Inferior Myocardial Infarction Research Articles

Massive Left Ventricular Aneurysm After Inferior Infarction

True ventricular aneurysm is a rare complication of myocardial infarction. After a 53-year-old man presented late with an inferior ST-segment elevation myocardial infarction, he was found to have a massive posterobasal left ventricular aneurysm. Cardiac magnetic resonance imaging volumetric analysis highlighted the hemodynamic significance of the aneurysm. As the result of persistent symptomatic heart failure, the patient underwent surgical resection of the aneurysm and placement of a pericardial patch with excellent results at follow-up.

Yeni Açılan Kalp Merkezinin Koroner Anjiyografi Sonuçları

Introduction: Bandırma and the surrounding districts are in a geographical location with a dynamic population and a large number of immigrants due to university, industry, agriculture and trade. In this context, the coronary artery disease profile can be evaluated as a reflection of the country in general. In this study, it was aimed to determine the coronary artery disease profile of patients who underwent coronary angiography in Bandırma Training and Research Hospital, a new heart center, and the region where the hospital is located.
 Materials and Methods: Patients who underwent coronary angiography after the establishment of the heart center in Bandırma Training and Research Hospital were included in the study. The patients' age, gender, diagnosis, which treatment decision was made as a result of coronary angiography, stent restenosis, graft patency and coronary artery anomalies were evaluated. 
 Results: The number of patients who underwent coronary angiography was 3238 and 1079 unstable angina pectoris, 959 stable angina pectoris, 573 non-ST elevation myocardial infarction, 325 inferior myocardial infarction, 258 anterior myocardial infarction, 37 posterior myocardial infarction, 7 lateral myocardial infarction was diagnosed. The mean age of the patients was 62±12 years, and the mean age of angiography in females was 4 years longer than males. It was observed that medical treatment was given to 1209 patients, percutaneous coronary intervention to 1630 patients, and bypass surgery to 399 patients.
 Conclusion: The coronary artery disease profile of Bandırma and the surrounding districts reflects the coronary artery disease profile of the country in general.

INCIDENCE OF RIGHT VENTRICULAR INFARCTION IN PATIENTS WITH INFERIOR WALL MYOCARDIAL INFRACTION

The prospective study was conducted in the Department of Cardiology, Nishtar Medical Hospital & CPEIC Multan from August 2020 to February 2021 to evaluate the frequency of right ventricular infarction in subjects with inferior wall myocardial infarction. A total of 110 patients were included. Age, gender, smoking history, dyslipidemia, diabetes mellitus, and hypertension were recorded. Clinical and radiographic examination was done, and the right ventricular infarction was recorded accordingly. Results showed that of 110 subjects, 43 (39.09%) had right ventricular infarction. Thus, it was concluded that right ventricular infarction is highly prevalent in subjects with inferior wall myocardial infarction. Early diagnosis and treatment are important for reducing morbidity and mortality.

Prognostic value of right ventricular diastolic dysfunction in patients with inferior ST-elevated myocardial infarction

BackgroundRight ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricular dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not routinely evaluate RV diastolic dysfunction. In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI.ResultsSixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Patients with pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (E′, A′ and E/E′ ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. The average age of the study population was 51.58 ± 10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary edema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 h. Patients who developed MACE had high filling pressures, as all of them had E/E′ > 6. E′ velocity ≤ 6 cm/sec was associated with increased MACE as 25% of patients with E′ velocity ≤ 6 had MACE compared with 2.3% of patients with E′ velocity > 6 with a p value of 0.015.ConclusionsTricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/E′ and E′ velocity have a prognostic value in patients with inferior STEMI and RV infarction; E/E′ > 6 and E′ velocity ≤ 6 cm/sec were associated more MACE in patients with inferior STEMI and RVI.

A novel coronary artery healing pattern suggesting the axial progression of coronary plaques.

A 54-year-old man, current smoker, without previous cardiovascular history was admitted for an inferior transient ST-segment elevation myocardial infarction. An emergent coronary angiogram revealed an unstable, non-obstructive, thrombus-rich plaque in the mid segment of the right coronary artery (RCA) (Panel A). Optical coherence tomography (OCT) imaging disclosed a healthy vessel wall in the proximal RCA, along with a long, heterogenous plaque at the culprit lesion, where three distinct phenotypes were clearly recognized (Panels a-d, circle denotes wire artifact). First, the very proximal segment of the plaque showed a layered morphology with multiple high and low signal-rich strata, suggestive of an old healing process (Panels a and b, arrowheads). In the middle part of the plaque, a superficial, laden, organized circumferential thrombus was observed, probably reflecting an early healing stage (Panel c, asterisks). Finally, the most distal part of the lesion showed a plaque rupture with a large, ‘red’ fibrin-rich, fresh protruding thrombus (Panel d, star). Percutaneous coronary intervention with a new-generation stent obtained excellent results.

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.

Is there an Electro-Angiographic Correlation in RD Infarction?

Introduction: Coronary angiography is the examination of choice in the evaluation of coronary anatomy during acute myocardial infarction, particularly of the right ventricle (RV), whose diagnosis remains difficult. The electrocardiogram reflects the pathophysiology of myocardial ischemia, thus allowing prediction of the culprit lesion.
 Objective: To investigate the correlation between electrical and coronary data and to judge the reproducibility of the electrocardiogram in identifying the culprit lesion in RV infarction.
 Materials and Methods: Retrospective study of patients hospitalized in the Cardiology Department of the Mohammed VI University Hospital in Marrakech over a period of 24 months for MDI extended to the RV.
 Results: During the study period, 120 patients were hospitalized for MI with RV extension.
 Inferior MI represented 70% of all cases of infarction extended to the RV. It is represented electrically by isolated ST-segment elevation in V3R found in 76%, as well as in association with an elevation in V4R in 45% of cases.
 Conduction disorders were noted in 38% of cases, presented essentially by first degree atrioventricular block, without any electrical specificity.
 Coronary angiography was performed in 91% of patients, half of whom underwent coronary angioplasty. A bi-truncular involvement (RC + VIA) was found in 40% of cases, the middle DC is the culprit lesion in almost half of the cases of VD infarction.
 The presence of an ST elevation in the isolated V3R shunt is a specific criterion of right middle coronary involvement, found in 48% of patients.
 Conclusion: The ECG remains an essential tool in the early prediction of the artery responsible for the infarction. Because of its complementary nature, the combination of ECG and coronary angiography is essential for a better evaluation of acute myocardial infarction.

Inferior and precordial ST-segment elevation myocardial infarction due to large wrap-around left anterior descending artery occlusion

Left anterior descending artery (LAD) occlusion normally develops into precordial ST-segment elevation; however, we describe a case of a 50-year-old man with inferior and precordial ST-segment elevation myocardial infarction that resulted from proximal occlusion of the wrap-around LAD perfusing the anterior and inferior wall. We performed early and prompt reperfusion and were able to save the patient without any complications. A wrap-around LAD perfuses a large myocardial area; therefore, this type of coronary occlusion causes severe myocardial damage and has a poor prognosis. The rates of new-onset heart failure and heart failure rehospitalization are also high. Simultaneous inferior and precordial ST-segment elevations on electrocardiography suggest acute myocardial infarction with a wrap-around LAD lesion, which requires prompt revascularization. More careful medications for heart failure and follow-up should be also required even after discharge in such case.

Inferior ST segment elevation myocardial infarction combined with hyperextension cervical spine injury: A rare case report.

Inferior ST-segment elevation myocardial infarction (STEMI) is usually caused by acute occlusion of the right coronary artery or left circumflex coronary artery (LCX). Inferior STEMI can cause a high-grade atrioventricular block, sinus bradycardia, and hypotension, leading to hemodynamic collapse, syncope, and disturbance of consciousness. A case of a sudden disturbance of consciousness after chest tightness as the initial symptom, followed by incomplete paralysis and paresthesia of the extremities due to the collision of the face with the ground. Coronary angiography showed about 99% of stenosis in the LCX. Cervical spine magnetic resonance imaging showed C2/3, C3/4, C4/5, and C5/6 intervertebral disc herniation with secondary spinal stenosis, spinal cord compression, and edema. The patient was diagnosed with inferior STEMI combined with hyperextension cervical spine injury. Bivalirudin was used for anticoagulation, the LCX lesion was pre-expanded with a balloon and the thrombus was removed, and anti-platelet aggregation therapy was given postoperatively. After rehabilitation therapy, hyperextension cervical spine injury improved. There was no recurrence of syncope and precordial pain during the 6-month follow-up. Hyperextension cervical spine injury has unique hemodynamic features that mimic those associated with inferior STEMI, so a detailed medical history inquiry and physical examination should be carried out to avoid missed diagnoses.

Nursing of an octogenarian patient with acute inferior myocardial infarction combined with sick sinus syndrome

Nursing of an octogenarian patient with acute inferior myocardial infarction combined with sick sinus syndrome

A Rare Case of Acute Stanford Type a Aortic Dissection Presenting with Anterior St-Elevation Myocardial Infarction

Abstract Introduction Aortic dissections occur as a result of a tear in the intimal layer, continued longitudinal splitting within the intima and media, and formation of false lumen. This could lead to sudden death or severe aortic regurgitation and cardiogenic shock. The presented case here describes a patient with acute anterior ST-elevation myocardial infarction due to acute Stanford type A ascending aortic dissection. Case presentation A 55-year-old male presented with severe chest pain, radiating into the back, jaw, and left arm, and signs of cardiogenic shock. Electrocardiography showed acute anterior ST-elevation myocardial infarction and echocardiography confirmed that there was a reduced left ventricle ejection fraction (38% calculated using the Simpson method), severe aortic regurgitation, and wall motion abnormalities. Based on these findings, we made a diagnosis of acute myocardial infarction. In accordance with the current guidelines, we opted for an interventional therapeutic approach. Angiography showed left main trunk dissection extending to the left anterior descending coronary artery caused by ascending aorta dissection. This finding altered the diagnosis and treatment plan and the patient was immediately sent to the operating room for emergency surgery. Conclusions Aortic dissection should be suspected in patients presenting with acute anterior ST-elevation myocardial infarction, severe aortic regurgitation, and cardiogenic shock. Involvement of the left main trunk and left anterior descending artery occurs much more rarely than that of the right coronary artery, which causes inferior myocardial infarction.

Risk factors and inflammatory markers in acute coronary syndrome-ST elevation myocardial infarction (STEMI).

The increasing prevalence of coronary artery disease [CAD] poses worrying statistics. Atherosclerosis of coronary vessels is the main culprit for the spectrum of CADespecially acute coronary syndrome. Atherosclerosis is regarded as a consequence of inflammatory changes in the coronaries. Our study aimed to assess the role of risk factors and inflammatory markers with acute ST-elevation myocardial infarction [STEMI]. 100 patients with ST-elevation Myocardial infarction [STEMI] and 100 age and sex matched controls were included in the study. A history of risk factors like smoking, hypertension, diabetes and hypertension was noted. A venous blood sample was obtained for analysis of inflammatory markers. The data thus obtained was statistically analyzed. The cases had a significant number of risk factors such as smoking, hypertension, and diabetes mellitus, previous history of CAD, increased body mass index [BMI], and raised high sensitive C-reactive protein [hs-CRP]. Patients with anterior myocardial infarction were older and had hypertension and diabetes mellitus. Patients with inferior myocardial infarction had high BMI, raised erythrocyte sedimentation rate [ESR] and alcoholism. Smokers, patients with diabetes mellitus, high total cholesterol, Low-density lipoprotein [LDL] cholesterol, and hs-CRP were more prone to complications. Patients with a greater number of risk factors and raised inflammatory markers were at high risk of STEMI and its complications. An approach to control the modifiable risk factors like obesity and lifestyle changes can reduce the disease burden.

Potential use of prophylactic intracoronary atropine in reducing reperfusion vagal reflex-related events in ST-elevation myocardial infarction

In this study, we evaluated the potential use of atropine in reducing reperfusion vagal reflex-related events during emergency percutaneous coronary intervention (PCI) for acute inferior ST-elevation myocardial infarction (STEMI). Retrospectively, we included 142 patients with inferior wall STEMI, who were treated between October 2015 and October 2020, in this study. The patients were divided into an experimental group (n = 70) and a control group (n = 72) depending on whether they received prophylactic intracoronary atropine. The experimental group was then subdivided into a low-dose group (0.5 – 1 mg atropine, n = 40) and a high-dose group (2 mg atropine, n = 30). We compared the incidence of reperfusion vagal reflex-related events and the application of temporary pacemakers between these groups. The results showed that the incidence of bradycardia (24.3% vs. 45.8%, P = 0.007), hypotension (18.6% vs. 40.3%, P = 0.005), ventricular tachycardia (4.3% vs. 19.4%, P = 0.005), and ventricular fibrillation (8.6% vs. 20.8%, P = 0.040) as well as the application of temporary pacemakers (14.3% vs. 29.2%, P = 0.032) were all much lower (all P < 0.05) in the experimental group than in the control group. In addition, the incidence of bradycardia (10% vs. 35%, P = 0.016), hypotension (6.7% vs. 27.5%, P = 0.027), ventricular tachycardia (6.7% vs. 25%, P = 0.044), and ventricular fibrillation (0 vs. 15%, P = 0.034) as well as the application of temporary pacemakers (3.3% vs. 22.5%, P = 0.036) were all much lower (all P < 0.05) in the high-dose group than the low-dose group. Our findings demonstrate that atropine pretreatment could prevent reperfusion vagal reflex-related events and reduce the application of temporary pacemakers during emergency PCI for acute inferior STEMI. These effects can be significantly enhanced by high-dose (2 mg) atropine pretreatment.

Detection of inferior myocardial infarction based on multi branch hybrid network

Background and ObjectivesEarly and accurate detection of inferior myocardial infarction (IMI) is important for reducing the risk of mortality from a heart attack. Although previous work has demonstrated IMI detection, the differences among patients have been ignored. Most models display excellent performance in the intra-patient scheme, but the inter-patient test results are not ideal. The present paper proposes a model based on densely connected convolutional and gated recursive unit (GRU) networks to enhance the generalization ability of the model. MethodsFirstly, the data of multi-lead beat in series is used with GRU, to obtain more inter-lead and intra-lead time correlation information. This correlation information is scientific and significant for IMI detection. Secondly, the proposed model retains both deep and shallow features of ECG through DenseNet, which include more detailed information of IMI. Finally, through the feature connection, the multi-dimensional features enrich the description of ECG signals, and help the network learn more essential characteristics of IMI, so as to enhance the generalization ability of the model. ResultsThe proposed method was verified by the PTB diagnostic database of the German National Metrology Institute. The generalization ability of the model was tested by intra-patient and inter-patient schemes. After 5-fold cross-validation, the average accuracy, sensitivity and specificity were 99.95%, 99.94% and 99.96% in the intra-patient scheme respectively. Furthermore, these parameters were 88.68%, 90.33% and 87.04% in the inter-patient scheme. ConclusionsThe experimental results show that the model displays good generalization ability, which has important clinical significance.

Incidentally Detected Chronic Left Ventricular Pseudoaneurysm After Subacute Inferior–Posterior Myocardial Infarction

We describe a 69-year-old man with subacute inferior myocardial infarction who had surgical repair for a left ventricular (LV) pseudoaneurysm incidentally detected by routine 6-month follow-up echocardiography. Although LV pseudoaneurysm is a rare complication after myocardial infarction, the delayed diagnosis and management can cause adverse patient outcomes. The present case suggests that patients with multiple risk factors for LV pseudoaneurysms, including advanced age, late presentation, and delayed revascularization, should receive intensive blood pressure control and closer examination using a multimodal imaging approach for early detection of aneurysmal formation and complications.

Frequency of Ventricular Tachycardia in First 48 Hours of ST-Elevation Myocardial Infarction

ST-elevation myocardial infarction (STEMI) has a poor long-term prognosis associated with early ventricular tachycardia (VT). Objective: To find out the frequency of ventricular tachycardia in the first 48 hours of ST-elevation myocardial infarction. Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1st October 2020 to 31st March 2021. All the patients having new onset ST-elevation Myocardial infarction as per Operational definition, both genders, aged between 40 and 75 years and who have given consent were included in the study. Non-probability consecutive sampling technique is being used for the sampling. Results: Standard deviation was ±1.357 years, while the average age was 51.56. Gender-wise distribution among patients male was 89(53.6%) and female was 77(46.4%). Distribution of duration of disease among patients 12-24 hours 80(48.2%) and more than 24 hours 86(51.8%) was 100(52.4%). Family History of coronary artery disease (CAD) 84(50.6%), diabetes mellitus 93(56.0%), hypertension 110(66.3%) and smoking status was 118(71.1%). Distribution of ventricular tachycardia was present among 103(62.0%) patients and was absent in 63(38.0%) patients. Conclusions: Ventricular tachycardia is the most common tachycardia occurring in patients in the first 48 hours who sustained myocardial infarction. It was shown that bradyarrhythmia was more common in patients with inferior wall myocardial infarction while ventricular tachycardia was found to be more in patients with anterior wall myocardial infarction.

Successful Treatment of a COVID 19-Associated Multisystem Thrombotic Event in a Young Patient in a Neurocritical Care Unit

AbstractThis case report describes a young patient with no comorbidities, who presented with two systemic thrombotic events within 24 hours of admission. She presented with a right middle cerebral artery territory infarct and developed an inferior wall myocardial infarction soon after. The hypotension was refractory to inotropes and required emergency intra-aortic balloon pump insertion. She was evaluated for prothrombotic states and other causes of stroke in young. However, the workup for the same was negative. Coronavirus disease-2019 immunoglobulin G antibody titer and inflammatory markers were found to be extremely elevated, which suggested recent severe infection. This case report throws light on the multidisciplinary management of thrombotic events, most probably secondary to coronavirus infection.

Inferior Subtle ST Elevation. Would You Activate Cardiac Catheterization Laboratory?

BackgroundAccording to guidelines, patients with inferior myocardial infarction only qualify for emergent reperfusion if they have at least 1 mm of ST elevation in two contiguous inferior leads. Although this has remained the standard for years, acute coronary occlusion may occur in patients with nondiagnostic ST elevation. Accordingly, a paradigm change is instigated, shifting the focus to physiopathology (occlusion myocardial infarction) rather than ST criteria. Case ReportA middle-aged man presented to our emergency department with chest pain and subtle nondiagnostic electrocardiography (ECG) changes in inferior leads. A careful examination of aVL to detect ST depression in this lead was the key to successfully diagnosing occlusion myocardial infarction, allowing early revascularization of an occluded right coronary artery. Why Should an Emergency Physician Be Aware of This?Accurate diagnosis of coronary occlusion by means of ECG can be challenging in certain situations, as acute myocardial ischemia may occur in patients with nondiagnostic ST elevation, especially in the inferior leads. A thorough examination of aVL searching for ST depression is essential in these situations.

Question: Uncommon masquerader of inferior STEMI.

A 54-year-old man brought into the emergency department with acute onset of chest pain. He had background history of hypertension. Physical examination was notable for an elevated blood pressure of 165/85 mmHg. His chest was clear to auscultation and his heart sound did not reveal any murmur. His electrocardiograph showed inferior ST Elevation Myocardial Infarction (STEMI) as shown in Figure 1A. Patient was transferred urgently to the catheterization laboratory for coronary angiography. Ultrasound guided vascular access was obtained in the right femoral artery. JL-4 catheter was used but noted to be catching in the ascending aorta. JR-4 guide into aortic root with non-selective shot is shown in Figure 1B (see Supplementary material online, Video S1). A pigtail aortogram was performed as shown in Figure 1C (see Supplementary material online, Video S2). ... Supplementary material is available at European Heart Journal: Acute Cardiovascular Care online.

Prediction of massive coronary thrombosis of the infarct-related artery in ST-elevation myocardial infarction.

Aim To identify clinical, laboratory and angiographic predictors for development of massive coronary thrombosis in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods This prospective, single-site study included 137 patients with STEMI (mean age, 66.5±13.2 years). Among these patients, 59 were in the group of massive coronary thrombosis and 78 patients were in the group of minor thrombosis. To identify predictors for the development of massive coronary thrombosis, medical history data, blood count and biochemistry, coagulogram, and angiography data were analyzed. A predictive model was constructed using the method of binary logistic regression followed by a search for the optimum value of the prognostic function with a ROC analysis.Results The study showed statistically significant roles of total bilirubin, platelets, prothrombin ratio (PTR), activated partial thromboplastin time (APTT), and presence of inferior myocardial infarction in prediction of massive coronary thrombosis in STEMI. The model sensitivity was 71.2 %, specificity 75.6 %, and overall diagnostic efficacy 73.7 %.Conclusion The predictive model for the development of massive coronary thrombosis in STEMI based on laboratory and instrumental data potentially allows assessing the thrombus load in the infarction-involved coronary artery and determining the optimum tactics of percutaneous coronary intervention in patients with STEMI. This reduces the probability of distal embolization with fragments of the disintegrated thrombus and improves the prognosis of STEMI patients both during the stay in the hospital and in the long-term. According to results of this study, the prognostic model for massive coronary thrombosis in STEMI based on such indexes as the platelet count, PTR, APTT, total bilirubin, and presence of inferior myocardial infarction provides accurate predictions in 73.7 % of cases. Independent predictors of massive coronary thrombosis were inferior myocardial infarction and total bilirubin.