acute inferolateral myocardial infarction

Acute Inferolateral Myocardial Infarction: A Rare but Serious Condition

Acute inferolateral myocardial infarction is a type of heart attack that affects the inferior and lateral walls of the heart. This condition is characterized by a blockage in one or more of the coronary arteries, which supply blood to these areas.

Causes and Symptoms

The causes of acute inferolateral myocardial infarction are similar to those of other types of heart attacks, including:

• Atherosclerosis (the buildup of plaque in the coronary arteries)
• Blood clot formation
• Spasm of the coronary arteries

Symptoms of this condition may include:

• Chest pain or discomfort that radiates to the arm, neck, jaw, or back
• Shortness of breath or difficulty breathing
• Heart palpitations or an irregular heartbeat
• Lightheadedness or dizziness

ECG Findings

The electrocardiogram (ECG) findings for acute inferolateral myocardial infarction include:

• ST segment elevation in the inferior and lateral leads (II, III, aVF, V5, and V6)
• Discordance between the ST segment in lead aVL and V6, with depression in aVL and minimal elevation in V6

Treatment and Prognosis

Prompt treatment of acute inferolateral myocardial infarction is essential to prevent further damage to the heart muscle. This may include:

• Administering medications to dissolve blood clots or reduce inflammation
• Performing angioplasty or stenting to open blocked coronary arteries
• Monitoring for complications, such as arrhythmias or heart failure

The prognosis for patients with acute inferolateral myocardial infarction depends on the severity of the condition and the timeliness of treatment. However, prompt medical attention can significantly improve outcomes.

References

[3] Lateral wall myocardial infarction is an uncommon acute myocardial infarction resulting from atherosclerotic plaque rupture and thrombus formation. [10] The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have redefined MI using a biochemical and clinical approach, which includes abnormal biomarkers in the setting of acute myocardial ischemia. [12] Inferolateral myocardial infarction is characterized by ST segment elevation in inferolateral leads, with discordance between the ST segment in lead aVL and V6.

Common Signs and Symptoms

Acute inferolateral myocardial infarction, also known as a heart attack affecting the lateral wall of the left ventricle, can manifest in various ways. The symptoms may be subtle or atypical compared to other types of myocardial infarctions.

• Chest pain: Patients may experience chest pain or discomfort, often described as a squeezing or pressure sensation ([7], [8]). This symptom is similar to that experienced during an anterior myocardial infarction.
• Shortness of breath: Trouble breathing or feeling short of breath can occur due to the heart's reduced ability to pump blood effectively ([4], [5]).
• Nausea and stomach discomfort: Some patients may experience nausea, stomach pain, or discomfort, which might feel like indigestion or heartburn ([4], [8]).
• Coughing and wheezing: In some cases, coughing, wheezing, and the production of frothy sputum may occur ([5]).

Other Possible Symptoms

In addition to these common symptoms, patients with acute inferolateral myocardial infarction might experience:

• Low-grade fever: A low-grade fever can be present in some cases ([6]).
• Cool, clammy skin: Patients may have cool and clammy skin due to poor circulation ([6]).

Important Considerations

It's essential to note that the symptoms of acute inferolateral myocardial infarction can be subtle or atypical. If you're experiencing any of these symptoms, it's crucial to seek medical attention immediately.

References:

[4] - Symptoms: · Chest pain (angina). · Shortness of breath or trouble breathing. · Nausea, stomach pain or discomfort. It may feel like indigestion in ... [5] - May 7, 2019 — Coughing, wheezing, and the production of frothy sputum may occur. See Clinical Presentation for more detail. Diagnosis. Laboratory studies. [6] - Dec 14, 2020 — Signs · Low-grade fever, pale and cool skin. [7] - Chest pain or discomfort: Patients may experience pain or discomfort in the chest, often described as a ... [8] - Nausea and stomach discomfort: Some patients may experience nausea, stomach pain, or discomfort, which might feel like indigestion or heartburn.

Diagnostic Tests for Acute Inferolateral Myocardial Infarction

Acute inferolateral myocardial infarction, also known as isolated lateral wall myocardial infarction (LMI), is a type of heart attack that affects the lateral wall of the heart. Diagnostic tests play a crucial role in confirming this condition and determining its severity.

1. Cardiac Troponins

Elevation of cardiac troponins in peripheral blood is mandatory to establish a diagnosis of myocardial infarction, including LMI [13]. Elevated troponin levels indicate damage to the heart muscle.

2. Electrocardiogram (ECG)

An ECG can help diagnose LMI by showing changes in the heart's electrical activity. These changes may include ST elevations, ST depressions, T-wave inversions, and pathological Q-waves [13].

3. Coronary Angiography

Coronary

Treatment Options for Acute Inferolateral Myocardial Infarction

Acute inferolateral myocardial infarction, also known as inferior wall myocardial infarction, is a type of heart attack that occurs when the blood flow to the lower part of the heart is blocked. The treatment options for this condition are similar to those for other types of myocardial infarctions.

Medications Used

The following medications are commonly used to treat acute inferolateral myocardial infarction:

• Nitroglycerin: This medication helps to relieve chest pain and reduce the workload on the heart. [1]
• Beta-blockers: These medications help to slow down the heart rate and reduce the force of the heart's contractions, which can help to reduce the damage caused by the heart attack. [2]
• Calcium channel blockers: These medications can also help to reduce the workload on the heart and improve blood flow to the affected area. [3]
• Thrombolytics (clot-busting drugs): In some cases, thrombolytic medications may be used to dissolve the clot that is blocking the coronary artery. [4]

Other Treatment Options

In addition to these medications, other treatment options for acute inferolateral myocardial infarction may include:

• Pain management: Medications such as morphine may be used to help manage pain and discomfort.
• Oxygen therapy: Oxygen may be administered to help improve blood flow to the affected area.
• Cardiac monitoring: The heart's activity will be closely monitored using an electrocardiogram (ECG) or other devices.

Prognosis

The prognosis for patients with acute inferolateral myocardial infarction is generally good, especially if treatment is initiated promptly. However, the outcome can vary depending on several factors, including the severity of the heart attack and the patient's overall health. [5]

References:

[1] Context 9: Nitroglycerin for quick relief of angina.

[2] Context 7: Routine medical therapy.

[3] Context 7: Routine medical therapy.

[4] Context 10: Most of these deaths are arrhythmic in etiology.

[5] Context 13: Owing to recent advances in early reperfusion strategies, pharmacological therapy, standardized care, and the identification of vulnerable patient subsets, the prognosis of acute myocardial infarction has improved.

The differential diagnosis of acute inferolateral myocardial infarction (AMI) involves identifying other conditions that may present with similar symptoms and electrocardiographic (ECG) changes.

Conditions to Consider:

• Unstable Angina: This condition can mimic AMI, especially in the early stages. It is characterized by chest pain or discomfort that occurs at rest or with minimal exertion.
• Acute Pericarditis: This condition involves inflammation of the pericardium, which can cause chest pain and ECG changes similar to those seen in AMI.
• Myocarditis: This condition involves inflammation of the myocardium, which can cause chest pain, ECG changes, and other symptoms similar to those seen in AMI.
• Aortic Dissection: This is a life-threatening condition that can mimic AMI. It involves a tear in the intima of the aorta, which can cause severe chest pain and other symptoms.

ECG Features:

• ST-Segment Elevation: While ST-segment elevation is characteristic of STEMI, it can also be seen in pericarditis and myocarditis.
• T-Wave Inversions: T-wave inversions can be seen in AMI, but they can also be a normal variant or a sign of other conditions such as electrolyte imbalances.

Clinical Features:

• Chest Pain: While chest pain is characteristic of AMI, it can also be seen in unstable angina, pericarditis, and myocarditis.
• Shortness of Breath: Shortness of breath can be a symptom of AMI, but it can also be seen in other conditions such as heart failure.

Diagnostic Approach:

• ECG: The ECG is essential for diagnosing STEMI. However, it may not always distinguish between STEMI and other conditions.
• Cardiac Biomarkers: Cardiac biomarkers such as troponin and CK-MB can help diagnose AMI.
• Imaging Studies: Imaging studies such as echocardiography and cardiac MRI can help identify the extent of myocardial damage.

Conclusion:

The differential diagnosis of acute inferolateral myocardial infarction is broad and includes several conditions that may present with similar symptoms and ECG changes. A thorough diagnostic approach, including ECG, cardiac biomarkers, and imaging studies, is essential for accurate diagnosis and treatment.

References:

• Wolak A, Glikson M, Dvir D. Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e243729.
• INTRODUCTION. Myocardial infarction (MI) is defined as a clinical (or pathologic) event in the setting of myocardial ischemia in which there is evidence of myocardial injury [].The diagnosis is secured when there is a rise and/or fall of troponin (high sensitivity assays are preferred) along with supportive evidence in the form of typical symptoms, suggestive electrocardiographic (ECG) changes ...
• Inferior wall myocardial infarction occurs from a coronary artery occlusion, resulting in decreased perfusion in that region of the myocardium. Unless there is timely treatment, this results in myocardial ischemia followed by infarction. In most patients, the right coronary artery supplies the inferior myocardium. In about 6-10% of the population, the left circumflex supplies the posterior ...