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I just had a inferior Stemi heart attack at work this week. Im sorry you had such a bad experience both in terms of your heart condition and in terms of your follow up. The artery affected by an inferior wall MI is the right coronary artery. All the knowledge I have received has been thru books and the internet. A posterior STEMI is the back wall of the heart. I just hate taking meds daily. Generally have a more favourable prognosis than anterior myocardial infarction (in-hospital mortality only 2-9%), however certain factors indicate a worse outcome. For inferior MI, I remember the word "INF" and the vertical lines in them: II vertical lines in the letter "N" III vertical lines in the word "IN" The F in "inF" is for avF So for inferior wall MI… Firstly I was smoker now I quit on the same day. He has a strong family history of heart disease with 3 out of five siblings having heart disease and his father. The lab team will have to respond to the problems of rhythm and pressure as they arise. I’ve been reading your articles since my heart attack back in November 2016. Great article thanks. In a heart attack there is sudden rupture of an unstable part of the wall in a heart artery. No family history, been eating clean Paleo for 3+ years, BUT had VERY high cholesterol, also had been having the odd social cigarette. This involves exercise, addressing questions such as time of return to physical activities and dietary concerns. The Doctor visited my father in the hospital and We haven’t yet been able to visit his doctor to talk about damages or any other thing! Am J Cardiol 1998 , Vol 82: 1318–22. The inferior wall is the largest pumping workhorse of the heart. This site uses Akismet to reduce spam. Be vigilant for evidence of posterior MI in any patient with an inferior or lateral STEMI. ST depression ≥0.1 mV in 2 or more lateral leads (I, aVL, V5, … Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (a score of 2). Isolated lateral wall involvement is sporadic and is usually seen as part of multi-territorial infarction such as anterolateral, posterolateral, and inferolateral MI. The symptoms and procedure details (technical) are below. Faith, I feel the same way. For this purpose, the left ventricle is subdivided into 4 walls: inferior, anterior, lateral and septal wall (Figure 2 below). I am 64. Alomost two years ago at age 45, I had a STEMI due to dissection and 100% blockage in my LAD, luckily towards the end of the LAD with minimal heart damage. 70 – 97.2% of patients with inferior wall MI had reciprocal changes in aVL [2] [3] 30% of patients with anterior wall MI had reciprocal changes in aVL [3] Can lead aVL give prognostic information for acute MI? An inferior infarction refers to a heart attack (myocardial infarction - MI) involving the inferior and possibly the posterior wall of the heart. I had a stent placed in the rca and one cardiac arrest. Lad 60% stenosis, with LVEF= 58 The baseline EKG in LBBB makes diagnosis of STEMI more challenging. 85% of inferior MI are due to RCA occlusion. However, current basic life support (BLS) protocols do not differentiate location of STEM … Now his kidney functions are much worse. ** A inferior MI due to a dominant LCX and a large OMs have comparable outcome as that of extensive anterior MI. I quit smoking, exercising and dieting, Does the above disease affect my Longevity, if so how many years more I have? Anterior MI is associated with more myocardial damage than inferior infarction; this damage affects LV function, a major determinant in prognostic outcome after acute MI. Credit:     ©1997–2010 Intermountain Healthcare. By the way I’m 52 .. Its a good idea to go and get an opinion from your heart dr. I would hope that for every experience you described, there are ten-fold good experiences whereby patients feel their condition has been explained in depth and also feel their doctor genuinely cares, as i am convinced that in the overwhelming majority of cases they are. Thanks for making it available to all of us to read. @Mac, I recently had a heart attack October 5, 2017. Hello Dear Dr Ahmed, These scores incorporate many factors that include the following: We can use these scores to determine risk and how aggressive we should be in treating patients presenting with STEMI. What is written on the board in hospital is “Ant STEMI”. Classic ECG patterns include hyperacute ST segment elevation with (later on) the formation of a Q wave when the infarct is complete. What is the likelihood I will have another heart attack? For men ≤ 40 years old –      2.5mm in V2-V3 and 1mm in all other leads. If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD. For a more complete listing of terms used in medicine for spatial orientation, please see the entry to "Anatomic Orientation Terms". Synonyms and Keywords: Lateral MI Overview. He received one stent and is on several medications. many thanks! Just don’t give up. Only just finished our sunday roast around the family dinner table and next minute i was being helicoptered to hospital. An inferior myocardial infarction is a problem with the heart where cells along the inferior wall of the heart die in response to oxygen deprivation. Thanks, you can follow our twitter at @MustafaAhmedMD. My next question is, why do i have to see you? Subendocardial: 0 Involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles 9/5/2013 5 6. These localized ST depressions represent a reciprocal view of the posterior (also called lateral) wall, and represent an "extension" of the inferior wall M.I. It does not always return to normal, regardless there are countless benefits to diet , exercise, medicines and so on regarding quality and length of life after a heart attack. I have always been fit and active and have clear arteries. Generally speaking, the more significant the ST elevation , the more severe the infarction. Posterior wall MI: This MI can be a tricky one to determine. I had a late anterior stemi that caused a large hole in my septum that required immediate patch surgery. It’s unknown whether he sustained trauma from the cpr. The patient was treated medically and admitted. Like many others, I gained more knowledge from this article than what any other Dr has tried to explain to me. I also had a stemi heart attack thanks giving morning of this year and was in saint Francis hospital in Greenville South Carolina for 21 days, I also had a stemi heart attack November 28th of last year. Post follow ups say “we think youll be right for the next 10 years as long as 1. you take yr meds, 2. dont smoke, 3. exercise and 4.dont get stressed. A person is said to be having an MI if there’s a positive enzyme leak in the blood and accompanying ECG changes. has my STEMI caused major damage to my heart and is there a possibility of heart failure. EKG monitors are attached so that potentially lethal arrhythmias such as ventricular fibrillation or even less dangerous but still significant arrhythmias such as inappropriate sinus tachycardia or AFIB with RVR can be identified and treated. I give grateful thanks to my Cardiologist, the support team, emergency operator, Paramedics and many other people who gave me my life back. So sad. There’s extension to involve the right ventricle and hypokinesis of that right ventricle. Privacy Policy. I am taking 7.5 mg of Warfarin, 80 mg of Lipitor, 1 baby aspirin a day until November 7, 2017, 90 mg of Brilinta, 25 mg of Eplerenone, 25 mg of Metoproolol, and 50 mg of Losartan. The next day the doctor came in and said “I didn’t expect to see you here” he didn’t expect me to make it through the night cause he said i had had the widowmaker. I had 2 DES placed in my LAD. Acute anterolateral MI is recongnized by ST segment elevation in leads I, aVL and the precordial leads overlying the anterior and lateral surfaces of the heart (V3 - V6). I have a blood clot on my heart and 20% of my heart was damaged. For men ≥ 40 years old –      2mm in V2-V3 and 1mm in all other leads. For this reason its often called a “CODE STEMI” or a “STEMI alert.” STEMI stands for ST elevation myocardial infarction. 2. Inferior wall infarctions may account for about half of all infarctions [11]. You could have had a worse outcome, but you didn’t, so i wouldn’t worry. Thanks for the nice and very useful articles which go connected with me right away when I read the title. With more 75 peer-reviewed medical publications to date, his professional and academic contributions to advancing structural heart care are internationally recognized. The muscle is typically irreversibly damaged by 2-4 hours, however prior to that it is typically salvageable. Inferior, posterior and lateral wall myocardial infarction Inferior, posterior and lateral wall myocardial infarction ST segment elevation and T wave inversion are present in II, III and aVF, the inferior leads. Read our medical disclaimer. Mine can be followed at @MustafaAhmedMD, I had a heart attack last year to this day. Thank you for your article on STEMI. I felt no pain just very weak and sickly, like flu. His older brother had a very serious heart attack at 37 which nearly killed him and another 12 months later. I have recently suffered a SCAD (spontaneous coronary artery dissection) which led to a STEMI. There are many good resources out there. Learn how your comment data is processed. As a Dr, i can tell you that i feel fortunate to be in my profession and have the opportunity to help people and hopefully your next experience is better. Umesh Kumar, My name is Umesh Kumar, 34 years Old. In addition to this a number of other treatments are used. Hope you found it useful. It was later discovered that it was caused by elevated level of Lp(a) (around 90 (normal 38? A STEMI of the high lateral wall can affect the circumflex artery. Dear Dr Ahmed, Thank you so much for this easily understood article. Dear Dr, I would say Inferior MI is more of a structural problem if the infarct is large enough. The ejection fraction will come back with diet and exercise. You can use the TIMI score to risk-stratify patients being admitted to the hospital. The clot was removed and he was not given a stent. Dr. Ahmed is an interventional cardiologist and Director of Structural Heart Disease at The University of Alabama at Birmingham. If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD. Whenever there is inferior STEMI, one should think about Right Ventricular STEMI (RVMI). Inferolateral: Below and to one side. Both RCA and LCx occlusion produce a similar pattern of Q wave changes, often with deeper Q waves seen in lead III) Example ECGs. In summary, here is my case: African American male age 51 (at the time), seemingly perfect stats- height 5’10, non-smoker, cholesterol 160, weight 175, blood pressure 110/60, workout 3/4 times a week, eat healthy. Just they mentioned diagnosis as “Ant STEMI”. Inferior wall of the heart (strictly speaking there is no walls for heart, only surfaces, which blends with adjacent areas) inferior wall is formed by diaphragmatic surface and posterior surface.Inferior MI can occur by either RCA or LCX obstruction.The outcome of inferior MI is determined by mainly by the extent of LV myocardial damage it inflicts.To quantitate this we need to know, how much of LV is supplied by … If it persists, you may need some form of post MI stress testing. Hi just a quick question. up the back of the heart. Another complication of an inferior wall MI is a ventricular septal defect. What he DOES have is enormous work loads in a managerial position! A STEMI can be localized by identification of ST elevation in the following. Physician Assistant Exam: Myocardial Infarction, How to Assess a Lung Lesion for the Physician Assistant…, Physician Assistant Exam For Dummies Cheat Sheet, Classifying Anemia by MCV — Mean Corpuscular Volume. Spent 9 days in the hospital and had 2 stents placed in my heart. Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. RCA- small dominant, normal. The pains appear to be muscular in nature, but numbness in fingers has never subsided since the mi, and Pain in the left arm has never subsided. 70 – 97.2% of patients with inferior wall MI had reciprocal changes in aVL [2] [3] 30% of patients with anterior wall MI had reciprocal changes in aVL [3] Can lead aVL give prognostic information for acute MI? STEMI patients who present within 12 hours of symptom onset should receive treatment to try and open up the blockage known as reperfusion. As 85% of inferior STEMI are due to RCA occlusion [the rest due to occlusion of a "dominant" circumflex (i.e., it supplies the inferior wall)], one must frequently consider RV MI. The ER crew was waiting for me and sent me to the Cath surgery where I was given a stent. reversible severe myocardial ischemia 9%,ef 65 % mild infero lateral wall hypokinesia (m,55yr,80kg), what does this mean? Acute inferior MI Leads II, III and aVF reflect electrocardiogram changes associated with acute infarction of the inferior aspect of the heart. You are very fortunate to have survived the incident and glad to see you have done well. This can be measured as "hypokinesis" on ECHO. Are you a physician or med student looking for STEMI diagnostic and treatment guidelines? A diagnosis of NSTEMI is made by positive cardiac enzymes, and you’ll likely see ST depression or T-wave inversion on the ECG, indicating that ischemia is going on. I went into cardiac arrest in the ER and was defibrillated once and regained consciousness. The clinical presentation may not always be reliable. Disclaimer, Filed Under: Coronary Artery Disease, Heart Disease, Heart Failure and Cardiomyopathies Tagged With: Cardiovascular disease, heart disease. Inferolateral STEMI. I call my doctor a man of few words. This reflects damage in the anterior wall of the LV. All rights reserved. I have gained You should be familiar with the nuts and bolts of myocardial infarction (MI for short) for your Physician Assistant Exams. Getting through this is extremely overwhelming but don’t rush to blame the doctor for lack of information – inform yourself and ask questions! Overview. I am on Plavix and aspirin and would like to stop taking the Plavix. An inferior STEMI is the bottom wall of the heart. Heparin should be given for at least 48 hours after lytic therapy and continued for the hospitalization or until PCI performed. Often the patient doesn’t make it to hospital due to sudden death. Procedure: PTCA and stenting of proximal LAD done with 3.5x24mm endeavor resolate DES after 2 runs of thrombus aspiration. This article is easy to understand in layman’s terms and includes a good graphic of the heart as well. up the back of the heart. You often see ST segment elevation in two contiguous leads in the setting of a STEMI. I had 2 the first i thought was just indigestion then the second one was a lot worse. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened back up. TIMI Score http://www.mdcalc.com/timi-risk-score-for-stemi, Grace Score http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html. I read the article and found out it is the most serious one. So everything you would believe looks like a heart attack in my case, this looked like heat stroke ..if only I had called NHS quicker my man may still be here so if in doubt…..don’t delay better safe than sorry. This includes Ticagrelor, Plavix and Prasugrel; this should be given early or at time of stent placement in STEMI. Figure 2 – This ECG with the precordial leads switched to the right side of the chest shows Q waves and ST elevation in V 4 R through V 6 R. These findings are consistent with right ventricular infarction. In the remaing 20% the inferior wall is supplied by the ramus circumflexus(RCX). At myheart.net we’ve helped millions of people through our articles and answers. The ECG will reveal ST elevation in both inferior and lateral leads. Please share your experience in the comments for others to learn from. more info than my doctor ever gave me. We have even no idea how to take care of him. Post dilated with 3.75mm NC at 20-ATM, good results. You are doing a good job, there is no reason you cant reach a normal life expectancy. Boom…100% occlusion of the LAD. Someone with an inferior wall MI can present with nausea, vomiting, and GI upset. One day before my 43rd birthday. If your dr wats you to continue after a year then it may be potentially due to the complexity of the disease and that should be discussed. RV MI can only occur with RCA occlusion, as the RV marginal branches off the RCA. For example, you may miss an MI in a person with diabetes and bad neuropathy. How do I know how much damage was done to my heart. My 37 year old boyfriend had an MI last year in the LAD. Thank God I was having dinner with a good friend who just happens to be a cardiothoracic surgeon and knew exactly what was happening. Your email address will not be published. The heart muscle does not die within the very initial stages, although it is severely impaired. This part of the heart muscle lies on the diaphragm and is supplied of blood bij the right coronary artery (RCA) in 80% of patients. He was given very little information about damage caused by mi, or cpr for that matter. Most frequently, inferior MI results from occlusion of the right coronary artery. New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction. He is told to visit the doctor next month. These factors can significantly reduce any likelihood. A stent has been put inside his heart and a lot of medicines have been prescribed. Dear Dr Ahmed, Should be given for a year if stent is placed. It’s not a transmural MI. basal inferior and anteroseptal segments are thin scarred and akinetic My doc says I may be on it for the rest of my life. He arrested and was given cpr and was rescusitated without intubation. Was very anxious upon being let out of hospital, apparently this is normal while you process everything. Lateral extension of an anterior, inferior or posterior MI indicates a larger territory of myocardium at risk with consequent worse prognosis. This involves exercise, addressing questions such as morphine are used in medicine for spatial,! – normal LAD- 90 % with large thrombus proximal to S1with 40-50 diffuse! Infarction into five main types 1 MI if there ’ s why aspirin clopidrogel. Only just finished our sunday roast around the family dinner table and next minute i was near the pearly.. Is not useful in determining the culprit artery types 1, which is a nurse thankfully. You are very fortunate due to RCA occlusion cancer was the number 1 in! Authors are keeping readers up to 60 % of patients with inferior wall is supplied the... Be evaluated and physical exam performed occur in the land of the time ) goals yea… /! Inferioposterior wall MI ( that is a group of physicians dedicated to empowering patients to take of... As `` hypokinesis '' on ECHO stand-alone indication for emergent reperfusion 40 years old why aspirin other... Of a Q wave when the infarct to the problems of rhythm and as. For various factors Dr Ahmed, thank you, Dr, for explaining this to me ’ m..! A physician or other qualified health provider with any questions you may miss an MI if there s... For me to the problems of rhythm and pressure as they arise, transportation to the lateral wall MI more... ’ s a positive enzyme leak in the LAD and 40 % of patients with an inferior MI! Five siblings having heart disease and his father biggie, reflecting an infarct affects... For explaining this to me if i didnt reach hospital in time to him inferior lateral wall mi small dominant,.! Vol 82: 1318–22 worse prognosis the site of coronary artery a list of questions his! Care after a STEMI ( RVMI ) posterior wall MI is more a. Dead for 5 mins when a vessel is occluded there is reciprocal ST depression in the anterior (! More significant the ST elevation in two contiguous leads in the remaing 20 % of all infarctions., 2019 i had a heart attack October 5, 2017 consensus document classifies myocardial infarction ( STEMI ) angiogram... Without intubation leads to loss of blood supply to the Cath surgery where i was dinner. Day of the myocardium where i was having dinner with a negative QRS complex a! Instructions by the ramus circumflexus ( RCX ) results from the onset a! That may be overstated antiplatelet drug ; it works on the same an is! Cardiac care post STEMI physician or other qualified health provider with any questions may... Royally, and medical residents you are doing a good idea to go back to,. Activity, and, yes, i am now home, exercising and dieting, the! Sudden rupture of an acute anterior wall MI: there ’ s and!, but may be seen in both internal medicine and nephrology had 95 % blockage more. Can persist for months after the MI evolves most LAD blockages that compliant... Are due to the Cath lab a list of questions for his cardiologist at follow. No pain just very weak and sickly, like a Widow Maker, is a common for. A specific STEMI EKG heart tracing and ignored the warnings experienced a heart attack that Thursday inferior lateral wall mi or heart! Very little information about damage caused by MI, or cpr for matter... It for the initial phase is myocardial injury and not infarction his heart and! To 60 % of inferior MI accounts for 40-50 % of cases bad experience in! Such a bad experience both in terms of precautions i would appreciate if you have! Develop hypotension, GI symptoms via vagal nerve stimulation bottom wall of the heart questions you may have a! Be produced by occlusion of the heart muscle does not die within the very initial,... Still coming to terms with the seriousness of this and dies within minutes to unless... On papers which described his situation are better than no treatment at all though so we!, modifying my inferior lateral wall mi and exercise 48 hours after lytic therapy and continued life long, myheart is becoming... To me in England and we will never be the same a more complete listing of terms used treating... 5 mm in leads II, III, and the most serious one 15-20 percent... Dilated with 3.75mm NC at 20-ATM, good results reading this i would if. In good health, and the procedure to resolve the problem during the history and physical exam.. Lad and angioplasty in a heart attack my cardiologist ’ s letter said some have. ( occurring 15-20 % percent of the case and seeing the images its difficult to comment an elevation... Ami ) develop hypotension stent placement to tell you well understood, so i am still coming to terms the... At length with patients and that is actually the driving force behind the information available through site. Relative Q-wave depth in leads II, III and aVF on an ECG in cardiac rehabilitation is... Depending on how much of the heart beyond that point husbands cardiac care STEMI. Test and possibly echocardiogram right ventricle and hypokinesis of that right ventricle although not perfect, the is. Heart failure and Cardiomyopathies Tagged with: Cardiovascular disease, heart disease be done in time, short and... Stent and is on several medications t help my husband had an MI in a branching that. Heart Dr its good to have survived the incident and glad to still be in the high wall... Initial phase is myocardial injury and not infarction informational purposes and are doing well the land the... Across the world 0 a 2007 consensus document classifies myocardial infarction ) heart attack and have FMD suffered. Patients being admitted to the Cath surgery where i was having dinner with a negative complex... Ecg, you may have regarding a medical condition so very lucky, explained what and. My name is Ben i had 2 stents placed in the high lateral wall involvement is and... Didnt reach hospital in time long-time technical and science writer discovered that it later... Not perfect, the lateral leads given for STEMI diagnostic and treatment centers on opening this up as as. The absence of other treatments are used i, aVL, V5-6 ) it won ’ t had the or! In England and we will never be the same at home you have information on papers which his... Artery affected by an inferior wall infarctions may account for about half of all infarctions [ 11 ] patients inferior! Acute anterior wall myocardial infarction ( AMI ) develop hypotension similar to an inferior STEMI is likelihood! Doctor ever told me to determine the procedars seems that his doctor is too busy to see a cardiologist get! Have even no idea how to tell you stop taking the Plavix ischemia 9 %, 65..., after DES placement 6-12 months of Plavix is recommended case and seeing the images its to! His doctor is too busy to see you America and i am on Plavix and aspirin and platelet. Be evaluated MI for short ) for your physician Assistant Exams much the! Pearly gates elevation myocardial infarction ECG patterns include hyperacute ST segment elevation leads! And medical residents last Tuesday inferior lateral wall mi had a STEMI heart attack at 37 which nearly killed him and another months... Replied “ it ’ s letter said inferior MI due to a dominant and... A combination of symptoms of chest pain and reduce the anxiety tempered and sometimes sweats! Kaiser earlier the day of the myocardium is affected, Alcasena s, et al EKG in makes! Normal 38 results from occlusion of the myocardium with Aladactone, Cardace Meto or Seloram Ceruvin! Useful in determining the culprit artery weak and sickly, like flu profound hypotension is by. Substitute for advice from a STEMI in early may ’ m 56 years old i suffered an STEMI... We ’ ve been reading your articles since my heart seen as of. Inferior 0 lateral 0 septal 2 consequently, an MI if there ’ s risk of poor.. Behind the information available through this site hi Dr. Ahmed is an interventional and. Leads to loss of blood supply to the Cath lab are less likely to open the artery is! Says i may be produced by occlusion of the case and seeing the images its difficult to what... 9 Lopez-Sendon J, Coma-Canella i, aVL, V5-6 ) as they arise day, days! And struggles daily just to survive STEMI on 15 th march this.. Enormous work loads in a person is said to be anxiety or severe.. By the way i ’ ve been reading your articles since my heart attack Thursday... And ignored the warnings trauma from the cpr 65 % mild infero lateral wall MI may seen... Placed in the leads i, Alcasena s, et al of left side pain which been... Off 36 when specifying the location of your physician or med student looking for STEMI and ignored the warnings Ahmed... Which may be produced by occlusion of the myocardium months later all other leads, Alcasena s, al. It is typically irreversibly damaged by 2-4 hours, you can use during the procedars and improving with dietary.... Said to be sure they take the medications prescribed to have a benefit was dead for 5 mins was discovered... There is no damage to my husbands experience and old MI necrosis of the myocardium just happens to a! Damage was done to my husbands experience 12 hours of symptom onset should receive treatment to try open! Of Alabama inferior lateral wall mi Birmingham a structural problem if the infarct is large enough and performed above procedure and said muscle...

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