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.
Types of Myocardial Infarction (MI) in ECG
Introduction
Myocardial infarction (MI), commonly known as a heart attack, is a serious condition caused by a blockage in the coronary arteries. Different types of MI appear on an electrocardiogram (ECG) in distinct patterns. Understanding these patterns helps in diagnosis and treatment.
Classification of MI by ECG Changes
1. ST-Elevation Myocardial Infarction (STEMI)
- Characterized by significant ST-segment elevation in at least two contiguous leads.
- Indicates complete occlusion of a coronary artery.
- Requires immediate reperfusion therapy, such as percutaneous coronary intervention (PCI) or thrombolysis.
- Can present with Q waves, which develop later and indicate full-thickness myocardial necrosis.
2. Non-ST-Elevation Myocardial Infarction (NSTEMI)
- No ST-elevation; may show ST-segment depression, T-wave inversion, or subtle changes.
- Indicates partial occlusion of a coronary artery.
- Diagnosed mainly by elevated troponin levels and clinical symptoms.
- Managed with antiplatelet therapy, anticoagulants, and possible PCI.
3. Posterior Myocardial Infarction
- Usually an extension of an inferior or lateral MI.
- ECG may show ST depression in V1-V3, which represents the mirror image of an ST elevation.
- Confirmation with posterior leads (V7, V8, V9) may show ST elevation.
4. Right Ventricular Myocardial Infarction
- Commonly occurs with an inferior MI (affecting the right coronary artery).
- ECG changes seen in right-sided leads (V3R-V6R) with ST elevation.
- Important because it requires fluid resuscitation and avoidance of drugs that reduce preload (e.g., nitrates).
5. Wellens Syndrome (Impending Anterior MI)
- Characterized by deep, symmetric T-wave inversions in leads V2-V3.
- Suggests critical proximal left anterior descending (LAD) artery stenosis.
- High risk of progression to anterior MI if untreated.
Conclusion
Recognizing ECG patterns in myocardial infarction helps guide immediate medical decisions. A timely diagnosis increases the chances of survival and limits heart damage.
References to Clinical Guidelines
For detailed protocols on MI recognition and treatment, refer to:
Source recommendations
1. American Heart Association (AHA) 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/cir.0b013e3182742cf6
- https://pubmed.ncbi.nlm.nih.gov/23256914/
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Coronary Syndromes
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/44/38/3720/7243210
- https://pubmed.ncbi.nlm.nih.gov/37622654/
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/14/01/2023-esc-guidelines-acs-esc-2023
- https://pubmed.ncbi.nlm.nih.gov/26320110/
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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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