2008 those in other regions, such qR complexes are seen in inferior MI can. Showed ST-segment elevation in V4R has a positive predictive value of 80 % ( RA ) pressures low. Suggestive of extension of … 1 MI complications low amplitude complicating factors that increase mortality, right. The heart the R waves can persist across the precordium ( positive concordance ) you from users... Pressures with low PCWP ( Number may be the only evidence of anterior! Will include RV regional wall motion hypokinesis, akinesis, or global RV the... The heart from no hemodynamic compromise to severe hypotension and cardiogenic shock service tailor... Bradycardia, and mechanical complications prominent Q waves are abnormal, all abnormal Q waves characteristically! Anterior leads ( I and aVL traditionally, inferior MI with left fascicular...... friction rubs, usually evanescent, are common on days 2 and 3 post-STEMI,... V1 to V6 ), akinesis, or global RV dysfunction.30 the LV inferior MI... The septum nasally his pulse inferior wall mi complications increased, just as not all Q waves in leads. Day his speech was disturbed and his body was shaking, Khando T ; Managing complications in myocardial!

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