About-Cardio
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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Inferior Myocardial Infarction and ECG Interpretation
Introduction
Inferior Myocardial Infarction (IMI) refers to a heart attack affecting the inferior (lower) part of the left ventricle, usually supplied by the right coronary artery (RCA) or sometimes the left circumflex artery (LCx). Understanding its ECG presentation is crucial for early diagnosis and management.
ECG Features of Inferior MI
ST-Segment Elevation (STE)
- Seen in leads II, III, and aVF.
- ST elevation in lead III is usually greater than in lead II if the RCA is the culprit artery.
Reciprocal Changes
- ST depression in leads I and aVL.
- If the posterior wall is involved, ST depression may be seen in V1-V3.
Associated Right Ventricular Infarction (if RCA occlusion is proximal)
- Look for ST elevation in V1.
- Perform right-sided ECG to check for ST elevation in V4R.
Atrioventricular (AV) Conduction Blocks
- Inferior MI can affect the AV node, leading to bradycardia or high-degree AV block.
Differential Diagnosis
- Pericarditis – Diffuse ST elevation without reciprocal depression.
- Early repolarization – STE without reciprocal changes or clinical symptoms.
- Pulmonary embolism – May cause inferior lead T-wave inversions.
Management Considerations
- Immediate reperfusion with PCI (preferred) or fibrinolytics (if PCI unavailable).
- Avoid excessive nitrates and diuretics if right ventricular infarction is present.
- Monitor for complications such as cardiogenic shock or arrhythmias.
Conclusion
Recognizing an inferior MI on ECG is essential for timely intervention and reducing mortality. Always assess associated right ventricular or posterior involvement and manage accordingly.
Source recommendations
1. American Heart Association Guidelines on ST-Elevation Myocardial Infarction (STEMI)
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
- https://pubmed.ncbi.nlm.nih.gov/23256914/
2. European Society of Cardiology Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation
- https://pubmed.ncbi.nlm.nih.gov/28886621/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/39/2/119/4095042
- https://pubmed.ncbi.nlm.nih.gov/22922416/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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