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

Manish Pendse, Gayatri Pendse, Dhaval Dave, Prashant Kashyap.

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.

Key words: Inferior wall myocardial infarction, Electrocardiography, Right coronary artery, Left circumflex coronary artery



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