Posterior myocardial infarction

(Redirected from True posterior MI)
Jump to navigation Jump to search

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

Home

Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Cardiac MRI

Echocardiography

Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Antithrombins
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Overview
Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

Posterior myocardial infarction On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Posterior myocardial infarction

CDC on Posterior myocardial infarction

Posterior myocardial infarction in the news

Blogs on Posterior myocardial infarction

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for Posterior myocardial infarction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: posterior MI, true posterior MI

Overview

A posterior myocardial infarction (MI) is a heart attack or cessation of blood flow to the heart muscle that involves the backside or posterior side of the heart. Rather than causing the traditional ST segment elevation characteristic of the electrocardiogram of many heart attacks (a "STEMI"), because the heart attack is on the opposite side of the heart, the ST segments are depressed in the anterior precordial leads rather than elevated.

Pathophysiology

A posterior MI is due to occlusion of the left circumflex artery.

EKG Findings

EKG findings in the precordial leads V1-V3:

EKG Examples

Shown below is an EKG demonstrating changes during acute posterolateral MI depicting ST depression in precordial leads V2-V3.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG illustrating inferior-posterior myocardial infarction with complete AV block and ventricular escape rhythm with RBBB pattern and left axis, followed by sinus rhythm.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG demonstrating atrial fibrillation and inferior-posterior myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG demonstrating atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete right bundle branch block. Lead I shows ST depression, suggestive of right coronary artery involvement.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG demonstrating ST elevation in leads II, III and aVF and ST depression in leads V1, V2 and V3 depicting a posterior MI.

Angiography

Posterior MI results from the total occlusion of either the right coronary artery or the left circumflex.

Shown below are an animated image and a static image depicting PERFUSE grade 6 thrombus in the RCA. Encircled in yellow in the image on the right is the thrombus area where you can notice an abrupt blunt cut-off appearance beyond which no dye is penetrating the artery.

PERFUSE grade 6 thrombus in the RCA PERFUSE grade 6 thrombus in the RCA


Shown below are two animated images of the same case depicting TIMI grade 6 thrombus in the left circumflex. The image on the left shows the same thrombus before PCI and the image on the left shows the patent left circumflex after PCI.

TIMI grade 6 thrombus in the left circumflex before PCI TIMI grade 6 thrombus in the left circumflex after PCI

References

  1. Pride YB, Tung P, Mohanavelu S, Zorkun C, Wiviott SD, Antman EM; et al. (2010). "Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression: a TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38) substudy". JACC Cardiovasc Interv. 3 (8): 806–11. doi:10.1016/j.jcin.2010.05.012. PMID 20723851.

Template:WH Template:WS