Posterior wall myocardial infarction: a case report/Infarkt zadnjeg zida miokarda: prikaz slucaja

Citation metadata

Authors: Milenko Cankovic, Snezana Bjelic, Vladimir Ivanovic, Anastazija STOJSIC Milosavljevic, Dalibor Somer and Milana Jarakovic
Date: January-February 2017
From: Medicinski Pregled(Vol. 70, Issue 1-2)
Publisher: Drustvo Lekara Vojvodine
Document Type: Case study; Report
Length: 2,925 words
Abstract :

Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1-V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1-V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy. Key words: Myocardial Infarction; Electrocardiography; Diagnosis; Coronary Angiography; Risk Assessment; Myocardial Revascularization; Myocardial Reperfusion; Diagnostic Errors; Prognosis Uvod. Akutni infarkt miokarda je klinicki oblik koronarne bolesti koja nastaje pri suzenju koronarnog krvnog suda ili njegovoj okluziji koji dovode do nastanka ireverzibilne ishemije miokarda. Elektrokardiografski registrovana depresija ST segmenta u odvodima V1-V3 ukazuje na ishemiju prednjeg, iako se zapravo radi o ST eleviranom infarktu miokarda zadnjeg zida. Izostanak jasne elevacije ST segmenta doprinosi da se on previdi, sto vodi drugacijem terapijskom algoritmu koji u znacajnoj meri moze da utice na ishod. Prikaz slucaja. Pacijentkinja starosti 77 godina primljena je u jedinicu intenzivne kardioloske nege zbog tegoba u vidu prolongiranog bola u grudima, pracenog mucninom, i elektrokardiografski registrovane horizontalne denivelacije ST segmenta u V1-V3 do 3 mm. Postavljena je dijagnoza ST eleviranog infarkta miokarda zadnjeg zida koji se komplikovao razvojem incipijentnog kardiogenog soka i ishemijske mitralne regurgitacije. Uradena je urgentna koronarografija i primarna perkutana koronarna intervencija sa implantacijom stenta u ramus circumfexus koja je bila infarktna arterija, a zbog visesudovne koronarne bolesti indikovana je hirurska revaskularizacija miokarda. Zakljucak. Transmuralni infarkt miokarda zadnjeg zida je najcesce previdena dijagnoza prilikom tumacenja 12-kanalnog elektrokardiograma. Rutinska upotreba dodatnih posteriornih (lateralnih) odvoda kod svih bolesnika sa bolom u grudima nema dijagnosticki i terapijski benefit, ali je indikovana kod sumnje na infarkt posteriornog ili lateralnog zida. Upotreba posteriornih odvoda povecava broj dijagnostikovanih ST eleviranih infarkta miokarda, sto doprinosi boljoj proceni rizika, prognozi i prezivljavaju zahvaljujucu reperfuzionoj terapiji. Kljucne reci: infarkt miokarda; elektrokardiogram; dijagnoza; koronarna angiografija; procena rizika; revaskularizacija miokarda; reperfuzija miokarda; greske u dijagnostikovanju; prognoza

Main content

Source Citation

Source Citation
Cankovic, Milenko, et al. "Posterior wall myocardial infarction: a case report/Infarkt zadnjeg zida miokarda: prikaz slucaja." Medicinski Pregled, vol. 70, no. 1-2, 2017, p. 44+. Accessed 6 Aug. 2020.
  

Gale Document Number: GALE|A493447804