Myocardial infarction posterior

A 71-year-old woman who had undergone total thyroidectomy with subsequent irradiation because of follicular carcinoma 3 years before (22). Since then, she had taken oral levothyroxine 0.15 mg and 0.2 mg on alternate days. When latent hypothyroidism became evident despite replacement therapy, the dose of levothyroxine was increased to 0.3 mg/day. Three weeks later, she had formed an acute posterior myocardial infarction, although she had no previous history of coronary artery disease. Subsequent coronary arteriograms revealed no evidence of disease of the major vessels. Myocardial scintigraphy 3 weeks after infarction still showed a persistent perfusion defect. 

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. 

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 5.50 ECG-VCG of complete LBBB with signs suggesting associated infarction. It might be suspected from the morphology in V5 (qrs) and evident slurrings in V2-V4 (Cabrera s sign). Also the initial forces are posterior in the VCG, which is abnormal and clearly suggests associated myocardial infarction.

AMI, acute myocardial infarction AS, anteroseptal infarction A, antero(lateral) infarction I, infero(posterior) infarction. Adapted from Wackers et al. (1978). 

Bough E, Boden W, Kenneth K, Gandsman E. Left ventricular asynergy in electrocardiographic posterior myocardial infarction. J Am Coll Cardiol 1984 4 209. 

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Hoshino Y, Hasegawa A, Nakano A et al. Electrocardiographic abnormalities of pure posterior myocardial infarction. Intern Med 2004 43(9) 883. 

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Matetzky S, Freimark D, Feinbergt MS et al. Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9 hidden ST-segment elevations revealing acute posterior infarction. J Am Coll Cardiol 1999 34 748. 

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Zalenski RJ, Rydman RJ, Sloan EP et al. Value of posterior and right ventricular leads in comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial infarction. Am J Cardiol 1997 79 1579. 

In the prefibrinolytic era, BBB of new or indeterminate age occurred in 6% to 15% of patients with acute myocardial infarction (9,10,12). The most common forms were left BBB (38%) and right BBB with left anterior fascicular block (34%), followed by isolated right BBB (11%), right BBB with left posterior fascicular block (10%), and alternating BBB (6%). In the current era, the incidence of new or indeterminate-age BBB is still 10% to 13% overall... 

Bevacizumab (Avastin) VEGF 2004 Not conducted ECG in monkey— no effect 6-month monkey Bone plate changes Non-gastrointestinal fistula formation, arterial thnunboembolic events (e.g., myocardial infarction, cerebral infarction), hypertension, revtasible posterior leukoencephalopathy syndnune (RPLS), proteinuria, infusion reactions... 

The CS drains venous blood from the heart into the right atrium. Many branches from the LV flow into the CS, including those from the lateral and posterior LV. Currently, it is there that a left ventricular pacing lead is optimally placed. This maybe best visualized under fluoroscopy from a left anterior oblique (LAO) perspective. Many patients who are candidates to receive a CS left ventricular lead, however, have had myocardial infarctions that may limit the ability to pace from these sites. Stimulation of the left phrenic nerve during ventricular pacing may occur, and can preclude placement there (the left phrenic nerve travels in close proximity to this cardiac region on its way to the left hemi-diaphragm). 

Ventricular rhythms originating in the left ventricle Posterior Myocardial Infarction (MI) Wolff-Parkinson-White syndrome (WPW) Dextrocardia... 

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