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2.1
Lateral Myocardial Infarction
Lateral Heart Attack

Presentation

A 55-year-old white woman presented to the emergency department with symptoms of dull aching shoulder and chest pain. [ncbi.nlm.nih.gov]

Clinical Presentation Patients who are experiencing an acute STEMI are classically described as presenting with pressure or crushing chest pain associated with shortness of breath, nausea/vomiting or diaphoresis. [cdemcurriculum.com]

Example 4 Anterolateral STEMI: ST elevation is present in the anterior (V2-4) and lateral leads (I, aVL, V5-6). Q waves are present in both the anterior and lateral leads, most prominently in V2-4. [lifeinthefastlane.com]

The clinical presentation can be similar to an inferior wall MI (that is, GI symptoms can predominate). On an ECG, you see ST depression in the anterior leads (V1 and V2 big time). [dummies.com]

Pathology of cardiac conduction as seen in 3-lead and 12-lead monitoring systems are presented in a practical manner to build confidence in this valuable diagnostic tool. [books.google.com]

Entire Body System

  • Coronary Atherosclerosis

    Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. [emedicine.medscape.com]

Cardiovascular

  • Chest Pain

    A 55-year-old white woman presented to the emergency department with symptoms of dull aching shoulder and chest pain. [ncbi.nlm.nih.gov]

    The chest pain might be described as radiating into the patient’s neck, left arm or jaw. Oftentimes, they will appear visibly uncomfortable and may have a fist clutching the center of their chest. [cdemcurriculum.com]

    With QRS Fragmentation SUBTLE ST CHANGES This ECG was obtained from an 87-year-old man who was experiencing chest pain. [ecgguru.com]

    Chest. 125 (4): 1561–76. doi : 10.1378/chest.125.4.1561. PMID 15078775. [en.wikipedia.org]

    The 15-lead ECG in emergency department chest pain patients: Comparison to the 12-lead ECG. Ann Emerg Med Abstract. Publication pending. 3. Pollack M, et al. [ahcmedia.com]

  • Heart Disease

    […] ischaemic heart disease, unspecified Ischaemic heart disease (chronic) NOS Processed on 29.10.2004 M.S. [apps.who.int]

    ICD 9 CM Field Value Diagnosis Code: 410.50 Long Description: Acute myocardial infarction of other lateral wall, episode of care unspecified Short Description: AMI lateral NEC, unspec Chapter: Diseases Of The Circulatory System Block: Ischemic Heart Disease [emedcodes.com]

    Ischemic heart diseases Use Additional code to identify presence of hypertension ( I10-I16 ) Ischemic heart diseases I21 ICD-10-CM Diagnosis Code I21 Acute myocardial infarction 2016 2017 2018 - Revised Code 2019 Non-Billable/Non-Specific Code Includes [icd10data.com]

    ICD-9 code 410.5 for Acute myocardial infarction of other lateral wall is a medical classification as listed by WHO under the range -ISCHEMIC HEART DISEASE (410-414). [coder.aapc.com]

Workup

Electrocardiograms (ECGs) are a series of leads placed on a person's chest that measure electrical activity associated with contraction of heart muscle. [77] The taking of an ECG is an important part in the workup of an AMI, [23] and ECGs are often not [en.wikipedia.org]

Axis

  • Right Axis Deviation

    Axis Deviation: Use Lead I, II, and aVF to diagnois Axis Deviation Vectors and Axis Vector: A quantity of electrical force that has a known magnitude and direction. [publicsafety.net]

    Note pathologic Q-waves in V1-4, late R wave in V1, wide S waves in lead I, and left axis deviation (-80 degrees). [ecg.utah.edu]

T Wave

  • T Wave Inversion

    These feature are suggestive of posterior wall infarction, being the inverse of Q wave, ST elevation and T wave inversion which would have been recorded in a posterior lead. [cardiophile.org]

    Within a few hours, you can begin to see negative T waves or T wave inversion as the MI evolves. The T wave inversion can persist for months after the MI. [dummies.com]

    There is also slight ST elevation in leads I, aVL, and T wave inversion in the lateral leads. The EKG is consistent with a lateral wall myocardial infarction. [wikidoc.org]

    In 8 of these 22 patients, the infarct was silent in the sense that no ST segment elevation or Q waves were seen, although ST depressions or T wave inversions, or both, in all but one patient were compatible with subendocardial infarction. [ncbi.nlm.nih.gov]

    Normal ECG prior to MI Hyperacute T wave changes - increased T wave amplitude and width; may also see ST elevation Marked ST elevation with hyperacute T wave changes (transmural injury) Pathologic Q waves, less ST elevation, terminal T wave inversion [ecg.utah.edu]

Treatment

The emphasis on cardiac care in the field has evolved from dysrhythmia recognition and treatment only to recognition and treatment of an evolving MI. [emsworld.com]

[…] for a myocardial infarction that has received initial treatment, but is still less than 8 weeks old. [coder.aapc.com]

Final message Inferior STEMI generally lacks the vigor to cause extensive damage to myocardium in most situations .Further they respond better to treatment. [drsvenkatesan.com]

Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover. [icdlist.com]

But early recognition of the signs and symptoms and prompt treatment can improve outcomes. [americannursetoday.com]

Prognosis

Anterior myocardial infarction carries the worst prognosis of all infarct locations, mostly due to larger infarct size. [lifeinthefastlane.com]

By definition, patients in quadrant 4 are in "cardiogenic shock" and have a poor prognosis, unless they have a correctable mechanical complication, or unless they are early into the course of their MI, and some of the ischemic myocardium is recovered [brown.edu]

FACTORS THAT DETERMINE PROGNOSIS IN ACUTE MYOCARDIAL INFARCTION (BOX 1) The immediate prognosis in patients with acute myocardial infarction is inversely related to the amount of myocardial reserves (total myocardial mass less the myocardium involved [pmj.bmj.com]

St-segment - elevation (> 1mm or more abouve baseline) is an indication of occlusive thrombus with poorer prognosis 14. reciprocal ST segment depression may occur in the leads facing the area opposite the site of injury 15. [quizlet.com]

Etiology

Differential diagnosis of ST elevations The most serious cause of ST elevations on ECG is a ST elevation MI, however there are other possible etiologies. As usual always consider the “worst first”. [cdemcurriculum.com]

Epidemiology

"Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance". [en.wikipedia.org]

Pathophysiology

It is important to appreciate that the ECG provides information about a totally different aspect of pathophysiology in acute myocardial infarction than does the coronary angiogram. [pmj.bmj.com]

Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty. Lippincott Williams & Wilkins. p. 172. ISBN 9781469816685. [en.wikipedia.org]

Prevention

"Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force". [en.wikipedia.org]

FDA approves Amgen's Repatha (evolocumab) to prevent heart attack and stroke [press release]. Available at https://www.amgen.com/media/news-releases/2017/12/fda-approves-amgens-repatha-evolocumab-to-prevent-heart-attack-and-stroke/. [emedicine.medscape.com]

For secondary prevention, beta-blocker therapy will continue after discharge because it decreases mortality after MI by 30%. [americannursetoday.com]

What they ... [ Read Full Story ] May 10, 2019 If your provider is ordering nebulizers and the drugs used in them for their patients, here are things in the documentation that will help prevent a resubmission to Medicare and ease medical codi... [ Read [coder.aapc.com]

But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 9-1-1 if you or someone else is having them. [icdlist.com]

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2.1
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