Lateral Wall Myocardial Infarction (MI) on ECG

Introduction

Lateral wall MI refers to the infarction of the lateral portion of the left ventricle, typically caused by occlusion of the left circumflex (LCx) artery or a branch of the left anterior descending (LAD) artery.

ECG Changes in Lateral Wall MI

To diagnose lateral wall MI, it is essential to look for characteristic ECG changes:

1. ST-Segment Elevation (STE)

  • Typically seen in leads I, aVL, V5, and V6.
  • These leads correspond to the lateral wall of the heart.

2. Reciprocal Changes

  • ST-segment depression may be observed in the inferior leads (III, aVF), which suggests reciprocal changes due to the lateral wall infarction.

3. Q-Waves (Late Finding)

  • Pathological Q waves may develop in leads I, aVL, V5, V6 over time, indicating myocardial necrosis.

Possible Complications

Lateral wall MI can lead to complications such as: - Heart failure due to impaired left ventricular function. - Arrhythmias, including atrial fibrillation or ventricular tachycardia. - Mitral regurgitation (if the papillary muscles are affected). - Cardiogenic shock in severe cases.

Management Strategy

Immediate management follows the acute coronary syndrome (ACS) protocol, including: 1. MONA: Morphine, Oxygen, Nitrates, Aspirin. 2. Dual Antiplatelet Therapy (DAPT): Aspirin + P2Y12 inhibitor. 3. Anticoagulation: Heparin or Enoxaparin. 4. Revascularization: Either primary PCI (preferred) or thrombolysis if PCI is unavailable.

Conclusion

Lateral wall MI is a serious cardiac event diagnosed primarily via ECG with ST-segment elevations in lateral leads. Prompt intervention with reperfusion therapy and supportive care improves outcomes significantly.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of ST-Elevation Myocardial Infarction

  1. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
  2. https://pubmed.ncbi.nlm.nih.gov/15289388/
  3. https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
  4. https://pubmed.ncbi.nlm.nih.gov/23256914/
  5. https://www.sciencedirect.com/science/article/pii/S073510972106157X

2. European Society of Cardiology 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://academic.oup.com/eurheartj/article/42/14/1289/5898842
  5. https://pubmed.ncbi.nlm.nih.gov/21873419/

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