Lateral Wall Myocardial Infarction Research Articles

Clinical, Demographic, and Angiographic Profiles of Amarnath Pilgrims Presenting With Acute Coronary Syndrome.

The challenges posed by high altitude are particularly significant in terms of cardiovascular health. There are currently no data available on acute coronary syndrome (ACS) among Amarnath pilgrims. The objective of this study was to investigate the clinical and angiographic profiles of ACS among Amarnath pilgrims, focusing on demographic characteristics, risk factors, types of ACS, clinical presentation, angiographic findings, and in-hospital outcomes. By examining these aspects, we aimed to provide insights into the unique challenges faced by pilgrims during their spiritual journey and to identify potential strategies for improving the prevention and management of ACS in this population. Methods: This was a hospital-based, prospective, observational study that included patients who had participated in the pilgrimage and presented with ACS between 2022 and 2023. Results: Sixty patients were recruited for the study, with a mean age of 51.19 ± 11.17 years. Of these, 43 (71.7%) were male. Risk factors identified in the study included hypertension in 35 (58.3%), smoking in 23 (38.3%), diabetes mellitus in 18 (30%), and dyslipidemia in 25 (41.6%) patients. ST-elevation myocardial infarction (STEMI) was present in 46 (76.66%) patients, Anterior wall myocardial infarction (AWMI) occurred in 29 (48.3%), inferior wall myocardial infarction (IWMI) in 15 (25%), and high lateral wall myocardial infarction (HLWMI) in two (3.3%) patients. Of the 60 patients, 19 (31.6%) were in Killip class I, 16 (26.6%) were in class II, and 25 (41.6%) were in classes III or IV. The average time from the onset of symptoms to hospitalization was 7.6 ± 3.1 hours, significantly higher in those with Killip class III or IV (9.3 ± 3.6 vs. 5.4 ± 2.7 hours, p = 0.01). There were nine (15%) in-hospital deaths, and in the multivariate analysis, advanced Killip class (p = 0.04) and delays in hospitalization of more than six hours (p = 0.03) were found to be significant predictors of mortality. In conclusion, 40% of patients presented in the advanced Killip class, and 15% experienced in-hospital mortality. The average time from the onset of symptoms to hospitalization was significantly higher for those categorized in the advanced Killip classes. Our study highlights a significant association between advanced Killip class, delay in hospitalization, and in-hospital mortality among Amarnath pilgrims with ACS, underscoring the importance of timely intervention. It is recommended that appropriate measures be taken to improve patient outcomes in these cases.

Endovascular treatment of subdural haematoma in patient under anti-platelet therapy: a case report

Introduction: The incidence of chronic subdural haematoma (cSDH) is relatively high among the elderly population. Other known risk factors for cSDH include male sex, dependency on anti-platelet or anticoagulant medication, and chronic alcoholism. Although, the standard mode of treatment for cSDH is surgery, embolization of the middle meningeal artery (MMA), either upfront or as an adjunct to surgical evacuation can be used for the treatment of cSDH. Case presentation: The authors present a case of a 75-year-old female with prior history of posterior-lateral wall myocardial infarction (MI) eight years back presented to our centre with the chief complaints of a gradual onset of cough and headache for 2 months. The patient had no history of trauma, loss of consciousness, seizures, and vomiting. There was no history of diabetes, hypertension, pulmonary tuberculosis, and other chronic illness. Discussion: The concurrent use of anti- platelet drug during a surgical procedure can make the treatment challenging. Endovascular treatment can be a primary treatment modality in such situation. Conclusion: Elimination of blood supply by middle meningeal artery embolization is emerging as a safe, minimally invasive alternative to treat cSDH.

An unintended connection – Radial arteriovenous fistula after coronary angiogram

Abstract The following case is of a 44-year-old female undergoing maintenance hemodialysis (MHD) due to chronic interstitial nephritis, utilizing a left brachiocephalic (BC) arteriovenous fistula (AVF). Following presentation with retrosternal anginal pain, diagnosed as high lateral wall myocardial infarction, coronary angiogram revealed normal coronaries. Subsequently, dilated veins along the right forearm were noticed, attributed to a patent right radiocephalic AVF. Despite being asymptomatic, the patient underwent a Doppler ultrasound confirming a blood flow of 400 ml/min through the AVF. No further intervention was planned as the patient continued MHD through the left BC AVF.

ST-Elevation Myocardial Infarction in Patient with Subarachnoid Hemorrhage

We present the case of a 35-year-old man with ST-elevation lateral wall myocardial infarction and Subarachnoid Hemorrhage (SAH) from a ruptured aneurysm of the Anterior Cerebral Artery (ACA). Before the stroke was diagnosed, Electrocardiography (ECG) was performed, which showed changes characteristic of lateral wall ST-elevation myocardial infarction. Therefore, coronary angiography was carried out, revealing no stenotic lesions in the coronary arteries. Myocardial necrosis was confirmed by high troponin I levels and akinesia of lateral wall segments found in echocardiography examination. Once SAH was diagnosed, percutaneous embolization of the aneurysm was performed. Despite all the medical interventions undertaken, the patient died.

Clinical profile of patients presenting with acute coronary syndromes at tertiary healthcare hospital in Northern Maharashtra

Background: ST-elevation myocardial infarction (MI) in very young patients has devastating consequences and causes a huge loss to the economy and productivity. However, data regarding demographic, clinical, and angiographic profile of this population are lacking in India as also in the western literature and characteristics of presentation with acute MI (AMI) in very young patients who have been inadequately studied. Aims and Objectives: The aims of this study were to assess the demographic, clinical, echocardiographic, and angiographic profile and risk factor pattern of patients with acute coronary symptoms at our tertiary healthcare providing hospital in Northern Maharashtra. Materials and Methods: It was a descriptive comparative study with longitudinal design that was carried out from January 2021 to December 2021 (1 year) in the emergency room and out-patient department of our tertiary healthcare providing hospital in Northern Maharashtra, conducted among 206 consecutive patients aged ≥18 years suspected to have AMI. Results: Among examinations and diagnostic workup, majority of the study subjects were diagnosed as ST elevation acute coronary syndromes (ACSs) (76.69%), out of which majority had anterior wall myocardial infarction (AWMI) (45.63%), followed by inferior wall MI (26.7%), lateral wall MI (4.37%). About 23.3% study subjects had non-ST elevation types of ACSs. Conclusions: The conventional risk factors are highly prevalent even among young patients with coronary artery disease. Despite all the recent advances, delayed presentation in ACS is unfortunately widespread. AWMI is more common, most of the patients have a single-vessel disease, and in-hospital mortality is low in this young population.

INVOLVED CULPRIT ARTERIES AND PROPORTION OF SPONTANEOUS ARTERIAL RECANALIZATION IN ACUTE LATERAL WALL MYOCARDIAL INFARCTION ADULT PATIENTS IN PAKISTAN

Objectives: To elucidate the involved culprit arteries and proportion of spontaneous arterial recanalization (SAR) in acute lateral wall myocardial infarction (ALWMI) patients in Pakistan. Methodology: This cross-sectional study was conducted in the outpatient department (OPD) of a tertiary care cardiac center from February 2019 to July 2019. Patients meeting selection criteria of ALWMI were included. Key angiographic outcomes were recorded for each patient. Proportion of SAR in terms of involved culprit arteries was assessed. Results: One hundred fifty two (152) patients were included, out of which 81% (124) were males. Mean age was 54.73 ± 11.03 years. Most (46.4%) of the study patients presented with single vessel disease. Overall, 89 (59%) patients showed SAR with settled ECG changes. Of them 73 (66%), 8 (33%) and 8 (47%) patients had diagonal artery involvement, 1st obtuse marginal artery involvement and ramus intermedius artery involvement respectively. Statistical significance (p=0.006) is observed for relationship of involved culprit arteries and SAR in ALWMI patients. Conclusion: This cross-sectional study reports the proportion of arterial recanalization in terms of involved culprit arteries. Diagonal was the culprit artery (~ 73%) in most patients presented with ALWMI. SAR proportion is also highest in patients with diagonal artery involvement. This tendency of SAR was more in single vessel diseases patients compared to double vessel and triple vessel diseases patients.

The South African flag sign-an electrocardiographic sign to predict the culprit artery.

We report a case of acute high lateral wall myocardial infarction with ST-segment elevation in leads I, aVL, and V2 with reciprocal ST-segment depression in the lead III. This pattern of ST-segment elevation and depression is called the South African flag sign as it occupies the middle green strip of the South African flag. This classic sign can help us localize the culprit artery, which is usually the first diagonal branch (D1) of the left anterior descending artery (LAD).

Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina

The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians with different specialties and experience. We performed an observational, cross-sectional study, with a comparative correlation and paired sampling. 56 physicians from a university hospital in Buenos Aires city were included: Cardiologists from the Coronary Care Unit (CCU) and Cardiology Division, Internal Medicine physicians from the hospitalization, ambulatory care and Emergency divisions, and third- and fourth-year Internal Medicine residents. Each participant analyzed 6 electrocardiograms and was asked to determine the magnitude of the ST-segment elevation at the J-point, and the corresponding diagnosis. The inter-rater coefficient was lower than 0.2, and the global kappa coefficient was 0.06 (p < 0.001). The global correct interpretations were: inferior wall myocardial infarction (MI): 89.3%; anterior wall MI: 51.8%; lateral wall MI: 75%; left bundle branch block: 91.1%; left ventricle hypertrophy: 44.6%; acute pericarditis: 25%. We believe that the low correlation was probably due to the difficulty in determining the J-point. These findings could suggest the need to strengthen the electrocardiographic concepts of ischemia, and the differentiation between ischemic and non-ischemic ST-segment elevations.

One year follow-up of post percutaneous transluminal coronary angioplasty in patients with coronary heart disease

Background: Globally, the Cardiovascular Diseases (CVDs) has become the number one cause of death. Antithrombotic therapy along with Percutaneous Coronary Intervention (PCI) is the most common preferred approach to improve clinical outcomes. Aims: To know the clinical end points of Myocardial infarction like unstable angina, congestive cardiac failure and death in post Percutaneous Transluminal Coronary Angioplasty (PTCA). Methodology: This study was designed as prospective observational study, carried out on myocardial infarction patients who have underwent PTCA surgery. These patients were subjected to detailed clinical examination with observation on signs of unstable angina, reinfarction and mortality. All the patients were called for follow up at 3, 6, and 12 months and they underwent clinical examination, ECG and 2D echo. The collected data was entered into excel chart and analysed using SPSS V.23. The Chi-square test was used and p-value less than 0.05 was considered as statistically significant. Results: A total of 240 patients were included with mean age of 56.7 ± 9.6 years with a range and gender ratio of 3.1:1. Around half of the patients had anterior wall Myocardial Infarction (MI), 31.2% had inferior wall MI and 13.8% had lateral wall MI. Nine (3.8%) patients had global ischemia. All patients had undergone PTCA surgery. At 12 months follow-up, 8.33% had angina, 5.8% had reinfarction and 3.3% died during the study period. Conclusion: Angioplasty in myocardial infarction cases is able to achieve good long-term results.

Demographic data and predictors of acute myocardial infarction in Egyptian young adults

Abstract Background Myocardial Infarction carries a significant morbidity, psychological effects, and financial constraints for the patient and the family when it occurs at young age. However there is limited data on the clinical features of young adults with AMI in Egypt and the Middle Eastern region. We therefore sought to investigate the clinical profile, risk factors and angiographic variables of this age group in Egypt. Aim of the Work To determine the clinical profile and prevalence of different risk factors including Cigarette Smoking, Tramadol use, Cannabis smoking, HDL & LDL levels, stressful lifestyle and bad sleeping habits in Egyptian patients presented with Myocardial Infarction for the first time at age ≤45 years. Methods We conducted a cross sectional observational study on 106 consecutive patients aged ≤45 years admitted with 1st time myocardial infarction in the period between February 2018 and August 2018 at Ain Shams University, Egypt. Clinical, and Angiographic variables were recorded from all patients. Results Out of 1207 patients admitted with 1st time MI, 106 were young that gave a prevalence of 8.8% in our center. Out of 106 patients, 101 were male. Mean age was 39.19 yrs. 71 patients had ST elevation myocardial infarction (MI) (67%) and 35 had non ST elevation MI (33%). Anterior wall MI was present in 49 patients (46.2%), inferior wall MI in 20 patients (18.9%) and lateral wall MI in 2 patients (1.9%). 93 patients (88%) were smokers, 31 patients (29.2%) were Tramadol users, 43 patients(40.6%) smoked cannabis, 50 patients (47.2%) had bad sleeping habits, 29 patients (27.4%) had high stress levels, 37 patients (34.9%) were hypertensive, 22 patients were diabetic (20.8%). Family history of CAD was present in 20 (18.9%) patients. Low High-density lipoprotein (HDL) was seen in 47 patients (44.3%), and high Low-density lipoprotein in 20 patients (18.9%). LAD was involved in 56% of patients, with a significant association between Tramadol use and LAD involvement. We found significant association between both Tramadol use and Cannabis smoking and the presence of Heavy thrombus burden in Coronary Angiography. Conclusion AMI in the young almost exclusively occurs in male, Anterior wall MI is most common, with LAD being involved in around half of patients. Smoking, hypertension, low HDL, Tramadol use, Cannabis smoking, and bad sleeping habits are the major risk factors. Tramadol use was associated with significant affection of LAD. Tramadol use and Cannabis smoking were associated with high thrombus burden on coronary angiography,

Myocardite aiguë induite par la cocaïne

Cocaine is a potent sympathomimetic drug usually associated with cardiotoxicity, including ventricular arrhythmia, systemic hypertension and acute myocardial infarction. It constitutes the most frequent cause of drug-related death reported by medical examiners in the US, and these events are most often related to the cardiovascular manifestations of the drug. However; to the best of our knowledge; cocaine induced acute myocarditis has very rarely been reported. We describe the case of a 19 year-old male regular user of marijuana and cocaine who was admitted for a suspicion on an acute lateral-wall myocardial infarction and in whom the final diagnosis of acute cocaine myocarditis has been made. We report diagnosis modalities and evolution.

Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina

The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians with different specialties and experience. We performed an observational, cross-sectional study, with a comparative correlation and paired sampling. 56 physicians from a university hospital in Buenos Aires city were included: Cardiologists from the Coronary Care Unit (CCU) and Cardiology Division, Internal Medicine physicians from the hospitalization, ambulatory care and Emergency divisions, and third- and fourth-year Internal Medicine residents. Each participant analyzed 6 electrocardiograms and was asked to determine the magnitude of the ST-segment elevation at the J-point, and the corresponding diagnosis. The inter-rater coefficient was lower than 0.2, and the global kappa coefficient was 0.06 (p < 0.001). The global correct interpretations were: inferior wall myocardial infarction (MI): 89.3%; anterior wall MI: 51.8%; lateral wall MI: 75%; left bundle branch block: 91.1%; left ventricle hypertrophy: 44.6%; acute pericarditis: 25%. We believe that the low correlation was probably due to the difficulty in determining the J-point. These findings could suggest the need to strengthen the electrocardiographic concepts of ischemia, and the differentiation between ischemic and non-ischemic ST-segment elevations.

Apical ballooning (takotsubo) syndrome with concurrent ST-segment elevation myocardial infarction

We present the case of a 61-year-old woman admitted with chest pain and an ECG demonstrating ST-segment elevation in the lateral leads. Emergency coronary angiography demonstrated an occluded obtuse marginal...

Occurrence of Kounis syndrome under anesthesia.

Occurrence of Kounis syndrome under anesthesia.

T wave abnormalities identify patients with previous lateral wall myocardial infarction and circumflex artery disease

BackgroundThe diagnosis of previous lateral myocardial infarction is based on QRS morphology. ObjectivesTo explore the diagnostic role of T wave abnormalities. MethodsWe studied 166 patients with known or suspected ischemic heart disease who underwent a 12-lead electrocardiogram, myocardial perfusion scintigraphy, and coronary arteriography within 90days. We excluded patients with bundle-branch block, hypertrophy, or paced rhythm. ResultsOnly one patient had a prominent R wave in V1, no patient showed lateral Q waves of necrosis. T wave amplitude in V2–V6 ≥0.6mV, and T wave amplitude in lead 1+V6 ≤0mV detected a lateral infarction (sensitivity 33 and 44%, specificity 83 and 80%). T wave amplitude in lead 1+V6 ≤0mV was the only independent predictor of infarction or LCx occlusion (AUC 0.72 and 0.74). Serum potassium values were not associated with T wave abnormalities. ConclusionT wave abnormalities identify previous lateral infarction and LCx disease.

Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement.

Background:Coronary artery disease (CAD) mostly occurs in persons older than 45 years of age. In India, CAD manifests almost a decade earlier than in Western countries. This study was done to study the risk factors and angiographic profile in young patients presenting with acute myocardial infarction (AMI).Patients and Methods:One hundred and twenty four consecutive patients presenting with AMI at less than 40 years of age were studied for risk factors. Coronary angiography was done in all.Results:Out of 124 patients, 123 were male. Mean age was 35.94 ± yrs. One hundred and eighteen had ST elevation myocardial infarction (MI) (95.16%) and six had non ST elevation MI (5.84%). Anterior wall MI was present in 88 patients (70.97%), inferior wall MI in 31 patients (25%) and lateral wall MI in five patients (4.03%). Seventy three patients (58.8%) were smoker, 55 were hypertensive (44.35%), 10 were diabetic (8.06%). Family history of CAD was present in 22 (17.7%) patients. Low High-density lipoprotein (HDL) was seen in 53 patients (42.7%), and high triglycerides in 60 patients (48.38%). Significant CAD was found in 88 (70.96%) patients, 13 (10.48%) had normal coronaries. Single vessel disease was seen in 57 patients, two-vessel disease in 15 patients and three-vessel disease in eight patients. Total 125 lesions were seen and left anterior descending (LAD) was the commonest vessel involved, with 78 lesions (62.4%).Conclusion:AMI in young almost exclusively occurs in male, and ST elevation MI is the main presentation. Anterior wall MI is most common, with LAD being involved in around 2/3 patients. Smoking, hypertension, low HDL and high triglycerides are the major risk factors.

Left arm–left leg lead reversal in a case of inferior wall myocardial infarction mimics as high lateral wall infarction

A 56-year-old male patient was admitted with an evolved inferior wall myocardial infarction (IWMI). Electrocardiogram (ECG) showed presence of ST elevation and T wave inversion in the inferior leads. ECG taken on the next day surprisingly showed features suggestive of acute high lateral wall myocardial infarction (LWMI), without features suggestive of re-infarction which was finally diagnosed to be an artefact due to lead reversal. Lead reversal between left arm and left leg can mimic as high LWMI in a case with IWMI and we should aware of this situation before misdiagnosing it as re-infarction.

A case of coronary-vertebral subclavian steal syndrome

A 59-year-old woman with type 2 diabetes and two-vessel disease had undergone double coronary bypass grafting (CABG) five years previously, with left internal mammary artery (LIMA) to left anterior descending (LAD) artery and free radial graft (Y type), from LIMA to obtuse marginal (OM). Three months ago, the patient began to suffer angina and episodes of dizziness after upper limb exercise, followed by a lateral wall myocardial infarction one month ago. Urgent femoral catheterization revealed thrombotic occlusion of the circumflex (Cx) artery; the LAD had an old occlusion and the LIMA could not be catheterized. The right coronary artery (RCA) was normal. Primary angioplasty of the culprit Cx was performed and two bare-metal stents were deployed. The acute chest pain resolved, but angina and dyspnea recurred one week later. Physical examination revealed absent pulses in the left arm. Cardiac CT angiography revealed abrupt occlusion of the left subclavian artery 1.8 cm after its origin, proximal to the LIMA and the ipsilateral vertebral artery. Both these arteries supplied a scant flow to the axillary artery (Figures 1 and 2), but the LIMA

Cardiac tamponade by myocardial rupture after acute myocardial infarction prevented by old thorax trauma

A 59-year-old man was admitted to our cardiology unit for an acute lateral wall myocardial infarction with ST-segment elevation on presenting electrocardiogram. His medical history reported a thoracic trauma with laceration of the pleura and pericardial effusion due to a penetrating knife injury, which was surgically treated >30 years ago. For his current diagnosis, the patient underwent primary percutaneous coronary intervention (PCI), with coronary stenting of the obtuse marginal branch of the LCx. Additionally, he received standard medical treatment including aspirin, clopidogrel, heparin, and a glycoprotein IIb/IIIa inhibitor. After successful …

Evaluation of the electrocardiogram in identifying and quantifying lateral involvement in nonanterior wall infarction using cardiovascular magnetic resonance imaging

PurposeThe objective of this study was to assess the involvement and extent of lateral wall myocardial infarction (MI) in patients with a first nonanterior wall MI, as reflected by changes in precordial leads. Delayed enhancement cardiac magnetic resonance imaging was used as a gold standard to localize and quantify myocardial scar tissue. MethodsElectrocardiogram and cardiac magnetic resonance were studied in 56 patients. Areas involved were related to QRS changes in precordial leads. ResultsSignificant correlations were found between lateral wall involvement and R waves in V1 and V6 (P = 0.009-0.022). For patients with circumflex branch occlusions, the MI size of the apical and lateral segments correlated strongly with the characteristics of R waves in V1 and V2 (P = 0.001-0.034). ConclusionsTall and broad R waves in V1 reflect lateral wall MI, especially in circumflex occlusions.