The document provides information on inferior wall myocardial infarction (MI), including:
1. Definitions, epidemiology, etiology, clinical features, diagnosis, treatment and complications of inferior wall MI are discussed. Worldwide over 7 million people experience STEMIs or NSTEMIs annually.
2. Diagnosis involves ECG, cardiac imaging, cardiac biomarkers like troponin and CK-MB. Reperfusion therapy within 6 hours includes PCI or thrombolysis. General treatment measures include aspirin, clopidogrel, anticoagulants, analgesics, beta-blockers, nitrates and oxygen.
3. The history of pioneers in cardiology and development of techniques like echocardi
2. Sir William Osler said, “Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease
21. DEFINITION Criteria for Acute ,Evolving ,Recent MI : Either of the following criteria satisifies the diagnosis: 1.Typical rise and /or fall of biochemical markers of myocardial necrosis with atleast one of the following : A.Ischemic symptoms B.Development of the pathological q waves in the ECG. C.Ecg changes indicative of ischemia.(ST segment elevation or depression). D.Imaging evidence of new loss of viable myocardium or new RWMA. 2.Pathological findings of an acute myocardial infarction.
22.
23. Worldwide more than 3 million people have STEMIs and 4 million have NSTEMIs a year.
24.
25.
26. RVMI is present in one third of patients with IWMI ,but clinically significant in less than 50 % of the one third…. CMDT 2009.
27. AV block is more common than infranodal block and occurs in approximately 20% of IWMI. (infranodal – AWMI) ………CMDT 2009 .
70. In as many as 25% of elderly patients, a population in whom 50% of myocardial infarctions occur; in such patients, the diagnosis is often established only retrospectively, by applying electrocardiographic criteria or by scanning the patients using 2-dimensional (2D) echocardiography or magnetic resonance imaging (MRI).
82. Impaired right ventricular diastolic function also leads to systemic venous hypotension, edema, and hepatomegaly with abdominojugular reflux, which may result in saline-response underfilling of the LV and a concomitant reduction in cardiac output.
108. Assess the LV function secondary to RVMI --- in case of refractory to IV Fluids --- to rule out cardiogenic shock.
109. MRI with gadolinium contrast enhacement –most sensitive –2 gm of MI can be detected.
110. Techntium scan – hot spot with calcium – insensitive to small infarctions.
111.
112. Highly specific monoclonal antibodies - not normally detectable in the blood of the healthy individuals but may increase after STEMI to levels greater than 20 times.
194. Take home message Inferior wall MI presents with nausea and abdominal pain also. Inferior wall in 30-50% cases is assosciated with RV MI. Take right sided V4R in all the patients with IWMI. Presence of RVMI increases the mortality of the patients. IV fluids and inotropes,pacing play a equally contributing role in the management of patients on presentation. Recurrence of IWMI at the same site is more than in the anterior wall MI. Triad of raised JVP ,hypotension and clear lungs think of RVMI. PWMI in case of R wave in V1 with upright T wave and R/S ratio >1 V1 and V2..take leads V7-9.