Myocardial infarction inferior

It is important to obtain a baseline EKG and cardiac enzymes to evaluate the possibility of an acute myocardial infarction. The short-term (2-4 weeks) stroke risk after acute myocardial infarction (AMI) is 2.5%. Stroke is usually an early (within 14 days) complication of AMI and is more common in anterior wall (4—12%) than in inferior wall infarction (1%). Approximately 40% of patients with an anterior wall myocardial infarction develop left ventricular thrombus. 

Obtain right precordial leads in any patient with an inferior wall myocardial infarction... 

Effects after myocardial infarction In patients with evidence of LV dysfunction early after myocardial infarction, the Valsartan in Acute Myocardial Infarction Trial (VALIANT) (48) demonstrated that valsartan had a benefit that was not inferior to that of ACE inhibitors without an advantage in terms of tolerability. However, the addition of an angiotensin II receptor blocker to an ACE inhibitor did not improve the outcomes and resulted in more side effects. 

A 34-year-old man who smoked a pack of cigarettes a day took amfetamine for mild obesity. He developed an acute myocardial infarction 1 week later. Echocardiography showed inferior left ventricular hypokinesia and a left ventricular ejection fraction of 50%. Coronary cineangiography showed normal coronary arteries but confirmed the inferior left ventricular hypokinesia. Blood and urine toxicology were positive only for amfetamine. 

A 62-year-old woman developed chest pain and sinus bradycardia (41/minute). She had third-degree heart block and was given atropine 1 mg intravenously. Three minutes later, her chest pain increased and the electrocardiogram now showed an acute inferior myocardial infarction, confirmed by serum markers. Angioplasty recanalized the right coronary artery. 

A 21-year-old woman had an inferior myocardial infarction, in the absence of cardiovascular risks and with normal coronary arteries on angiography (2). She made a good recovery, but with some persistent posterior-wall akinesia. 

Adult respiratory distress syndrome occurred after the intravenous infusion of dextran 40 in a 30-year-old woman, a smoker with a history of insulin-dependent diabetes mellitus, who had sustained an acute inferior myocardial infarction the dextran was given in... 

Adverse cardiac effects due to morphine are rare. They comprise inappropriate heart rate responses to hypotension, rather than conduction defects. They are not especially associated with inferior myocardial infarction, as was previously thought (SED-11,142) (14). 

A 41-year-old man employed in a munitions factory was admitted with crushing chest pain on a Sunday morning. There was evidence of an acute inferior myocardial infarction, and cardiac catheterization showed 80% narrowing of the proximal right coronary artery, which was reduced to 10% by intracoronary administration of glyceryl trinitrate. The electrocardiogram became normal. 

A 46-year-old man developed a Q-wave inferior and a right ventricular myocardial infarct with postinfarction angina after the third cycle of vincristine -I- doxorubicin for multiple myeloma. The patient had no risk factors for ischemic heart disease, except for a positive smoking history, nor for hyperviscosity (24). 

Figure 3.17 (A) and (B) ECG-VCG correlation of the T wave and the T loop of subepicardial ischaemia in two patients with myocardial infarction (A) of the inferior wall and (B) of the inferior and lateral walls. Observe that a T loop in both cases shows homogeneous inscription and is directed upwards (see FPa) in the first case and upwards and forward in the second case (see HPa). The QRS loop of (A) rotates only clockwise and of (B) rotates first clockwise and later counter-clockwise. In the first case inferior Ml is isolated and in the second, associated to superoanterior...

Figure 4.17 Acute myocardial infarction with ST-segment elevation in II, III and VF and ST-segment depression in V1-V3. This pattern corresponds classically to an infarction involving inferior and posterior walls. Nowadays, this is the pattern of STE-ACS of inferolateral zone evolving to inferolateral infarction due to distal occlusion of a dominant RCA (ST-segment depression in I and V1-V3,...

Figure 5.30 Typical example of inferior myocardial infarction (Qr in II, III and VF) with leftward AQRS. Nevertheless, the left-deviated AQRS (-35°) is not explained by an added superoanterior hemiblock (SAH), but simply by the inferior necrosis, because although the majority of the QRS loop in the frontal plane is above 0°, as it completely rotates in the clockwise sense, a small terminal r (Qr morphology) in II, III and VF is recorded. If an added SAH exists, the first part of the loop would be the same, but would later rotate in the counter-clockwise direction and would generate QS with notches but without the final r wave in inferior leads.

Figure 8.15 A 48-year-old patient with an acute inferior myocardial infarction due to RCA occlusion after the RV branches with an evident alteration of ST segment (STT in I, STf in III > II and STf in V1-V2). The fibrinolytic...

Figure 9.1 Inferior myocardial infarction. (A) The ECG shows Qr in leads Dill and VF and rS in V1. (B) CE-CMR image in a vertical long-axis (sagittal-like) view confirming inferior myocardial infarction as showed by delayed hyperenhancement (arrows). (C-E) Contrast-enhanced...

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Eskola MJ, Nikus KC, Niemela KO, Sclarovsky S. How to use ECG for decision support in the catheterization laboratory cases with inferior ST elevation myocardial infarction. J Electrocardiol 2004 37 257. 

Fiol M, Cygankiewicz I, Bayes-Genis A et al. The value of ECG algorithm based on ups and downs of ST in assessment of a culprit artery in evolving inferior myocardial infarction. Am J Cardiol 2004b 94 709. 

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Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol... 

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Kabakci G, Yildirir A, Yildiran L et al. The diagnostic value of 12-lead electrocardiogram in predicting infarct-related artery and right ventricular involvement in acute inferior myocardial infarction. Arm Noninvasive Electrocardiol 2001 6(3) 229-35. 

Kurum T, Oztekin E, Ozcelik F, Eker H, Ture M, Ozbay G. Predictive value of admission electrocardiogram for multivessel disease in acute anterior and anterio-inferior myocardial infarction. Ann Noninvasive Electrocardiol 2002 7 369. 

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