Study of electrocardiographic differentiation between RCA and LCx occlusion in isolated inferior wall myocardial infarction

Authors

  • Manish Pendse Department of Medicine, D.Y. Patil Hospital and Research Centre, Nerul, Navi-Mumbai, Maharashtra
  • Gayatri Pendse Department of Medicine, D.Y. Patil Hospital and Research Centre, Nerul, Navi-Mumbai, Maharashtra
  • Dhaval Dave Department of Medicine, D.Y. Patil Hospital and Research Centre, Nerul, Navi-Mumbai, Maharashtra
  • Prashant Kashyap Department of Medicine, D.Y. Patil Hospital and Research Centre, Nerul, Navi-Mumbai, Maharashtra

DOI:

https://doi.org/10.18203/2320-6012.ijrms20162240

Keywords:

Inferior wall myocardial infarction, Electrocardiography, Right coronary artery, Left circumflex coronary artery

Abstract

Background: Inferior myocardial infarctions account for 40 to 50% of all acute myocardial infarctions and are generally viewed as having a more favorable prognosis than anterior wall infarctions. The management, and in some instances, prevention of these complications, may be facilitated by early differentiation between AMI caused by RCA versus left circumflex coronary artery occlusion. These can be diagnosed from the electrocardiography (ECG) which remains a valuable and most widely used rational modality to diagnose and risk stratifying in an acute setting. The present study helps in Electrocardiographic differentiation between right coronary and the left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction.

Methods: The present study entitled “Electrocardiographic differentiation between right coronary and the left circumflex coronary arterial occlusion in isolated inferior wail myocardial infarction” was conducted from June 2007 to November 2009 at the Department of Medicine and Cardiology, Dr. D.Y. Patil Hospital and Research Center, Nerul, Navi Mumbai, Maharashtra, India.

Results: Out of 52 patients of acute inferior wall myocardial infraction, 41 were males and 11 were females. Thus the male to female ratio is 3.72:1. In the above table, the ST segment elevation in lead III was more than lead ii in42 patients. All these 42 patients were found to have RCA as the culprit vessel. The St Segment elevation in lead II was more than lead III in 9 patients. All these 9 patients were found to have LCx as the culprit vessel.

Conclusions: The incidence of acute inferior wall myocardial infarction is highest in age group of 50 to 59 years. The ST segment elevation in acute isolated inferior wall myocardial infarction was greater in lead III than in lead II when right coronary artery was the culprit vessel and vice versa when the left circumflex coronary artery was the culprit vessel. ST segment depression in lead I was common when the right coronary artery was the culprit vessel and not seen with left circumflex coronary artery occlusion. An upright T wave in lead V4R in acute isolated inferior wall myocardial infarction was common when the right coronary artery was the culprit vessel and not seen with left circumflex coronary artery occlusion.

 

References

Berger PB, Ryan TJ. Inferior myocardial infarction: high risk group. Circulation. 1990;81:401-11.

Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986;1:397-402.

ISIS-2 [second international study of infarct survival] collaborative group : Randomised trial of intravenous streptokinase, oral aspirin, both or either among 17187 cases of suspected acute myocardial infarction. Lancet. 1988;2:349-60.

Gupta A, Lokhandwala YY, Kerkar PG, Vora AM. Electrocardiographic Differentiation between right coronary and left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction. Indian Heart Journal. 1999;51:281-4.

Berger PB, Ruocco NA Jr, Ryan TJ, Jacobs AK, Zaret BL, Wackers FJ, et al Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy [results from thrombolysis in myocardial infarction [TIMI] II trial] Am J Cardiol. 1993;71:1148-52.

Kinch JW, Ryan TJ. Right ventricular infarction, NEJM 1994;330:1211-7.

Assali AR, Herz I, Vaturi M, Adler Y, Solodky A, Birnbaum Y, et al, Electrocardiographic criteria for predicting the culprit artery in inferior wall myocardial infarction, Am J Cardiol. 1999;84:87-8.

Zimetbaum PJ, Krishnan S, Gold A, Carrozza JP, Josephson ME. Usefulness of ST segment elevation in lead III exceeding that in lead II for identifying the culprit vessel in inferior wall myocardial infarction. Am J Cardiol. 1988;81:918-9.

Nair R, Glancy D. ECG discrimination between right coronary and left circumflex coronary arterial occlusion in patients with acute inferior wall myocardial infarction. Value of old criteria and use of lead V4R. Chest. 2002;122:134-9.

Saw J, Davies C, Fung A. Value of ST segment elevation in lead III greater than lead II in inferior wall myocardial infarction for predicting the site of lesion. Bayes de Luna A, clinical electrocardiography: A textbook, 2nd Edition, Armonk NY. 1998:3-26.

Chia BL, Yip JW, Tan HC, Usefulness of ST segment III/II ratio and ST segment deviation in lead I for identifying the culprit vessel in acute inferior wall myocardial infarction. Am J Cardiol 2000;86:341-3.

Fiol M, Carrillo A, Cygankiewicz I, Ayestarán J, Caldés O, Peral V,et al, New criteria based on ST changes in 12 lead surface ECG to detect proximal vs distal right coronary artery occlusion in cases of acute inferior wall myocardial infarction. Ann Noninvasive Electrocardiol. 2004;9(4):383-8.

Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol. 1997;80:1343-5.

Kosuge M, Kimura K, Ishikawa T, Hongo Y, Mochida Y, Sugiyama M, et al, New electrocardiographic criteria for predicting the site of lesion in acute inferior wall myocardial infarction. Am J Cardiol. 1998;82:1318-22.

Bairey CN, Shah PK, Lew AS, Hulse S. Electrocardiographic differentiation between occlusion of left circumflex coronary artery and right coronary artery as a cause of inferior acute myocardial infarction. Am J Cardiol. 1987;60:456-9.

Kontos MC, Desai PV, Jesse RL. Usefulness of admission electrocardiogram for identifying the infarct related artery in inferior wall myocardial infarction. Am J Cardiol. 1997;79:182-4.

Berry C, Zaleucki A, Vovach R, Savage M, Goldbert S. Surface electrocardiogram ischaemia during coronary artery occlusion. Am J Cardiol. 1989;63:21-6.

Huey BL, Beller GA, Kaiser DL, Gibson RS. A comprehensive analysis of myocardial infarction due to left circumflex coronary occlusion: Comparison with infarction due to right coronary artery and left descending artery occlusion. J Am coll Cardiol. 1988;12:1156-66.

Hasdai D, Birnbaum Y, Herz I, Sclarovsky S, Mazur A, Solodky A. ST segment depression in lateral limb leads in inferior wall acute myocardial infarction. Implications regarding the culprit artery and site of obstruction. Eur Heart J. 1995;16:1549-53.

Downloads

Published

2017-01-04

How to Cite

Pendse, M., Pendse, G., Dave, D., & Kashyap, P. (2017). Study of electrocardiographic differentiation between RCA and LCx occlusion in isolated inferior wall myocardial infarction. International Journal of Research in Medical Sciences, 4(8), 3164–3171. https://doi.org/10.18203/2320-6012.ijrms20162240

Issue

Section

Original Research Articles