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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.
Septal Myocardial Infarction on ECG
Introduction
A septal myocardial infarction (MI) refers to a heart attack that affects the septum, the wall separating the left and right ventricles of the heart. Diagnosing a septal MI using an electrocardiogram (ECG) is crucial for timely treatment and intervention.
ECG Findings in Septal MI
1. ST-Segment Elevation
- In leads V1 and V2, which correspond to the septal region, you may observe ST-segment elevation, indicating acute myocardial injury.
2. Pathological Q Waves
- Over time, pathological Q waves may appear in V1–V2, signifying necrosis of the septal myocardium.
3. T-Wave Changes
- Initially, hyperacute T-waves may be seen.
- Later stages may show T-wave inversion, which suggests ongoing ischemia or reperfusion.
4. Reciprocal Changes
- Sometimes, ST-segment depression in lateral leads (I, aVL, V5, and V6) may appear as a reciprocal change.
Differential Diagnosis
It is important to differentiate septal MI from other conditions that affect the septal leads, such as: - Left bundle branch block (LBBB) - Right ventricular hypertrophy (RVH) - Brugada syndrome - Pulmonary embolism (may show ST changes but has different clinical presentation)
Clinical Considerations
- Symptoms: Patients may experience chest pain, shortness of breath, sweating, nausea, or dizziness.
- Risk Factors: Smoking, diabetes, hypertension, hyperlipidemia, and family history of heart disease.
- Management: Immediate medical intervention with aspirin, oxygen, nitrates (if no contraindications), and possible percutaneous coronary intervention (PCI) or thrombolysis if PCI is not available.
Conclusion
Recognizing the ECG patterns of septal MI is essential for accurate diagnosis and timely treatment. If you suspect a septal MI, immediate medical evaluation and intervention are required to minimize heart muscle damage and improve outcomes.
Source recommendations
1. American Heart Association Guidelines for the Management of ST-Elevation Myocardial Infarction
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://pubmed.ncbi.nlm.nih.gov/23256914/
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
2. European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation
- https://pubmed.ncbi.nlm.nih.gov/32860058/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://pubmed.ncbi.nlm.nih.gov/26320110/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/21873419/
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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.
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