Acute Inferior Myocardial Infarction Research Articles

Abnormal ST-segment changes in anterior and inferior leads during acute inferior myocardial infarction

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.

High Risk Non-ST Elevation Myocardial Infarction - A Case Report

Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide. Electrocardiogram (ECG) remains an important tool in the diagnosis of acute myocardial infarction (MI) and further risk stratification. ST segment elevation myocardial infarction (STEMI) is a medical emergency requiring early diagnosis and prompt reperfusion of occluded coronary artery to prevent morbidity and mortality. Recent studies have shown that a subset of patients with acute MI in the absence of ST segment elevation (non-ST elevation myocardial infarction [NSTEMI]) have an acute occlusion of the culprit artery on coronary angiography. The Aslanger’s pattern is a specific ECG finding in acute inferior myocardial infarction with multivessel disease. It allows identification of inferior wall myocardial infarction that does not show ST elevation in contiguous leads but needs rapid evaluation by coronary angiogram and revascularization. We presented a case of acute coronary syndrome whose ECG showed Aslanger’s pattern and was confirmed to have significant stenosis of the left main coronary artery and right coronary artery (RCA) by coronary angiogram. STEMI criteria of ST elevation involving two contiguous leads may not be sufficient in diagnosing critical coronary artery occlusions in clinical practice. Keywords: Acute Myocardial Infarction; Aslanger’s Pattern; ST-Elevation; NSTEMI

Determinants of right coronary artery occlusion in patients with inferior wall myocardial infarction: A cross-sectional study from Western India

ABSTRACT Introduction: In acute inferior wall myocardial infarction (IWMI) and occlusion of the right coronary artery (RCA), the most important element is to recognize the culprit artery and the location and size of the infarct, which is essential in the treatment. Adequate knowledge about clinical determinants can aid in prompt and effective management. Materials and Methods: A cross-sectional study was conducted to find determinants of RCA occlusion among 103 subjects with IWMI from rural western India. Results: About 86.4% of subjects were male. Females experienced IWMI at a later age than males (62.4 ± 10.3 vs. 58.6.1 ± 11.8 years). Bradycardia was more prevalent than tachycardia (44.66% vs. 15.53%). Males had a 5.17 times higher odds of having RCA involvement in IWMI. Subjects with deranged lipid profiles had 2.37 times higher odds of involvement of RCA. RCA involvement was significantly associated with bradycardia (P = 0.006, aOR = 15.31, 95% confidence interval [CI] = 2.21–105.7) but not with tachycardia (P = 0.903). Proximal site occlusion was significantly associated (P = 0.027; aOR = 0.103; 95% CI = 0.013–0.772) with bradycardia compared to distal sites. Triple-vessel disease had significantly (P < 0.05) 12.9 times higher odds than single-vessel disease. Total occlusion of RCA was 2.9 times higher than obstructive coronary artery disease. Conclusion: These findings suggest determinants associated with RCA involvement in IWMI, including gender, lipid profile, cardiac rhythm disturbances (particularly bradycardia), and the extent and site of coronary artery occlusion. Incorporating these factors into clinical practice, clinicians can better predict the underlying pathophysiology of IWMI, anticipate its hemodynamic and electrophysiologic consequences, and tailor management strategies accordingly.

Surgical techniques using an attached patch for large left ventricular pseudoaneurysm after inferior acute myocardial infarction.

We report a case of large left ventricular pseudoaneurysm after inferior acute myocardial infarction. Patch repair is commonly performed; however, only a few studies have described specific surgical techniques for left ventricular pseudoaneurysm repair of the inferior left ventricular wall. As an optimal repair technique for left ventricular pseudoaneurysm of the inferior left ventricular wall is lacking, we believe our technique is safe and effective in repairing this pathology.

Prevalence and Clinical Profile of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction at a Tertiary Care Hospital

Objectives: Coronary artery disease remains a prominent global cause of illness and mortality. A significant proportion of individuals experiencing acute inferior myocardial infarction (IWMI) develop right ventricular infarction (RVI), contributing substantially to clinical and hemodynamic instability. This study aims to assess the prevalence of RV infarction in patients presenting with IWMI. Methodology: Consecutive IWMI patients visiting the Department of Cardiology at the National Institute of Cardiovascular Diseases between February 2021 and August 2021, of any gender and aged between 18 and 80 years, were recruited. Patients underwent a comprehensive assessment, including history, clinical examination, routine investigations, and electrocardiogram (ECG). Right ventricular infarction was evaluated based on a right-sided ECG. Results: A total of 155 patients were included, with a mean age of 56.2±12.4 years; 40 (25.8%) were between 18 to 50 years old. In terms of gender distribution, 105 (67.7%) were male. Comorbid conditions included hypertension in 88 (56.8%) patients, diabetes mellitus in 58 (37.4%), 64 (41.3%) smokers, and 26 (16.8%) with a positive family history. RVI was observed in 41 (26.5%) patients. Notably, the prevalence of RVI differed significantly between diabetic and non-diabetic patients (13.8% vs. 34%, p=0.006) and between those with positive and negative family histories (7.7% vs. 30.2%, p=0.017), respectively. No significant impact of other parameters on RVI was observed. Conclusion: Right ventricular infarction was prevalent in more than a quarter of patients with IWMI. It exhibited a negative association with the presence of diabetes and a positive family history.

Informativeness of echocardiography in inferior myocardial infarction at different stages of observation

Aim. to evaluate the informativeness of echocardiographic parameters in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at discharge from the hospital and in the long-term period.
 Material and methods. Echocardiographic data was analyzed using speckle tracking technology in 144 patients with acute inferior myocardial infarction of the left ventricle before discharge and 2 years later. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography.
 Results. Using the tree construction method, critical values of 7 ultrasound parameters were identified (for the left ventricle - ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle - tricuspid S', global longitudinal strain, free wall strain), which with a probability of 89.4% predict repeat revascularization.
 Identification of possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46-57%, specificity of 68-76%, and negative predictive value of 74-87% relative to the gold standard detection of postinfarction scarring by magnetic resonance imaging.
 According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercise were not accompanied by changes in segmental longitudinal deformation.
 Conclusion. The results of echocardiographic screening of patients with acute inferior myocardial infarction of the left ventricle using speckle tracking technology have high prognostic significance in assessing the likelihood of repeated revascularization at discharge and diagnostic information for verifying post-infarction fibrous changes in the long-term period.

The Impact of Percutaneous Coronary Intervention of Right Coronary Artery on Right Ventricular Function after Acute Inferior Myocardial Infarction

The Impact of Percutaneous Coronary Intervention of Right Coronary Artery on Right Ventricular Function after Acute Inferior Myocardial Infarction

Diagnostic value of electrocardiographic indices in discriminating the culprit vessel based on the coronary dominancy in inferior acute myocardial infarction

BackgroundIdentifying 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. MethodsThis 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 12‑lead 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. ResultsWe 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%). ConclusionIn inferior STEMI, ECG indices can predict the culprit vessel with acceptable sensitivity and specificity independent of coronary artery dominance.

Case Report of Type II Cardio- Cerebral Syndrome: Acute Ischemic Stroke followed by Acute Inferior Myocardial Infarction

We report a case of a preterm infant who underwent transcatheter closure of patent ductus arteriosus (PDA) with Amplatzer Piccolo device through the left femoral vein. During the procedure, a partially occluded inferior vena cava (IVC) with significant collateralization was noted. The catheter was negotiated using a coronary guide wire and the infant tolerated the procedure well. Interestingly, the infant had a normal IVC in prior radiological films. The cause of this acquired occluded IVC remained obscure.

Correlation Between Magnitude of ST Segment Elevation and the Proximal Right Coronary Artery Lesion in Acute Inferior Myocardial Infarction

Introduction: The determination of the probable site of occlusion within RCA in acute inferior MI is very important because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Furthermore, identification of infarct-related artery and its site in acute inferior myocardial infarction not only guide decision regarding the urgency of revascularization but also guide to avoid therapy that may adversely affect the outcome. Objective: To predict the site of lesion in right coronary artery in acute inferior myocardial infarction by the magnitude of ST segment elevation in inferior leads (II, III and aVF). Methodology: This cross-sectional study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, from January 2014 to December 2015. A total of 50 consecutive patients with inferior MI who present within 12 hours of symptom onset and received fibrinolytic therapy were selected according to inclusion and exclusion criteria. Using 12-lead ECG, height of ST segment elevation in leads II, III and aVF were measured & coronary angiography(CAG) was performed during index hospital period .CAG which showed culprit lesion in RCA were only taken for the study. The sum of STsegment elevation in inferior leads were then correlated with the proximal lesion in RCA. Results: The age of the patients ranged from 31 to 70 years with the mean age of 51.1 (SD 9.2) years. Majorities (88%) of the patients were male and ratio of male to female was 7.33:1.Out of 50 patients, 26(52%) had the lesion in proximal, 19 (38%) in mid and 05 (10%) in distal RCA. Patients with proximal RCA lesion showed a mean ST segment elevation of 12.5(SD 1.07) mm, with mid RCA lesion 8.5 (SD 0.80) mm and distal RCA lesion 6.5(SD 0.42) mm. There was a positive correlation of sum of ST segment elevation in inferior leads II, III and aVF to the proximal lesion in RCA (r=0.923, P < 0.05). Conclusion: From the study it is concluded that the magnitude of ST segment elevation in inferior leads (II,III, aVF) can predict site of lesion in RCA in acute inferior wall myocardial infarction; the greater the sum of the height of ST segment elevation in inferior leads, the higher is the probability of lying the lesion in proximal right coronary artery. Bangladesh Heart Journal 2024; 39(1): 44-48

TAPSE, Tissue Doppler Systolic annular velocity(S’) and myocardial performance Index (MPI) as a predictor of proximal RCA occlusion in acute inferior wall myocardial ST elevation infarction

TAPSE, Tissue Doppler Systolic annular velocity(S’) and myocardial performance Index (MPI) as a predictor of proximal RCA occlusion in acute inferior wall myocardial ST elevation infarction

Autonomic Responses During Acute Anterior Versus Inferior Myocardial Infarction: A Systematic Review and Meta-Analysis.

Autonomic responses elicited by myocardial infarction varydepending on the site of injury, but accurate assessment using heart rate variability during the acute phase is limited. We systematically searched PubMed without language restrictions throughout July 2023. We reviewed studies reporting autonomic indices separately for anterior and inferior infarcts, followed by a meta-analysis of those reporting the standard deviation of the inter-beat interval between normal sinus beats during the initial 24 hours after the onset of symptoms. Six studies were included, comprising 341 patients (165 anterior, 176 inferior infarcts), all with satisfactory scores on the Newcastle-Ottawa quality scale. The estimated average of the standardized mean difference (based on the random-effects model) was -0.722 (95% confidence intervals: -0.943 to -0.501), which differed from zero (z=-6.416, p<0.0001). This finding indicates sympathetic and vagal dominance during acute anterior and inferior infarcts, respectively, with excessive responses likely contributing to early arrhythmogenesis. Despite the amelioration of autonomic dysfunction by revascularization, infarct location should be considered when commencing β-adrenergic receptor blockade, especially after delayed procedures.

Differentiation of acute inferior wall myocardial infarction caused by acute type A aortic dissection from atherosclerotic inferior myocardial infarction

Abstract Background Myocardial infarction (MI) caused by acute type A aortic dissection (AAD) is a rare but serious complication. To avoid unnecessary and possibly harmful treatment, differentiation of AAD-MI from atherosclerotic MI (AMI) is very important. However, there is a paucity of data regarding differentiation between AAD-MI and AMI. Purpose To compare the differences of clinical features between AAD-MI and AMI, and develop an effective way of differentiation. Methods Among 318 cases with AAD between 1982 and 2020, 18 cases (5.7%) had AAD-MI, of which 13 had inferior wall AAD-MI. Clinical features were compared with 25 consecutive inferior ST elevation AMI cases between 2017-2019. Categorial data and numerical data were compared using Fisher’s exact test and Student T test, respectively. Results Mean age and male/female ratio in AAD-MI and AMI were similar at 67.5 vs 66.3 years and 7/6 vs 13/12, respectively. The distribution of coronary risks factors and pain as presenting symptoms were similar in both groups. Initial systolic blood pressure (SBP) was significantly lower, and the incidence of shock was significantly higher in AAD-MI group compared to AMI group (SBP: 97.5 ± 26.4 vs 124.6 ± 32.7 mmHg, P = 0.014. shock: 9/13, 69.2% vs 5/25 20.0%, P = 0.0048). Although the heart rate was similar in both groups, AAD-MI group was more tachypnoeic than AMI group (27.8 ± 7.4 vs 22.7 ± 5.9/min, P = 0.046). All cases in both groups had ST elevation &amp;gt;1mm in inferior leads (by definition). There were no differences of the degree of ST elevation (2.46 ± 1.19 vs 2.54 ± 1.50 mm. P = 0.87), and the incidence of arrhythmias such as AV block. Chest X-ray showed higher incidence of mediastinal widening (MW) in AAD-MI group compared to AMI group (11/13, 84.6% vs 5/25, 20.0%. P =0.0003), whereas the incidence rates of cardiomegaly and congestive heart failure were not different. Pulse deficit (PD) and hemiplegia were seen in AAD-MI group only (pulse deficit: 5/13, 38.5% vs 0/25, 0%. P = 0.0026. hemiplegia: 2/13, 15.4% vs 0/25, 0% P = 0.11). The incidence of tamponade (T) and aortic regurgitation (AR) were higher in AAD-MI group than in the AMI group (T: 7/13, 53.8% vs 0/25, 0%. p=0.00014. AR: 8/13, 61.5% vs 4/25 16.0% P = 0.009). The combination of either PD, AR, or T increased the sensitivity up to 84.6% while the specificity was 84.0%. Intimal flap was successfully identified by bedside echocardiography in 7 out of 9 cases (77.8%) in AAD-MI group. Conclusion ADD-MI and AMI present with similar risk factors, clinical symptoms, and electrocardiographic findings. However, ADD-MI cases were associated with worse findings, such as, lower initial SBP, tachypnoea and had higher incidences of shock, PD, MW, T, and AR compared to AMI cases. Echo is of critical importance as it can identify abnormalities more specific for AAD (AR, T) and can make final diagnosis of AAD through visualizing the intimal flap.Summary tableA representative case

Abstract 16172: Impella Use in Large Post-Infarct Ventricular Septal Rupture

Background: Ventricular Septal Rupture (VSR) is a deleterious complication associated with myocardial infarction (MI). The most common form of mechanical circulatory support (MCS) utilized in post-MI complications is intra-aortic balloon pump (IABP). Impella is a far less commonly used modality as there is the potential for right-to-left shunting and a chance of mechanical perforation of the heart. Below is a case where an Impella 5.5 catheter was necessary to bridge a patient for surgical repair. Case presentation: A 76-year-old male patient presented to an outside hospital with an acute inferior ST-elevation myocardial infarction. He was treated with thrombolysis and was emergently taken to the catheterization lab where he underwent stenting of his RCA with plan to medically manage his non-culprit disease. His hospital course was complicated by cardiogenic shock with an echocardiogram that demonstrated a large VSR (Figure 1). A right heart catheterization demonstrated a significant left-to-right shunt (Qp/Qs ratio of 6:1) which necessitated mechanical support with an IABP as per standard of care. Post-IABP his Qp/Qs ratio improved to 1.6:1 but he continued to be under supported and remained in cardiogenic shock. Surgical repair of the VSR was planned for 1-week post-MI so he was transitioned to an Impella 5.5 catheter in order to stabilize and bridge him for surgery. Patient underwent surgical VSR repair and CABG on hospital day 7. Post-op he did well and was later discharged to rehabilitation center with subsequent recovery. Conclusions: If properly managed, utilization of an Impella catheter can be an effective tool to stabilize patients in post-MI VSR with refractory cardiogenic shock and bridge patients towards surgical repair. It is particularly effective when additional MCS support is required beyond the contemporary IABP and it can be used to stabilize patients for longer durations to ultimately avoid emergent surgery.

Echocardiographic and Angiographic Assessment of Right Ventricular Function and Right Coronary Artery Stenosis in Acute Inferior Wall Myocardial Infarction.

Cardiovascular diseases (CVDs) are a global concern. CVD remains a primary cause of death despite reduced coronary heart disease death rates. Acute coronary syndrome (ACS) involves myocardial infarction (MI) and unstable angina, sharing mechanisms such as plaque instability. Our study assesses the right ventricular (RV) function's predictive value in acute inferior wall MI (IWMI) to identify high-risk patients with an elevated likelihood of experiencing severe cardiac complications, hemodynamic instability, or a higher mortality risk following an acute IWMI. The research was conductedin the Department of Cardiology at theRajendra Institute of Medical Sciences (RIMS), Ranchi, from July 2021 to June 2022, following the necessary ethical approval. A cohort of 140 patients with IWMI, carefully chosen according to rigorous criteria, clearly understood the study's objectives before providing informed consent. The evaluations were conducted in the following order: clinical assessments, followed by blood testing, then echocardiography, and finally, coronary angiography. Furthermore, the study examined risk factors and utilized statistical methods to elucidate the associations between qualities and results. The study included 140 participants, with 61% being male and 39% female. Among the participants, 14% were aged 30-45, 50% were aged 46-60, and 30% were over 60. Age shows significant proportions in different categories. Diabetes, dyslipidemia, hypertension, and smoking/tobacco addiction did not differ among stenosis groups. Proximal right coronary artery (RCA) stenosis patients had elevated jugular venous pressure (JVP). The echocardiograms were performed within 48 hours of post-percutaneous coronary intervention, and significant differences between groups were observed. Participants with proximal stenosis had lower tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC), which showedcompromised RV systolic function. Proximal stenosis patients had reduced systolic motion velocity (Sm), indicating impaired myocardial contraction. Echocardiographic parameters such as early diastolic velocity (Em), atrial contraction velocity (Am), Em/Am ratio (a marker of diastolic function), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) between groups were different, indicating distinct cardiac functions. Proximal stenosis increased the myocardial performance index (MPI), indicating cardiac impairment. The left ventricular ejection fraction (LVEF) was comparable in the two stenosis groups, indicating similar left ventricular performance. Echocardiography showed significant RV function differences in acute inferior wall ST-segment elevation myocardial infarction (STEMI) patients with proximal and distal RCA lesions. RV dysfunction is linked to right ventricle myocardial infarction (RVMI), and echocardiographic markers can provide valuable insights. Results emphasizethat acute inferior wall STEMI is diagnosed by electrocardiogram (ECG) criteria, particularly ST-segment elevation. However, these markers emphasize the importance of RV assessment in RCA involvement assessment. These findings suggest that RV function can help diagnose acute inferior wall STEMI RCA involvement. In acute inferior STEMIs, RV function echocardiography is essential for RCA lesion location.

A tale of two culprits: a case report

Acute thrombotic closure of more than one coronary artery causing STEMI is an infrequent finding in coronary angiography during primary angioplasty in myocardial infarction (PAMI). We presented a case of 37 years old male with acute inferior wall myocardial infarction (IWMI) with complete heart block (CHB) with left ventricular failure (LVF). Coronary angiography showed thrombotic occlusion in right coronary artery (RCA) and circumflex arteries. Clinical condition improved only after percutaneous transluminal coronary angioplasty (PTCA) of both arteries. Given this unique presentation, the best management is not standardized. Further studies are needed to better predict outcomes and guide future management.

Effect of Cardiac Rehabilitation Program on Right Ventricular Function after Acute Inferior Wall Myocardial infarction

Abstract Aim and objectives To assess the role of cardiac rehabilitation on right ventricular (RV) functional recovery by 2D speckle-tracking echocardiography (STE) in a cohort of patients with successful reperfusion after the first episode of acute inferior myocardial infarction (MI) associated with RV infarction. Patients and Methods Fifty patients who underwent successful percutaneous coronary intervention (PCI) after inferior MI mainly associated with ECG criteria of RV infarction were prospectively included (56.08 ± 10.79 years, 40 Men). Twenty-five patients started an exercisebased cardiac rehabilitation (exCR) program after 2-4 weeks of discharge; another twenty-five patients, who were taken as the control group, received the usual care but didn’t participate in the cardiac rehabilitation program. Both groups received guideline-directed medical therapy (GDMT). Echocardiography (including 2D STE and conventional parameters for assessment of RV systolic function ) was performed at baseline, and after a 3-month follow-up for all patients. High levels of strain impairment were observed in both groups at baseline. All parameters improved at 3-month follow-up compared to baseline. Nevertheless, RV global longitudinal strain (GLS) and free wall strain (FWS) improved significantly for patients who completed the cardiac rehabilitation program compared to the control group. Conclusion Cardiac rehabilitation is effective in improving RV strain parameters in patients who developed acute inferior MI associated with RV infarction. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.

Comprehensive assessment of the outcomes of inferior wall myocardial infarction according to echocardiography in patients after percutaneous coronary intervention

Aim. To identify significant echocardiographic parameters in the screening assessment of long-term outcomes of inferior wall myocardial infarction (MI) with primary percutaneous coronary intervention (PCI) using a logistic regression model.Material and methods. The study included the examination results of 144 people with inferior wall MI with primary PCI at admission, discharge and 6, 12, 24 months after discharge. Logistic regression analysis to identify screening outcomes of inferior wall MI included 184 variables, including 131 echocardiographic signs. Analysis of variance was performed using the ANOVA Type II method. The model quality was assessed using the likelihood ratio test and the Akaike criterion.Results. In patients with inferior wall MI and primary PCI, adverse outcomes were observed in 59,7% of cases in the form of repeated myocardial infarction and PCI, coronary artery bypass grafting, the development of stage 2 chronic heart failure, and/or rehospitalizations. For the long-term prognosis of inferior wall MI, in addition to left ventricular ejection fraction, mitral E/A, left atrial volume index and wall motion score index (WMSI), the following echocardiographic predictors were assessed: tricuspid S’ and e’, circumferential strain of the medial level, longitudinal strain of the apical and basal left ventricular levels, longitudinal strain of the segments included in the blood supply area of the circumflex artery.Conclusion. Echocardiographic parameters using Doppler and speckle-tracking technology have proven to be significant in screening outcomes of acute inferior wall MI with PCI.

Electrocardiographic acute inferior myocardial infarction with right ventricle involvement due to acute thrombotic left anterior descending occlusion in a patient with atrial septal defect

Detecting the anatomic location of the lesion with the help of electrocardiography (ECG) is an important and time-saving decision in cases of acute ST-segment elevation myocardial infarction. However, it can be difficult in some patients with different coronary anatomies or underlying structural heart diseases. Here, we reported a 34-year-old male patient with an underlying atrial septal defect (ASD) who presented with acute inferior myocardial infarction with right ventricle (RV) involvement due to acute thrombotic left anterior descending artery occlusion.

St-elevation myocardial infarction in a healthy 16-year-old adolescent: a clinical case

Background. Diagnosis of acute myocardial infarction (AMI) in pubertal patients is a diagnostic challenge, as individuals of such a young age usually do not have traditional risk factors for coronary heart disease (CHD) and, as a result, are at increased risk of misdiagnosis.Objective. To describe a clinical case of AMI in a 16-yearold patient against the background of complete well-being.Design and methods. A 16-year-old patient, against the background of complete well-being, developed pressing pains in the chest, which stopped on their own after a few hours. During hospitalization, in addition to an increase in the level of troponin, the results of other laboratory and instrumental studies did not confirm the version of AMI, as a result of which other cardiac and non-cardiac causes of the development of chest pain formed the basis of the diagnostic search. This was the reason for the delayed diagnosis and endovascular treatment of thrombotic occlusion of the right coronary artery, and, as a result, the formation of an area of persistent hypokinesia of the lower parts of the left ventricle. Further search for possible causes of AMI, including the analysis of genetically associated conditions, did not yield results.Results. This publication describes a case of acute inferior myocardial infarction with ST segment elevation and thrombotic occlusion of the right coronary artery in a 16-year-old adolescent and the impact of an irrational diagnostic process on long-term prognosis.Conclusion. The presented clinical case demonstrates the importance of including the diagnosis of AMI in the process of differential diagnosis of acute chest pain, even in adolescent patients.