INFERIOR-SEPTAL MYOCARDIAL INFARCTION MISDIAGNOSED AS ANTERIOR-SEPTAL MYOCARDIAL INFARCTION: ELECTROCARDIOGRAPHIC, SCINTIGRAPHIC, AND ANGIOGRAPHIC CORRELATIONS

摘要

Objective To explore the infarct sites in patients with inferior wall acute myocardial infarction (AMI) concomitant with ST segment elevation in leads V_1-V_3 and leads V_(3R)-V_(5R). Methods Five patients diagnosed as inferior, right ventricular, and anteroseptal walls AMI at admission were enrolled. Electrocardiographic data and results of isotope ~(99m)Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and coronary angiography (CAG) were analyzed. Results Electrocardiogram showed that ST segment significantly elevated in standard leads Ⅱ, Ⅲ, aVF, and leads V_1 -V_3, V_(3R)-V_(5R) in all five patients. The magnitude of ST segment elevation was maximal in lead V_1 and decreased gradually from lead V_1 to V_3 and from lead V_1 to V_(3R)-V_(5R). There was isotope ~(99m)Tc-MIBI myocardial perfusion imaging defect in inferior and basal inferior-septal walls. CAG showed that right coronary artery was infarct-re-lated artery. Conclusions The diagnostic criteria for basal inferior-septal wall AMI can be formulated as follows: (1) ST segment elevates ≥ 2 mm in lead V_1 in the clinical setting of inferior wall AMI; (2) the magnitude of ST segment elevation is the tallest in lead V_1 and decreases gradually from lead V_1 to V_3 and from lead V_1 to V_(3R)-V_(5R). With two conditions a bove, the basal inferior-septal wall AMI should be diagnosed.