Lateral Myocardial Infarction (MI) on ECG

Introduction

Lateral Myocardial Infarction (MI) occurs when the blood supply to the lateral wall of the heart is blocked, most commonly due to a blockage in the left circumflex (LCx) artery or diagonal branches of the left anterior descending (LAD) artery.

ECG Features of Lateral MI

1. ST-Segment Elevation

  • Seen in leads I, aVL, V5, and V6.

    2. Reciprocal Changes

  • ST-segment depression in leads III and aVF, indicating opposing electrical activity from inferior leads.

    3. Q Waves (if present)

  • In I, aVL, V5, V6, suggestive of a completed infarction.

    4. T-wave Inversion (later stage)

  • Can develop in the affected leads as the infarction evolves.

Differential Diagnosis

  • Pericarditis: Diffuse ST elevation, usually without reciprocal ST depression.
  • Early Repolarization: Benign, especially in young individuals.
  • Left Ventricular Hypertrophy (LVH): Can mimic ST elevation in lateral leads.

Management of Lateral MI

Lateral MI requires urgent medical intervention as it can lead to complications such as heart failure or arrhythmias.

Immediate Treatment:

  • Aspirin + P2Y12 inhibitor (e.g., Clopidogrel, Ticagrelor).
  • Anticoagulation (e.g., Heparin).
  • Oxygen (if hypoxic).
  • Reperfusion therapy:
    • Primary PCI (preferred if available within 90 minutes).
    • Fibrinolysis (if PCI is unavailable).

Conclusion

Recognizing lateral MI on ECG is vital for early intervention and preventing complications. If you suspect a lateral MI, seek immediate medical attention.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) STEMI Guidelines

  1. https://www.acc.org/Guidelines
  2. https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
  3. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.005
  4. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
  5. https://pubmed.ncbi.nlm.nih.gov/23256914/

2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Coronary Syndromes

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
  2. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
  3. https://pubmed.ncbi.nlm.nih.gov/37622654/
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/14/01/2023-esc-guidelines-acs-esc-2023
  5. https://pubmed.ncbi.nlm.nih.gov/26320110/

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