Isolated posterior myocardial infarction is occurring in 3-11% of all infarctions. ST - segment depression in leads V1-V3 suggests myocardial ischaemia, especially when the terminal T - wave is positive (ST - segment elevation equivalent), and confirmation by concomitant ST-segment elevation ≥ 0,5mm recorded in leads V7-V9 should be considered as a mean to identify posterior myocardial infarction. Emergent coronary angiography and percutaneous coronary intervention of the infarct - related artery is indicated.
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Anamnesis:
63-years-old woman.
FH: Father and brother have overcome myocardial infarction.
PH: Common childhood illnesses, without history of arterial hypertension, diabetes mellitus, stroke, thyroid gland diseases, operations.
MH: Sine.
AH: Sine
SH, AH: Smoker, alcohol rarely, retiree.
GA: Menopause.
EH: Sine.
Chief complaints: 63 years old smoker, with positive family history of coronary artery disease, was admitted to the Clinic of cardiology for 18 hours lasting chest pain with propagation to the left hand and to the back. She indicates the progression of dyspnoe.
Laboratory results:
Initial examinations:
ECG in admission: SR, fr. 73/min, axis of the heart +40°, PQ 140ms, QRS 80ms, STD 2mm V1-V4, negative T wave in aVR, without ectopic rhythms. ECG including posterior leads V7-V9: STE 1mm and Q wave in V8 and V9.
Initial laboratory results:
Biochemical analysis: S-Alb ...43.9; S-ALT ...1.00; S-AST ...5.46; S-Bil-T ...16.6; S-CB ...72.2; S-CK ...83.06; S-CRP ...9.49; S-Gluk ...8.2; S-K ...3.2; S-Kreat ...63.5; S-Na ...130.9; S-PBNP ...3418.00; S-PCT ...0.024; S-TnT ...10.000; S-Urea ...7.06 ...12.41.
Blood count: APTT ...163.5; Fib ...4.37; Hct ...0.39; HGB ...13.40; PLT ...238; PT ...1.05; PT % ...92.00; RBC ...4.66; RDW ...13.4; WBC ...16.79;, S-HDL ...1.04; S-Chol ...8.69; S-LDL ...6.00; S-TG ...3.61.
Diagnosis and treatment:
According to previous examinations, the diagnosis of posterior myocardial infarction with ST - segment elevations, KILLIP II, was made. Patient received the medication of acute coronary syndrome: Brilique 180mg, ANP 200mg (p.o.) a Heparin 5000 IU (i.v.) and was indicated to emergent coronary angiography. Coronary angiography: Left main coronary artery: without stenosis. Left anterior descending artery: without stenosis. Circumflex coronary artery: proximal occlusion TIMI 0. Right coronary artery: dif. AS changes up to 50%.
Conclusion:
2 vessels disease Intervention: PPCI + POBA + 2x DES RCX-RMS1. Successive examination and the course of hospitalization: - Echocardiography – TTE (conclusion): LV without dilatation, mild hypertrophy of IVS, akinesis of lateral wall, LV EF 37-40%. Diastol. dysf. II-III. dg., LA without dilatation, mild MR, optimal systolic function of RV, doppler signs of mild pulmonary hypertension, without pericardial effusion.
Patient is going through rehabilitation. Without arrhythmias within hospitalization. She is discharged to outpatient care on the 5th day. Medical therapy in discharge: Anopyrin 100mg 0-1-0 (long-term), Brilique 90mg 1-0-1 (within 1 year), Nolpaza 20mg 1-0-0, Sortis 80mg 0-0-1, Concor 2,5mg 1/2-0-0, Gopten 0,5mg 1-0-0, Furon 40mg 1/2-0-0, Inspra 25mg 0-1-0.
Authors declare the case report will not be published in any national or international publications.
Classification ICD-10:
I21.2 Acute transmural myocardial infarction of other sites
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citation: Marianna Vachalcová: Posterior wall myocardial infarction. Multimedia support in the education of clinical and health care disciplines :: Portal of Pavol Jozef Šafárik University in Košice Faculty of Medicine [online] , [cit. 25. 11. 2024]. Available from WWW: https://portal.lf.upjs.sk/articles.php?aid=312. ISSN 1337-7000.