DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20205012

Clinical profile of patients with inferolateral myocardial infarction: a comparison study

Sibaram Panda, Sunil Kumar Jena, Uttam Kumar Pattanaik

Abstract


Background: Patient with lateral wall changes in inferior wall myocardial infarction (MI) usually ignored most often. However above lateral MI changes in the clinical setting of inferior wall MI usually impact on final clinical outcome and prognosis of the patients. Our aim of the study is observe diversity in clinical profile of inferolateral MI in comparison to patient with inferior wall without any lateral wall MI changes.

Methods: Current study enrolled 405 patients admitted to cardiology emergency with inferior wall MI. Patients divided into three groups on the basis of ECG changes, inferolateral (group A), isolated inferior wall MI (group B) and inferior wall MI with RVMI (group C). Patients with RVMI (group C) excluded from the group. Clinical profile and outcomes compared between group A and B.

Results: Around 33.8% pts with inferior wall STEMI have ECG changes of lateral wall AMI. STEMI equivalent in lead V1, V2 which is the most common ECG presentation, seen in 65% inferolateral patients. 45.7% of population of inferolateral MI are above age group of 60 years. 66.2 % of the patients with inferolateral MI having two or more risk factors. Dyspnoea is one of common symptom seen in 29.9% patients. Statistically significant number of patients in inferlateral MI have clinical picture of LVF (crepitation, S3), higher Killip class as compared to inferior wall MI. Incidence of complications like LVF, MR, VT, death is significantly higher in this group.

Conclusions: Around 1/3rd patient with lateral MI changes seen in inferior wall MI patients. STEMI equivalent changes in anterior precordial leads are most common ECG presentation. More no patients are older and with multiple risk factors. Complication and death are higher in this group. So meticulous attention should be given to patients with lateral wall MI changes in inferior wall MI.

 


Keywords


Lateral wall MI, STEMI equivalent in anterior precordial leads, Dyspnoea, Mitral regurgitation, Left ventricular failure, Mortality

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References


ayés de Luna A. New heart wall terminology and new electrocardiographic classification of Q-wave myocardial infarction based on correlations with magnetic resonance imaging. Rev Esp Cardiol. 2007;60(7):683-9.

Bayés de Luna A, Wagner G, Birnbaum Y, Nikus K, Fiol M, Gorgels A, et al. A new terminology for left ventricular walls and location of myocardial infarcts that present Q wave based on the standard of cardiac magnetic resonance imaging: a statement for healthcare professionals from a committee appointed by the International Society for Holter and Noninvasive Electrocardiography. Circulation. 2006;114(16):1755-60.

Peterson ED. Prognostic significance of precordial ST segment depression during inferior myocardial infarction in the thrombolytic era: J Am Coll Cardiol. 1996;28(2):305-12.

Oraii S, Maleki M, Tavakolian AA, Eftekharzadeh M, Kamangar F, Mirhaji P. Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction. J Electrocardiol. 1999;32(3):275-8.

Adawi K, Atar S. Clinical implications and angiographic and electrocardiographic correlation of ST segment elevation in leads V7-V9 in patients with ST elevation myocardial infarction. Harefuah. 2008;147(7):587-90.

Patel ND, Barreiro CJ, Williams JA, Weiss ES, Conte JV, Nwakanma LU. Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration. Ann Thorac Surg. 2007;83 (6):P2017-28.

Matetzky S, Freimark D, Chouraqui P, Rabinowitz B, Rath S, Kaplinsky E, Hod H. Significance of ST segment elevations in posterior chest leads (V7 to V9) in patients with acute inferior myocardial infarction: application for thrombolytic therapy. J Am Coll Cardiol. 1998;31(3):506-11.

Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J. 2003;79(935):490-504.

Berger PB, Ryan TJ. Clinical progress series of inferior myocardial infarction in high-risk subgroups: Circulation. 1990;81(2):401-11.