Inferior MI: Difference between revisions

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{{Chapter|Myocardial Infarction}}
{{Chapter|Myocardial Infarction}}
'''ST elevation in II, III and aVF'''
'''ST elevation in II, III and aVF'''
[[image:V4R_occlusion.svg|thumb|ST elevation or depression in V4R can help in differentiating a RCA from a RCX occlusion.]]


This part of the heart muscle lies on the diaphragm and is supplied of blood bij the right coronary artery (RCA) in 8% of patients. In the remaing 20% the inferior wall is supplied by the ramus circumflexus(RCX).
This part of the heart muscle lies on the diaphragm and is supplied of blood bij the right coronary artery (RCA) in 80% of patients. In the remaing 20% the inferior wall is supplied by the ramus circumflexus(RCX).


An occlusion of the RCA can be distinguished of a RCX occulsuion on the ECG: in a RCA occlusion, there is ST depression in I and AvL and the ST-elevation is higher in III than in II. If the elevation is higher in II, suspect a RCX occlusion.
An occlusion of the RCA can be distinguished of a RCX occulusion on the ECG:<cite>Zimetbaum</cite>
;Distal RCA occlusion (sens 90%, spec 71%)
*ST segment elevation in III higher than ST segment elevation in II ("the highest elevation points at the culprit")and
*ST segment depression in I, AVL, or both (>1 mm)
;Proximal RCA occlusion (sens 79%, spec 100%)
*Additional ST segment elevation in V1, V4R or both
;RCX occlusion (sens 83%, spec 96%)
*ST segment elevation in I, AVL, V5, and V6 and
*ST segment depression in V1, V2, and V3
{{clr}}
{{clr}}
==Examples==
==Examples==
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Image:Ami0005.jpg|Posterior-lateral MI due to RCX occlusion
Image:Ami0005.jpg|Posterior-lateral MI due to RCX occlusion
</gallery>
</gallery>
==References==
<biblio>
#Zimetbaum pmid=12621138
</biblio>

Latest revision as of 09:51, 14 October 2007

This is part of: Myocardial Infarction

ST elevation in II, III and aVF

ST elevation or depression in V4R can help in differentiating a RCA from a RCX occlusion.

This part of the heart muscle lies on the diaphragm and is supplied of blood bij the right coronary artery (RCA) in 80% of patients. In the remaing 20% the inferior wall is supplied by the ramus circumflexus(RCX).

An occlusion of the RCA can be distinguished of a RCX occulusion on the ECG:[1]

Distal RCA occlusion (sens 90%, spec 71%)
  • ST segment elevation in III higher than ST segment elevation in II ("the highest elevation points at the culprit")and
  • ST segment depression in I, AVL, or both (>1 mm)
Proximal RCA occlusion (sens 79%, spec 100%)
  • Additional ST segment elevation in V1, V4R or both
RCX occlusion (sens 83%, spec 96%)
  • ST segment elevation in I, AVL, V5, and V6 and
  • ST segment depression in V1, V2, and V3


Examples

  • A typical example of an inferior wall infarction.]]

    A typical example of an inferior wall infarction.]]

  • Inferior-posterior MI due to RCA occlusion

    Inferior-posterior MI due to RCA occlusion

  • Inferior MI due to RCA occlusion

    Inferior MI due to RCA occlusion

  • Inferior MI due to RCX occlusion

    Inferior MI due to RCX occlusion

  • Posterior-lateral MI due to RCX occlusion

    Posterior-lateral MI due to RCX occlusion

References

  1. Zimetbaum PJ and Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med. 2003 Mar 6;348(10):933-40. DOI:10.1056/NEJMra022700 | PubMed ID:12621138 | HubMed [Zimetbaum]
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