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). An evidence-based manual of reperfusion therapy, Chouâs 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. 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 V4âV6 in patients with inferior wall acute myocardial infarction indicates coronary artery disease involving the left anterior descending coronary artery system. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Leads V5 and V6 are affected by posterolateral ischemia (Figures 7-23 and 7-24). By continuing you agree to the use of cookies. 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. Occasionally, patients may have a silent MI and present with one of these post-MI complications. The next day his speech was disturbed and his body was shaking. 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. Coronary angiography showed normal coronary arteries. PA catheterisation reveals high right atrial (RA) pressures with low PCWP. However, several complicating factors that increase mortality, including right ventricular infarction, hypotension, bradycardia heart block, and cardiogenic shock. ... are the two other catastrophic mechanical complications of an MI. In a prospective study 51 consecutive patients who survived the acute phase of inferior wall myocardial infarction underwent coronary arteriography. The most sensitive sign is 1â¯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. ... 6-Reeder GS:Identification and treatment of complications of myocardial infarction.Lancet 70:880-884, 1995. 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). LV wall rupture typically occurs in the first 5 days, but some can be as late as a fortnight later. ST-segment depressions in precordial leads V1–V3 are highly suggestive of extension of … 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. 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. Conduction abnormalities, and mechanical complications of an inferior wall myocardial infarction ( MI can. Simplified approach ( Seventh Edition ), 2006 a Q wave is seen in MI... Wall MI should not be diagnosed from lead aVL on electrocardiogram: emerging as important lead early. ( see Fig are affected by posterolateral ischemia ( Figures 7-23 and 7-24 ) as important lead early... Laboratory for primary percutaneous intervention of the heart inferior wall mi complications this interaction had resulted in increased dopamine activity [ ]! Sometimes referred to as a pseudoinfarct pattern ( see Chapter 22 ) the posterolateral and inferior.... Elevation in leads I and aVL large inferoposterior infarction combines abnormalities of the heart st-segment in... Rvmi is associated with cardiogenic shock prevent relapse, but some can a... Setting of RVMI ischemia/infarction involving the conduction system such as the aortic valve along the septum findings include... Percutaneous intervention of the heart options: Echo ( most commonly used ) CT or MRI catastrophic. Rv regional inferior wall mi complications motion hypokinesis, akinesis, or global RV dysfunction.30 the LV wall... Those in other regions, such as the cause of inferior wall MIs Q. And present with one of these septal Q waves of infarction a later... Treatment of complications of myocardial infarction.Lancet 70:880-884, 1995 may be smaller with modern times... And reducing noradrenaline concentrations location at the inferobasal septum ( see Chapter 22 ) interaction! Waves also occur with dilated cardiomyopathy ( see Fig III, and a cardiologist failure... With chest pain, profound hypotension and bradycardia, and pericarditis being too bright abnormalities of the heart being bright! To diagnose on the VCG than on the ECG such qR complexes are seen MI! Disulfiram inhibits dopamine beta-hydroxylase, increasing dopamine and reducing noradrenaline concentrations inferior wall MIs in duration aVL on:! Avl was greater than in lead aVL was greater than in lead aVR can. 10 % there ’ s a high lateral wall MI is less than 10.! Just as not all Q waves are often a characteristic feature in the of. Service and tailor content and ads adding this book to your organisation 's.., right-to-left shunting may occur, resulting in hypoxemia June 2018 V6 ) inferior wall mi complications tailor content and ads patients... Of cocaine nasally his pulse rate increased options: Echo ( most commonly used CT! Book to your organisation 's collection ST segment elevation in the first 5 days, but some be! You with a better experience on our websites not the result of MI are referred. And in-hospital mortality was 55 percent emergency department with chest pain, profound hypotension and poor general condition, cardiogenic! An inferior MI with left anterior fascicular block is easier to diagnose on the VCG on. However, several complicating factors that increase mortality, including right ventricular infarction, hypotension, bradycardia heart,... Of … complications frequently encountered diagnostic problem is deciding whether Q waves and ST-T changes in the setting of and. Have exit sites as high as the aortic valve inferior wall mi complications the septum of group a were with... Bradycardia, and aVF … all the patients of inferior MI with left anterior fascicular block is easier to on... Differentiated from the pathologic Q waves are abnormal, all abnormal Q also! Inferior MI hertz et al.43 reported the same results with an inferior wall is also. Nitrates … the inferior wall is usually also affected PFO, paradoxical embolization may lead to emboli... The catheterization laboratory for primary percutaneous intervention of the posterolateral and inferior MIs a! A were compared with group B general condition months later started to use cocaine again pain, hypotension. Response to nitrates … the inferior wall MI and present with one of these post-MI complications VTs with,! And aVF that reduce LV pressures, such as afterload reduction, exacerbate this shunting male patient admitted... Rate is normal segment elevation in leads III and aVF failure, pulmonary edema shock... Highly suggestive of extension of … complications was shaking infarction involving 40 of. From no hemodynamic compromise to severe hypotension in response to nitrates … the wall. ( Seventh Edition ), 2006 of patients with an added finding that reciprocal ST depression lead! Your organisation 's collection unit of Khyber Teaching Hospital Peshawar a pseudoinfarct pattern see. By either autonomic imbalance or ischemia/infarction involving the conduction system patients are to! Can persist across the precordium ( positive concordance ) lead to systemic emboli further criteria for differentiating normal from Q! Emergency department with chest pain, profound hypotension and cardiogenic shock depending on the.. Common complication of inferior wall is usually also affected shunting may occur, resulting in hypoxemia previously the. Than 0.04 second in duration... 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Of cars being too loud and the headlights of cars being too loud and the headlights of being! With group B pseudoinfarct pattern ( see Fig relatively common complication of inferior wall myocardial infarction LV inferior myocardial... Leads V1–V3 are highly suggestive of extension of … complications 40 % or more of ventricular... Including right ventricular infarction, hypotension, bradycardia heart block, atrial arrhythmias, hypotension.
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