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Simultaneous anterior and inferior wall MI
A 48 yr old male smoker developed acute onset chest pain. ECG no 1 is at presentation and no 2 within 15 minutes. he was thrombolysed with tenecteplase. ECG no 3 is post thrombolysis and taken on day 2. pateint did well after thrombolysis with no post infarction angina or LVF. unfortunately a coronary angiogram could not be done.
what do you interpret from this challenging ECG? what is the frequency of simultaneous anterior and inferior infarction and possible mechanisms behind this? what are your comments regarding the markedly deep t wave inversions in precordial leads? and what is the rhythm in ecg no 2?
Tags: ACS, MI, anterior, infarction, inferior, simultaneous, thrombolysis
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Permalink Reply by Ayman Tantawy on -
Its very difficult to have 2 acute thrombosis at the same time in LAD and RCA but possibly this ecg might be due to suboccluded LAD for long time with presence of collaterals between LAD and RCA (mostly the anastomosis in interventricular septum) so if a thrombus occlude RCA it will affect also the LAD as the LAD is dependant on RCA and the ECG will show elevation in anterior and inferior leads.
I think Cath will show subtotal or total occlusion of LAD( poor distal run off) with occlusion of RCA.
what are opinions of you professors.
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Permalink Reply by Ayman Tantawy on
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as regard ECG its not apparent here i can only count HR 50pbm. anterior leads show severe ischemia
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Permalink Reply by NIKHIL CHOUDHARY on -
ecg 2 had not been uploaded correctly by the site. plz have a look again.
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Permalink Reply by Iftikhar Ahmad Khan on -
hi , nice ECGs , well i do agree with dr tantawy idea that it may be development of collaterals from RCA to a totally or sub totally occluded LAD , but i think its the other way round , cause if u see the ST are up far more in the LAD than RCA ,i previously hypo perfused area wont produce that much of ST s , the ST in RCA territory are not that high , but the bottom line is History , did he had previous ischemia . an angiogram will resolve the issue, or it could be a LMS occlusion with a dominant left side circulation with PDA arising from CIRC.
