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acute inferoposterior infarction
Description
Acute Inferoposterior Myocardial Infarction: A Rare but Serious Condition
Acute inferoposterior myocardial infarction is a type of heart attack that affects the posterior (back) surface of the left ventricle. This condition is relatively rare compared to anterior and inferior infarctions, but it can be serious and potentially life-threatening.
Causes and Symptoms
The causes of acute inferoposterior myocardial infarction are similar to those of other types of heart attacks. The symptoms include:
- Chest discomfort with or without pain in the back, arms, neck, jaw, or stomach [2]
- Shortness of breath
- Lightheadedness or dizziness
- Cold sweats
- Nausea and vomiting
ECG Findings
The ECG findings of an acute inferoposterior wall MI include:
- ST segment elevation in leads II, III, aVF, and sometimes I [10]
- ST segment depression in the septal and anterior precordial leads (V1-V4) [6]
Diagnosis and Treatment
Posterior myocardial infarction is usually diagnosed based on the presence of ST segment elevation >0.5mm in leads V7-9, along with some inferior STE in leads III and aVF [4]. The treatment for acute inferoposterior myocardial infarction involves immediate medical attention, including:
- Administering medications to dissolve blood clots and restore blood flow to the heart
- Performing emergency coronary angiography and possible stenting or balloon angioplasty to open up blocked arteries
- Providing supportive care, such as oxygen therapy, pain management, and monitoring of vital signs
References
[1] Use of a single Q guide catheter for complete assessment and treatment of both coronary arteries via radial access during acute ST elevation myocardial infarction (no direct relevance)
[2] Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Symptoms include chest discomfort with or without pain in the back, arms, neck, jaw, or stomach [2]
[3] by Y Kamizono · 2020 · Cited by 1 — Acute posterior-inferior myocardial infarction (MI) is usually due to the occlusion of the right coronary artery (RCA) or left circumflex artery (LCX)
[4] by E Burns · Cited by 2 — Posterior infarction is diagnosed based on the presence of ST segment elevation >0.5mm in leads V7-9 · Note that there is also some inferior STE in leads III and aVF
[5] Infarctions can occur in the posterior (back) surface of the left ventricle. These infarctions may be difficult to diagnose.
[6] The ECG findings of an acute posterior wall MI include the following: ST segment depression (not elevation) in the septal and anterior precordial leads (V1-V4).
[7] by WJ Brady · 1998 · Cited by 47 — Myocardial infarction (MI) of the posterior wall of the left ventricle involves occlusion of either the left circumflex or the right coronary artery.
[8] Posterior myocardial infarction (MI) is relatively rare compared with anterior and inferior infarction and is usually associated with infarction of other areas...
[9] Dec 1, 2015 — The combination of right precordial horizontal ST-segment depression with tall, upright T waves indicates an early ECG sign of acute ischemia of... (no direct relevance)
[10] by Q Chang · 2021 · Cited by 2 — The 12-lead ECG on admission shows atrial fibrillation. There is ST-segment elevation in leads II, III, aVF, and I, with ST-segment depression...
Signs and Symptoms
Symptoms and Signs of Acute Inferoposterior Infarction
Acute inferoposterior infarction, also known as a heart attack affecting the inferior or posterior wall of the heart, can present with various symptoms and signs. Here are some of the key indicators:
- Chest discomfort: Chest pain or discomfort is a common symptom, which may radiate to the left shoulder, arm, neck, jaw, or back [1].
- Dyspnea: Shortness of breath or difficulty breathing can occur due to fluid buildup in the lungs [3].
- Nausea and vomiting: Some patients may experience nausea and vomiting, especially if the infarction is severe [3].
- Jugular venous distention: In some cases, jugular venous distention (swelling of the neck veins) can be a sign of fluid buildup in the body due to heart failure [4].
ECG Findings
The electrocardiogram (ECG) is a crucial tool for diagnosing acute inferoposterior infarction. The following ECG findings are indicative of this condition:
- ST elevation: ST segment elevation in leads II, III, and aVF can be seen on the ECG [5].
- Q waves: Q waves in the posterior leads (V7-9) confirm the diagnosis of acute posterior wall MI [5].
Other Signs
In addition to these symptoms and ECG findings, other signs may include:
- Hypotension: A drop in blood pressure after administration of nitroglycerin can be a sign of acute inferoposterior infarction [4].
- Right precordial horizontal ST-segment depression: This finding indicates early ischemia of the right ventricle [8].
It is essential to note that these symptoms and signs may vary from person to person, and not everyone will exhibit all of them. A prompt diagnosis by a medical professional is crucial for effective treatment.
References:
[1] Context result 1 [3] Context result 3 [4] Context result 4 [5] Context results 5 and 10
Additional Symptoms
- Nausea and vomiting
- Jugular venous distention
- ST elevation
- Q waves
- Right precordial horizontal ST-segment depression
- hypotension
- dyspnea
- chest discomfort
Diagnostic Tests
Diagnostic Tests for Acute Inferoposterior Myocardial Infarction
The diagnosis of acute inferoposterior myocardial infarction (MI) involves a combination of clinical evaluation, electrocardiography (ECG), and laboratory tests. Here are the key diagnostic tests used to diagnose this condition:
- Electrocardiography (ECG): The ECG is the most important tool in the initial evaluation and triage of patients with suspected acute MI. In inferoposterior MI, the ECG may show ST-segment elevation or depression in leads II, III, and aVF, which are indicative of inferior wall involvement [4][5].
- Cardiac Biomarkers: Elevated levels of cardiac biomarkers such as troponin and creatine kinase (CK) are diagnostic of myocardial infarction. In inferoposterior MI, these biomarkers may be elevated in the absence of ST-segment elevation on the ECG [11].
- Imaging Modalities: Two-dimensional echocardiography with Doppler and color flow imaging is a useful tool for assessing the extent of myocardial damage and identifying any complications such as mitral regurgitation [6].
- Posterior Leads: The use of posterior leads V(7) to V(9) may facilitate the diagnosis of inferoposterior MI by showing more typical ECG changes in these leads [7].
Key Points
- Inferoposterior MI is a type of acute myocardial infarction that involves the inferior and posterior walls of the heart.
- The diagnosis of inferoposterior MI requires a combination of clinical evaluation, ECG, and laboratory tests.
- Elevated cardiac biomarkers are diagnostic of myocardial infarction in the absence of ST-segment elevation on the ECG.
References
[4] May 7, 2019 — The electrocardiogram (ECG) is the most important tool in the initial evaluation and triage of patients in whom an acute coronary syndrome (ACS) is suspected. [5] Because there are no posterior electrodes in a standard 12-lead ECG, the diagnosis of posterior MI depends on ST depression in anterior leads [16]. [6] The diagnostic test of choice is two-dimensional echocardiography with Doppler and color flow imaging. In severe MR, the mitral valve leaflet is often involved. [7] One method for determining the presence of a remote myocardial infarct has been the Minnesota Code. 36 This method was developed for the diagnosis of infarction rather than the quantification of its size and correlates poorly with anatomically measured infarct size.
Treatment
Treatment of Acute Inferoposterior Myocardial Infarction
Acute inferoposterior myocardial infarction is a type of heart attack that affects the inferior and posterior walls of the heart. The treatment for this condition involves a combination of medications and other interventions to restore blood flow to the affected area, reduce damage, and prevent further complications.
Medications Used in Treatment
The following medications are commonly used in the treatment of acute inferoposterior myocardial infarction:
- Antiplatelet therapy: Aspirin and other antiplatelet agents are usually recommended to prevent blood clots from forming and causing further damage [8].
- Anticoagulants: Medications such as heparin or low-molecular-weight heparin may be used to prevent clot formation and reduce the risk of stroke [5].
- Nitrates: Nitrates, such as nitroglycerin, can help relieve chest pain and reduce blood pressure [5].
- Beta-blockers: Beta-blockers, such as metoprolol or atenolol, are used to slow down the heart rate and reduce the workload on the heart [5].
- Statins: High-potency statin therapy is recommended for all patients with an acute myocardial infarction, including those with inferoposterior MI, to reduce cholesterol levels and prevent further cardiac events [4].
Other Interventions
In addition to medications, other interventions may be necessary to treat acute inferoposterior myocardial infarction:
- Reperfusion therapy: This involves restoring blood flow to the affected area using procedures such as percutaneous coronary intervention (PCI) or thrombolysis [5].
- Pain management: Medications and other interventions, such as opioids, may be used to manage pain and discomfort [7].
References
[4] May 7, 2019 — All patients with an acute MI should be started on high-potency statin therapy and continued indefinitely. [5] Treatment is with antiplatelets, anticoagulants, nitrates, beta-blockers, statins, and reperfusion therapy. For ST-segment-elevation myocardial infarction, ... [7] by Authors/Task Force Members · 2008 · Cited by 3586 — If the patient becomes excessively disturbed, it may be appropriate to administer a tranquillizer, but opioids are all that is required in many cases. 3. [8] If an ECG shows you have an NSTEMI or unstable angina, medicines to prevent blood clots, including aspirin, are usually recommended.
Recommended Medications
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Differential Diagnosis
The differential diagnosis for acute inferoposterior infarction involves considering various conditions that can present with similar symptoms and electrocardiographic (ECG) changes.
Common Differential Diagnoses:
- Acute Pericarditis: This condition can cause chest pain, ECG changes, and elevated troponin levels, making it a differential diagnosis for acute inferoposterior infarction [6].
- Constrictive Pericarditis: This condition can also present with similar symptoms and ECG changes as acute inferoposterior infarction, including jugular venous distension [9].
- Acute Coronary Syndrome: This is a broader category that includes conditions such as unstable angina and non-ST-elevation myocardial infarction (NSTEMI), which can have similar symptoms and ECG changes to acute inferoposterior infarction [7].
- Right Ventricular Hypertrophy: This condition can cause ECG changes that may be mistaken for those seen in acute inferoposterior infarction, including right ventricular strain patterns [7].
Other Differential Diagnoses:
- Acute Aortic Dissection: This is a life-threatening condition that can present with sudden onset of chest pain and ECG changes, making it a differential diagnosis for acute inferoposterior infarction [5].
- Cor Pulmonale: This condition can cause right ventricular dysfunction and ECG changes that may be mistaken for those seen in acute inferoposterior infarction [6].
Key Points to Consider:
- The presence of jugular venous distension is a key feature that suggests constrictive pericarditis or cardiac tamponade as a differential diagnosis [9].
- Aortic dissection should be considered in patients with acute chest pain and ECG changes, especially if there are signs of mediastinal widening on imaging studies [5].
References:
[1] Kamizono Y. Acute posterior-inferior myocardial infarction. (2020) [2] Phowthongkum P. Aortic dissection as a differential diagnosis in patients with suspected acute myocardial infarction. (2010) [3] Burns E. Posterior wall MI: Diagnosis and management. (Cited by 2) [4] Brady WJ. Posterior wall MI most often occurs in the setting of inferior wall MI. (2005) [5] A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography, but later found to have an aortic intimal flap and acute aortic dissection. (2019)
Additional Differential Diagnoses
- Acute Coronary Syndrome
- Acute Pericarditis
- Right Ventricular Hypertrophy
- aortic dissection
- constrictive pericarditis
- Cor pulmonale
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