Acute Inferior Wall Myocardial Infarction Research Articles

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.

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

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 >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

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.

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.

Frequency of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction Presenting At a Tertiary Care Hospital, Peshawar

Objectives: Right ventricular infraction has prognostic significance in the setting of acute “inferior wall myocardial infarction (IWMI)”, this research is intended to determine the frequency of “right ventricular infarction (RVI)” in patients with acute IWMI. Methodology: This descriptive cross-sectional study took place at a tertiary care hospital in Peshawar, Pakistan. The study included consecutive patients who were diagnosed with acute IWMI. The presence of RVI was determined based on specific ECG findings showing >1.0mm ST segment elevation on right-sided chest leads. Results: In a sample of 150 patients, 87 (58%) were male. The average age of the patients was 61 ± 10.7 years. Among the patients, 111 (74%) had hypertension, 64 (42.7%) were diabetic, and 45 (30%) were smokers. A body mass index (BMI) exceeding 25 kg/m2 was observed in 83 (55.3%) patients. RVI was observed in 62 (41.3%) of the patients. The occurrence of RVI did not show statistically significant differences between males and females (41.4% vs. 41.3%; p=0.989), hypertensive and non-hypertensive individuals (41.4% vs. 41.0%; p=0.964), diabetics and non-diabetics (42.2% vs. 40.7%; p=0.855), smokers and non-smokers (42.2% vs. 41.0%; p=0.885), and patients with BMI ≤25 kg/m2 and >25 kg/m2 (41.8% vs. 41.0%; p=0.920), respectively. Conclusion: Based on the research findings, it can be concluded that RVI is a relatively common occurrence in patients with acute IWMI, as it was observed in more than 40% of the patients studied. However, no statistically significant association exists between RVI and various demographic and clinical factors.

Outcomes of Late Presenters with Acute Inferior Wall Myocardial Infarction Complicated by Complete Heart Block Treated with Percutaneous Coronary Intervention

Objective: The objective of this study was to evaluate the outcomes of delayed presenters with acute inferior wall MI complicated by complete heart block treated by PCI of culprit artery. Methods: A descriptive cross-sectional study conducted on 40 patients with late presentation of either 48 hours or more with acute inferior wall MI complicated by complete heart block were included. All patients underwent coronary angiography and PCI of culprit vessel attempted. Outcomes were measured in terms of restoration of normal sinus rhythm along with heart block recovery time, requirement for implantation of permanent pacemaker and in hospital mortality. The statistical analysis was performed using SPSS 24. Results: The mean age was 55.73 ± 7.679. Male were 65% (n=26), diabetes 62.5% (n=25), hypertension 57.5 (n=23), smoking 30% (n=12) and dyslipidemia 52.5% (n=21). Mean delay in presentation 69.35 ± 11.132 hours. Mean restoration time 69.25 ± 10.95 hours, with minimum of 48 hrs & maximum 86 hrs. Mean tropinin I level 1588.97± 996.70 pg/ml. Mean Ejection fraction 44.8± 9.48 %. Successful PCI has a significant correlation with recovery time (p=.004). There was no in hospital mortality. All restores normal sinus rhythm and no patient needed permanent pacemaker. Successful PCI has a significant correlation with recovery time (p=.004). Conclusion: Successful PCI of culprit artery in late presenter of CHB with acute inferior MI results in restoration of NSR all patients with reduction in heart block recovery time and no in hospital death. Keywords: Acute inferior wall MI, Complete heart block, PCI, late presenter

Frequency of Mitral Regurgitation in Patients with Acute Myocardial Infarction

BACKGROUND: Mechanical complications can occur after acute myocardial infarction. Most commonly mitral regurgitation (MR) occurs after infero-basal myocardial infarction (MI) due to papillary muscles dysfunction. MR may also develop with antero-apical MI. The objective of the study was to determine the frequency of mitral regurgitation in acute MI patients and to risk stratify the patients with MR for anterior and inferior wall MI. AIMS & OBJECTIVE: To assess the frequency of mitral regurgitation in patients with acute myocardial infarction. MATERIAL & METHODS: This was a descriptive case series carried out at the Cardiology department of Jinnah Hospital, Lahore from: 29-10-2013 to 29-04-2014. A total of 340 patients of MI were included. Echocardiography examination was carried out on all subjects on day 3-4 post MI. Frequency of mitral regurgitation in each group was measured by color flow Doppler technique. RESULTS: Out of study population, 153 (45%) were in between 30-50 years and 187 (55%) were in between 51-75 years. The mean of age was calculated as 55.09+11.81 years. In our data 181 (53.24%) were male and 159 (46.76%) were female. Frequency of MR in acute MI patients was recorded in 69 (20.29%) while 271 (79.71%) had no findings of MR. From the total of 69 cases, MR was recorded in 13 (18.84%) as anterior wall MI and 16 (23.19%) as inferior wall MI, p value was calculated as 0.532 which shows insignificant difference. There was a significant difference in hospital stay and mortality between both groups p-value 0.04. CONCLUSION: Mechanical complications develop after acute myocardial infarction and may be associated with serious outcomes. KEYWORDS: Acute MI, mitral regurgitation, anterior and inferior wall MI.

Treatment of Cardiogenic Shock and Refractory Ventricular Fibrillation: Pulling Out All the Stops

AbstractWe report the case of a 62-year-old woman who presented with an acute inferior wall myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation. Following prolonged resuscitation in the emergency room, she was transferred to the cardiac catheterization laboratory where, as a first step, mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (ECMO) was established. Next, a right heart catheterization study was performed, followed by coronary angiography and angioplasty of the infarct-related artery. Promptly on transfer to the intensive care unit, a hypothermia protocol was initiated. By postprocedure day 1, the patient's ventricular fibrillation had resolved, mean arterial pressure was >65 mm Hg, and pulmonary artery diastolic pressure was 10 mm Hg. Echocardiography demonstrated complete recovery of left ventricular systolic function. Lactate levels had fallen from 11.0 mmol/L (pre-ECMO) to 1.2 mmol/L. The patient was successfully weaned off pressor and ECMO support within 24 hours of the percutaneous coronary intervention procedure. She was extubated on postprocedure day 2 and discharged home on day 6. At 26-month follow-up, she remains well, angina free, neurologically intact, and without evidence of heart failure. The treatment algorithm used in this case should be considered favorably in the management of patients presenting with acute myocardial infarction complicated by cardiogenic shock and refractory ventricular fibrillation.

Successful percutaneous coronary intervention with extracorporeal membrane oxygenation in a patient with acute inferior wall myocardial infarction complicated by electrical storm, cardiogenic shock, and cardiac arrest: a case report

BackgroundHigh-risk patients with coronary heart disease who develop acute myocardial infarction (AMI) have severe coronary lesions. If severe complications occur, such as malignant ventricular arrhythmia, cardiogenic shock, and cardiac arrest, implementation of emergency percutaneous coronary intervention (PCI) may be hindered, leading to a higher perioperative mortality rate. Extracorporeal membrane oxygenation (ECMO) can pave the way for rapid myocardial reperfusion therapy. When cardiac arrest occurs, hemodynamic support with ECMO can facilitate revascularization with PCI, which can increase the time available for further salvage and treatment and reduce intraoperative risk during PCI.Case presentationHerein, we report a case of a 61-year-old man with AMI who suffered electrical storm of sustained malignant ventricular fibrillation, cardiogenic shock, and cardiac arrest and was successfully treated with PCI with ECMO support. During PCI, repeated aspiration and removal of the right coronary artery thrombus were performed, and blood flow was restored after right coronary artery balloon dilation. One episode of defibrillation was delivered to restore sinus rhythm. Then, stents were implanted in the distal and proximal right coronary artery lesions to achieve revascularization. After PCI with ECMO support, irreversible malignant arrhythmia returned to sinus rhythm through coronary perfusion, which prevented death following unsuccessful cardiopulmonary resuscitation. After applying active treatments, including anti-shock, mechanical ventilation, anti-inflammation, and organ support, the patient was discharged after his condition and vital signs stabilized. The patient was followed up once a week after hospital discharge, and his cardiopulmonary function recovered well.ConclusionsWith ECMO support, PCI should be performed immediately in patients with inferior wall AMI complicated by electrical storm of sustained ventricular fibrillation, cardiogenic shock, and cardiac arrest to facilitate stent placement, achieve complete revascularization, restore coronary perfusion, and avoid death

Correlation of Sum of ST Segment Depression in Leads V1 to V4 in Acute Inferior Myocardial Infarction with Angiographic Severity of Coronary Artery Disease

Background: Inferior wall acute myocardial infarction accounts for 40 to 50% of all acute STEMI. Patients of acute inferior myocardial infarction with ST depression in lateral leads often have greater incidence of triple vessel disease and proximal RCA lesion but in case of patients of acute inferior myocardial infarction with ST depression in precordial leads (leads V1 to V4), is a subject of determination whether it is associated with more sever coronary artery disease. The aim of this study is to determine the association of sum of ST depression in precordial leads with the probability of concomitant severity of coronary artery disease in patients with acute inferior STEMI. Methods: this cross sectional observational study was done at National institute of cardiovascular diseases (NICVD), Dhaka, Bangladesh. Total 90 patients of acute inferior myocardial infarction with precordial lead ST depression admitted at CCU within 12 hours of onset of chest pain were the study population. They were divided in two groups on the basis of sum of ST depression in precordial leads (Sum of ST depression d”4mm and >4mm), 36 patients in group I and 54 patients in group II. Coronary angiography was performed during the index hospitalization period. Gensini score and Reardon score were measured. Results: Overwhelming majority of the patients was male (83.3% and 90.7%) with mean age of 51.0±9.7 and 51.0±9.9 years in group I and II respectively. Smoking, hypertension and diabetes mellitus were the most frequent risk factors in both groups. Serum troponin level was significantly high in group II (6.2±2.2 vs. 13.6±17.7, p <0.05). Sum of ST depression in precordial leads was 2.84±0.66 and 7.53±3.51 in group I and group II respectively, and was statistically significant. Consideration of mean of ST depression in individual leads shows significantly higher mean in leads V2, V3 and V4 among group II patients. SVD was more frequent in group I but group II patients had higher statistically significant incidence of DVD and TVD. Gensini score (20.26±13.0 vs. 36.98±16.9) and Reardon score (4.63±2.2 vs. 6.83±2.2) was high in group II patients. Positive correlation had been depicted between summation value of ST segment depression with that of Gensini score & Reardon score (Gensini score r=0.61 and Reardon score r= 0.52). Conclusion: Involvement Triple vessel and double vessel disease was remarkably higher with increasing sum of ST segment depression in precordial leads. The severity of ST segment depression in terms of summation of ST depression in leads V1 to V4 is directly proportional to the extent and severity of coronary artery disease. Bangladesh Heart Journal 2022; 37(2): 116-121

Impact of percutaneous coronary intervention in right coronary artery on right ventricular function in patients with acute myocardial infarction.

Background: Right ventricular (RV) dysfunction is a potent predictor of mortality and morbidity following acute myocardial infarction (AMI). Despite the fact that elective percutaneous coronary intervention (PCI) has significantly decreased myocardial damage to the left ventricle, there is a lack of information regarding the effect of PCI on RV function. Aim: This study aimed to examine the effect of right coronary artery (RCA) revascularization on the systolic and diastolic functions of the right ventricle following acute inferior wall myocardial infarction. Methods: Fifty-nine patients diagnosed with acute inferior wall myocardial infarction after RCA revascularization were prospectively investigated between April 2018 and January 2020. The patients underwent 2D echocardiography. RV systolic and diastolic functions were reported before and after the PCI procedure and compared using echocardiographic RV systolic and diastolic parameters. Results: After PCI, echocardiographic RV systolic and diastolic functions significantly improved in the proximal and mid RCA in terms of TAPSE, RVFAC, and E/A. Significant improvement was found in the mid RCA in terms of S' velocity (p=0.008) and in the proximal RCA in terms of E/e' (p=0.021). Overall echocardiographic systolic and diastolic parameters in patients with RV dysfunction following PCI were improved [TAPSE (37.29% vs. 81.82%), S' velocity (37.29% vs. 68.18%), RVFAC (33.90% vs. 90.00%), and E/A (33.90% vs. 75.00%)]. Conclusion: Our findings revealed that patients with RV dysfunction showed remarkable improvement after RCA revascularization. Hence, in future cases, RCA revascularization may become an appropriate treatment alternative for the recovery of patients with RV dysfunction.

Assessment of right atrial function in inferior wall AMI

Background: Approximately 30–50% of patients with inferior infarction have some involvement of the right ventricle. The right ventricular (RV) infarction almost invariably develops in association with a large infarction of the adjacent septum and inferior 0 walls, but isolated infarction of the right ventricle is seen in just 3–5% of autopsy-proven cases of MI. This study is designed to assess the right atrial (RA) functions in inferior wall acute myocardial infarction (AMI) (IWMI) echocardiographically and to compare it with patients who do not have history of ischemic heart disease (IHD) but having risk factors for IHD. Aims and Objectives: The aims of this study were to study the patients presenting with Inferior wall MI IWMI for RA function. Materials and Methods: Patients admitted in the Cardiology ward of R G Kar Medical College and Hospital with IWMI from March 2020 to March 2022 were included in the study. Results: Average Measurement of RA volume index (RAVI) and RA Pressure (RAP) was highest among patients with IWMI+RV myocardial infarction (RVMI). Out of 100 IWMI patients, 33 had high RAVI and RAP and out of 100 non-IHD patients none had high RAVI. Conclusion: In our study, there was no statistically significant difference in average RAVI and RAP in patients presenting with IWMI and in patients with risk factors for myocardial infarction but without AMI. However, patients presented with IWMI+RVMI showed statistically significant increased RAVI and RAP as compared to inferior wall AMI only.

Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction: Reciprocal ST-segment depression and ST segment elevation myocardial infarction.

At present, the mechanism of reciprocal ST-segment depression (RSTD) is unclear. ST-segment changes may be caused by the potential difference between the positive and negative electrodes, although this requires further investigation. The characteristics of RSTD and their relationship with ST-segment elevation in acute ST segment elevation myocardial infarction (STEMI) patients were analyzed. We replaced the negative electrode of the precordial leads of an inferior wall myocardial infarction patient and observed the changes in the ST-segment of the precordial leads. A total of 85 patients were included, of which 75 were patients with RSTD. All 45 patients with inferior myocardial infarction had limb lead RSTD, and 37 had anterior lead ST-segment depression. All ST-segment changes in STEMI can be explained by the proposed mechanism, and the value of ST segment depression in limb leads can be calculated by the value of ST segment elevation. In summary, the mechanism of RSTD in acute myocardial infarction may be that the action potential (AP) of the negative electrode of the lead weakens or disappears and the AP of the positive electrode may not be completely offset, resulting in ST-segment depression. Animal experimental studies are needed for further confirmation. When the negative electrode of the precordial lead is changed in acute inferior wall myocardial infarction patient, the ST-segment of the precordial lead changes accordingly. All the changes are consistent with our analysis.

A Rare Presentation of Coronary Aneurysm following Bare-metal Stent

We present a case of post-percutaneous transluminal coronary angioplasty with a bare-metal stent to the right coronary artery (RCA). He presented with acute ST-elevation inferior wall myocardial infarction. Coronary angiography showed an aneurysm of proximal RCA extending from the proximal end of the stent to the distal end. There was a 90% discrete lesion beyond the stent with TIMI III flow. The development of coronary artery aneurysms (CAAs) was reported even before the era of stents. CAA can develop after plain balloon angioplasty, after directional coronary atherectomy, and after bare-metal and drug-eluting stents also but not after coronary angiography. Kachru et al. reported an incidence of 0.2% (4 of 2408) per DES without routine angiographic follow-up and Rha et al. reported an incidence of 1.7% (five out of 296) per patient at 6-month routine angiographic follow-up. CAA is an uncommon and often accidental finding, we report a case of CAA which presented as acute myocardial infarction mimicking stent thrombosis.

The Armchair Obtuse Marginals

Abstract We report a rare case of anomalous origin of obtuse marginals (OMs) from a common trunk arising from the right coronary sinus in an interesting armchair shape in a 52-year-old female presenting with acute inferior wall myocardial infarction. During routine coronary angiography, the origin of the left anterior descending coronary artery was visualized and the origin of the left circumflex (LCX) coronary artery was not visualized with the sign of nonperfused myocardium in the LCX artery territory. Our case is a rare illustration of armchair OMs with nonperfused proximal and middle LCX coronary artery territory.

Assessment of Right Ventricular Strain by Speckle Tracking Echocardiography for Prediction of Proximal Right Coronary Artery Lesion in Patients with Acute Inferior Wall Myocardial Infarction

Assessment of Right Ventricular Strain by Speckle Tracking Echocardiography for Prediction of Proximal Right Coronary Artery Lesion in Patients with Acute Inferior Wall Myocardial Infarction