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Peripartum cardiomyopathy (PPCM) is a rare disease with high mortality in which dilated heart failure occurs in the last month of pregnancy or within 5 months after delivery, without any other etiology or pre-existing heart disease. Sometimes, it may present with intracardiac thrombus and associated life-threatening embolic complications. Here, we will present the management of a 28-year-old patient who was diagnosed with PPCM and intracardiac thrombus immediately after delivery and was followed up in the intensive care unit, in which an inferior myocardial infarction was detected in the electrocardiogram taken for sudden onset chest pain. Although peripheral thromboembolism is occasionally detected in PPCM patients with intracardiac thrombus, coronary embolisms is not common. Presentation with coronary embolism in patients with PPCM has been described in only 4 cases in the literature, but to the best of our knowledge, this is the first case to describe embolism to the right coronary artery. [ABSTRACT FROM AUTHOR]

Background: In patients with inferior myocardial infarction (MI), involvement of the right chambers has a prognostic impact. The objective of this study was to evaluate the influence of left ventricular (LV) inferior wall MI in the right atrial (RA), and right ventricular (RV) longitudinal strain (LS) by 2D speckle tracking echocardiography (STE). Methods: 60 consecutive patients who underwent myocardial perfusion (MP) gated SPECT for chest pain were included. We studied 30 patients with LV inferior MI and 30 control subjects with normal MP. RV ejection fraction was measured by 3D transthoracic echocardiography, RV-free wall LS and RA reservoir, contraction, and conduit phases strain were analyzed by 2D speckle tracking echocardiography (STE). Results: The median age in the LV inferior MI was 65 (54--70) years, 27% had a transmural myocardial infarction and 47% had residual myocardial ischemia, most of them, mild (36.7%). RV-free wall LS (--26.1 vs --30.3, p < 0.01), RA LS-reservoir phase (31.5 vs 56.2, p < 0.01), and RA-conduit phase LS (12.5 vs 35, p = 0.01) were significantly lower in the LV inferior MI patients compared to control subjects. In a logistic regression model, the MI of the LV reduced the 3D ejection fraction of both ventricles, mitral regurgitation, and pulmonary hypertension were associated with a decrease in RV LS and RA LS. Conclusions: This study shows that RV free wall LS, RA peak strain (reservoir phase), and RA conduit phase strain were significantly lower in patients with LV inferior MI vs control individuals. Subclinical extension to the RV in the inferior MI of the LV and its role in the longitudinal strain of RA could be determined using speckle tracking echocardiography. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical value of Aslanger pattern of body surface ECG in predicting acute inferior myocardial infarction (AIMI). Methods: We collected 150 ECGs of patients with AIMI which had been firstly recorded before coronary artery opening. These patients were divided into Aslanger pattern group (9 cases) and non-Aslanger pattern group (141 cases). We compared and analyzed coronary angiography results, left ventricular ejection fraction, blood pressure and heart rate, Killip calssification, cTnI, CK-MB and NT-proBNP levels, etc. between the two groups. Results: In the Aslanger pattern group, cTnI and NT-proBNP levels, and the proportion of patients at Ⅲ - Ⅳ level of Killip classification are all significantly higher than those in the non-Aslanger pattern group (P <0. 05). Emergency coronary angiography reveals in the Aslanger pattern group, the proportion of patients with coronary lesions in two and three branches are both significantly higher than those in the non- Aslanger pattern group (lesions in two branches: 55. 56% vs. 17. 02%; lesions in three branches: 33. 33% vs. 2. 83%,P <0. 05). Conclusion: The concomitant Aslanger pattern in AIMI patients indicates more severe condition, worse cardiac function, and more likely to be found no less than two branches of coronary artery lesions. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical value of ST-segment changes and QRS duration in leads V4 and Ⅲ in identifying different involvements of the left anterior descending (LAD) artery among patients with acute inferior ST-segment elevation myocardial infarction (STEMI). Methods: Retrospective analysis was performed on 189 patients with inferior STEMI who had undergone coronary angiography. Among these patients, 64 were divided into LAD occlusion group (LAD obstruction≥99%, n =17), LAD stenosis group (50% -1. 46 mm and QRSV4 >97. 38 ms are of high predictive value for patients with inferior myocardial infarction complicating LAD involvement (including LAD occlusion or stenosis). The sensitivity of these two indexes are separately 83. 3% and 68. 4% while the specificity are 57. 1% and 80. 8%, respectively. A combination of the two are improved in diagnostic performance with a sensitivity of 76. 3% and a specificity of 84. 6%. Conclusion: Inferior STEMI patients with LAD lesion have many comorbidities, especially in the presence of LAD occlusion, their cardiac function would be worse. The indexes of STV4 ↓ - STⅢ ↑ and QRSV4 could provide clues for diagnosing complicated LAD lesions in patients with inferior STEMI. [ABSTRACT FROM AUTHOR]

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p

Despite the beneficial effects of anti-COVID-19 vaccination, monitoring its safety has identified potential cardiac adverse events, mainly myocarditis and pericarditis. The case of a healthy 32-year-old male patient who developed acute myocardial infarction (AMI) 48 hours after the second dose of anti-COVID-19 mRNA vaccine (BNT162b2) is reported. This is the first reported case in the literature of an AMI associated to post-COVID-19 vaccination with mRNA vaccine (BNT162b2) in a healthy young adult without coronary risk factors and normal coronary arteries. Despite this adverse event, the continuation of the anti-COVID-19 vaccination campaign is encouraged due to the benefits it brings. [ABSTRACT FROM AUTHOR]

Objectives: Acute myocardial infarction can cause the right ventricle (RV) dysfunction. The echocardiography (ECHO) can provide the first clue to RV involvement in patients with inferior MI. In addition, the echocardiographic assessment of RV function can help in the early diagnosis and management of these patients in whom ECG cannot be diagnosed for RV involvement. Consequently, the current study measured the right atrium (RA) volume index instead of conventional RV echocardiographic parameters in order to evaluate the RV function in patients with poor RV echo windows. Materials and Methods: To this end, 116 patients with inferior myocardial infarction (MI) (66 with isolated inferior and 50 with inferoRV MI) were included after 24-72 hours after MI. Furthermore, RV systolic function parameters were measured, including tricuspid annular plane systolic excursion (TAPSE), fractional area change, and peak systolic velocity of the tricuspid annulus at tissue Doppler imaging (TDI) mode (RVSm). Finally, monoplane Simpson’s and biplane area length methods were used to measure RA volume index in these patients. Results: Based on the results, the RA volume index was high in both inferior and inferoRV MI patients but was significantly higher in inferoRV MI. Patients with inferoRV MI more likely had RAEF≤35%, high E/E’, and high right ventricular end-diastolic diameter (RVEDD) compared to isolated inferior MI. The correlation between RAVI in both groups was very significant with E/E’ and RVEDD. Conclusions: RA volume index is a good parameter for demonstrating RV dysfunction in patients with inferior and inferoRV MI.

We report a case of a 53-year-old male with inferolateral myocardial infarction, presenting an atypical Aslanger pattern on electrocardiogram (ECG). The ECG showed ST elevation in leads III, aVR, aVF, and posterior leads, with ST depression in II and V2-V6 with terminal positive T waves. Coronary angiography revealed total occlusion of the left circumflex artery (LCx) with significant stenosis of the left anterior descending (LAD) and right coronary artery (RCA). The LCx was successfully revascularized. This case highlights the importance of recognizing atypical Aslanger patterns, which may indicate multivessel coronary artery disease., Competing Interests: Declaration of competing interest We have nothing to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Smoking, which is a major modifiable risk factor for coronary artery diseases, affects cardiovascular system with different mechanisms. We designed this study to investigate the association of smoking with location of ST-segment elevation myocardial infarction (STEMI), and short-term outcomes during hospitalization. Methods: In 1017 consecutive patients with anterior/inferior STEMI, comprehensive demographic, biochemical data, as well as clinical complications and mortality rate, were recorded. Patients were allocated into two groups based on smoking status and compared regarding the location of myocardial infarction, the emergence of clinical complications and in-hospital mortality in univariate and multivariate logistic regression analysis. Results: Among 1017 patients, 300 patients (29.5%) were smoker and 717 patients (70.5 %) were non-smoker. Smokers were significantly younger and had lower prevalence of diabetes, hyperlipidemia and hypertension. Inferior myocardial infarction was considerably more common in smokers than in non-smokers (45.7% vs. 36%, P = 0.001). Heart failure was developed more commonly in non-smokers (33.9% vs. 20%, P = 0.001). In-hospital mortality was significantly lower in smokers (6.7% vs. 17.3%, P = 0.001). After adjustment for confounding variables, smoking was independently associated with inferior myocardial infarction and lower heart failure [odds ratio: 1.44 (1.06-1.96), P = 0.01 and odds ratio: 0.61 (0.40-0.92), P = 0.02, respectively]. However, in-hospital mortality was not associated with smoking after adjustment for other factors [odds ratio: 0.69 (0.36-1.31), P = 0.2]. Conclusion: Smoking is independently associated with inferior myocardial infarction. Although smokers had lower incidence of heart failure, in-hospital mortality was not different after adjustment for other factors.

Background: In patients with inferior myocardial infarction (MI), involvement of the right chambers has a prognostic impact. The objective of this study was to evaluate the influence of left ventricular (LV) inferior wall MI in the right atrial (RA), and right ventricular (RV) longitudinal strain (LS) by 2D speckle tracking echocardiography (STE). Methods: 60 consecutive patients who underwent myocardial perfusion (MP) gated SPECT for chest pain were included. We studied 30 patients with LV inferior MI and 30 control subjects with normal MP. RV ejection fraction was measured by 3D transthoracic echocardiography, RV-free wall LS and RA reservoir, contraction, and conduit phases strain were analyzed by 2D speckle tracking echocardiography (STE). Results: The median age in the LV inferior MI was 65 (54–70) years, 27% had a transmural myocardial infarction and 47% had residual myocardial ischemia, most of them, mild (36.7%). RV-free wall LS (–26.1 vs –30.3, p < 0.01), RA LS-reservoir phase (31.5 vs 56.2, p < 0.01), and RA-conduit phase LS (12.5 vs 35, p = 0.01) were significantly lower in the LV inferior MI patients compared to control subjects. In a logistic regression model, the MI of the LV reduced the 3D ejection fraction of both ventricles, mitral regurgitation, and pulmonary hypertension were associated with a decrease in RV LS and RA LS. Conclusions: This study shows that RV free wall LS, RA peak strain (reservoir phase), and RA conduit phase strain were significantly lower in patients with LV inferior MI vs control individuals. Subclinical extension to the RV in the inferior MI of the LV and its role in the longitudinal strain of RA could be determined using speckle tracking echocardiography.

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Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate right ventricle (RV) dyssynchrony and its relation with mortality using speckle‐tracking echocardiography (STE) in patients with acute inferior myocardial infarction (IMI). Methods: One hundred and fifty‐eight consecutive patients with acute IMI treated with primary percutaneous coronary intervention, and 44 healthy subjects were included. RV myocardial involvement (RVMI) was defined as an elevation >1 mm in V1 or V4R and/or the presence of a culprit lesion at the proximal portion of the first RV marginal branch after reviewing coronary angiography. Patients were followed for 3 years to determine the cardiovascular mortality. Results: Overall, 70 patients with IMI had RVMI. IMI patients had significantly higher RV peak systolic longitudinal strain dyssynchrony (PLSSD) index, lower peak longitudinal systolic strain (PLSS), longer time to PLSS, and time to PLSS differences compared to healthy controls while the patients with RVMI had significantly worse values compared to patients without RVMI and healthy controls. Twenty‐seven patients (17.1%) died within 2 years. RVMI was more prevalent in mortality group, and they had significantly higher RV PSSD index, whereas they had lower RV free wall PLSS and longer time to PLSS differences. Receiver operating characteristics (ROC) analysis revealed that a RV PLSSD index > 65 ms predicted mortality with a sensitivity of 88.9% and specificity of 71.8% in IMI patients. Conclusions: Intra‐ and inter‐ventricular dyssynhcrony may develop in patients with acute IMI, especially in those with RV involvement, which might have a negative effect on the prognosis of these patients. [ABSTRACT FROM AUTHOR]

Objectives: Acute myocardial infarction can cause the right ventricle (RV) dysfunction. The echocardiography (ECHO) can provide the first clue to RV involvement in patients with inferior MI. In addition, the echocardiographic assessment of RV function can help in the early diagnosis and management of these patients in whom ECG cannot be diagnosed for RV involvement. Consequently, the current study measured the right atrium (RA) volume index instead of conventional RV echocardiographic parameters in order to evaluate the RV function in patients with poor RV echo windows. Materials and Methods: To this end, 116 patients with inferior myocardial infarction (MI) (66 with isolated inferior and 50 with inferoRV MI) were included after 24-72 hours after MI. Furthermore, RV systolic function parameters were measured, including tricuspid annular plane systolic excursion (TAPSE), fractional area change, and peak systolic velocity of the tricuspid annulus at tissue Doppler imaging (TDI) mode (RVSm). Finally, monoplane Simpson's and biplane area length methods were used to measure RA volume index in these patients. Results: Based on the results, the RA volume index was high in both inferior and inferoRV MI patients but was significantly higher in inferoRV MI. Patients with inferoRV MI more likely had RAEF=35%, high E/E', and high right ventricular enddiastolic diameter (RVEDD) compared to isolated inferior MI. The correlation between RAVI in both groups was very significant with E/E' and RVEDD. Conclusions: RA volume index is a good parameter for demonstrating RV dysfunction in patients with inferior and inferoRV MI. [ABSTRACT FROM AUTHOR]

Objective Electrocardiogram(ECG) and vectorcardiogram(VCG) were collected by Wilson and Frank dual lead system. The diseases caused by left deviation of ECG axis were timely identified. Methods The symptomatic patients with left deviation of ECG were selected and their ECGs and VCGs were analyzed. Results Five cases were similar in ECG pattern,and all of them showed left axis deviation. But the performance and diagnosis of VCG were different. Conclusion VCG showed better performance in the diagnosis of diseases caused by left deviation of electrocardiogram axis compared to ECG. It should be careful when identify the diseases caused by left deviation of electrocardiogram axis without the help of VCG. We should combine the advantages of both ECG and VCG,to well serve the clinic application and improve the accuracy of diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Some studies suggest that ST elevation in aVR (aVR-STE) can predict the presence of left main or multivessel disease (MVD) and relates to prognosis. Our purpose was to analyze the relationship of aVR-STE to MVD disease or cardiogenic shock (CS) in patients with inferior myocardial infarction (inferior STEMI).Methods: We analyzed two cohorts of consecutive patients admitted for inferior STEMI in the Coronary Unit of two university hospitals. ST elevation and ST depression in each derivation were compared between patients with and without MVD and with and without CS.Results: We included 342 patients-19.6% women and 80.4% men-with a median age of 60 (52, 70); 18 patients (5.2%) had MVD, and 25 (7.3%) patients presented CS. There was no relationship between ST elevation or ST depression in either derivation and MVD. In contrast, CS was associated with aVR-STE, ST-segment depression in lead aVL, and the sum of ST-segment depression. aVR-STE of 0.25 mm had a sensitivity of 24.0% and a specificity of 95.9% for CS. After multivariate analysis including clinical variables, aVR-STE was independently associated with CS.Conclusions: In patients with inferior STEMI, ST-segment analysis was not useful in predicting multivessel disease. aVR-STE was an independent predictor of CS, with high specificity but low sensitivity. [ABSTRACT FROM AUTHOR]

Introduction: Smoking, which is a major modifiable risk factor for coronary artery diseases, affects cardiovascular system with different mechanisms. We designed this study to investigate the association of smoking with location of ST-segment elevation myocardial infarction (STEMI), and short-term outcomes during hospitalization. Methods: In 1017 consecutive patients with anterior/inferior STEMI, comprehensive demographic, biochemical data, as well as clinical complications and mortality rate, were recorded. Patients were allocated into two groups based on smoking status and compared regarding the location of myocardial infarction, the emergence of clinical complications and in-hospital mortality in univariate and multivariate logistic regression analysis. Results: Among 1017 patients, 300 patients (29.5%) were smoker and 717 patients (70.5 %) were non-smoker. Smokers were significantly younger and had lower prevalence of diabetes, hyperlipidemia and hypertension. Inferior myocardial infarction was considerably more common in smokers than in non-smokers (45.7% vs. 36%, P = 0.001). Heart failure was developed more commonly in non-smokers (33.9% vs. 20%, P = 0.001). In-hospital mortality was significantly lower in smokers (6.7% vs. 17.3%, P = 0.001). After adjustment for confounding variables, smoking was independently associated with inferior myocardial infarction and lower heart failure [odds ratio: 1.44 (1.06-1.96), P = 0.01 and odds ratio: 0.61 (0.40-0.92), P = 0.02, respectively]. However, in-hospital mortality was not associated with smoking after adjustment for other factors [odds ratio: 0.69 (0.36-1.31), P = 0.2]. Conclusion: Smoking is independently associated with inferior myocardial infarction. Although smokers had lower incidence of heart failure, in-hospital mortality was not different after adjustment for other factors. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) is a major cause of cardiovascular mortality. Inferior MI accounts for 30-50% of infarctions but it is associated with a favorable prognosis compared to anterior infarct. This study aimed to study the epidemiological, clinical, electrical, echocardiographic, angiographic features of inferior MI, as well as its complications and its therapeutic approaches. Over a period of 3 years, we admitted 720 patients with STEMI, of whom 103 with inferior STEMI, reflecting a rate of 14.3%. There was a clear male predominance, with an average age of 58 years (men) and 62 years (women). Smoking was the main risk factor for cardiovascular disease (57.28% of patients were smokers). Right ventricular infarction was found in 11.65% of cases. Half of these patients had hemodynamic instability. Third-degree atrioventricular block was diagnosed in 12.6% of patients. Therapeutic approach was based on thrombolysis (7 patients) and coronary angiogram (42 patients). Inferior MI was caused by right coronary lesion in 53% of cases and circumflex artery occlusion in 47% of cases. Right coronary is responsible for right ventricular infarction in 100% of cases. Coronary angioplasty was performed in 18 patients after coronary angiogram. Eleven patients underwent transluminal coronary angioplasty in the right coronary while 2 patients underwent transluminal coronary angioplasty in the circumflex artery. Early mortality at 30 days was 1.94%. In the right ventricular infarction group mortality rate was about 17%. [ABSTRACT FROM AUTHOR]

Background: There are several approaches widely used in the localization of the responsible artery in inferior myocardial infarction. However, the existing papers show differences in the point where the ST segment is measured. The purpose of our investigation is to analyse the influence of the point at which elevation of the ST segment is measured on the results of these algorithms.Methods: We analysed the 12‑lead electrocardiograms of 90 consecutive patients with inferior myocardial infarction. The ST segment elevation or depression was measured at the J-point and at 80 ms, and three algorithms were applied to predict the culprit artery with both measurements. Sensitivity, specificity, the area under the curve, and the kappa index of agreement were analysed to compare each algorithm at the J-point and at 80 ms.Results: The area under the curve was better at the J-point than at 80 ms in two algorithms (0.696 vs. 0.635, p < 0.043, and 0.754 vs. 0.661, p < 0.045) and did not change in one. Agreement between the J-point and 80 ms was suboptimal in all three algorithms (0.71, 0.65, and 0.58).Conclusions: The result of different algorithms to detect the culprit artery in inferior STEMI patients can change significantly depending on the point where ST elevation or depression is measured. [ABSTRACT FROM AUTHOR]

Background: Isolation of infract related artery and timely revascularisation remains vital in the setting of primary percutaneous coronary intervention.Objectives: To analyse the predictive value of ST-T changes in lead aVR in inferior myocardial infarction in terms of prognosis and timely risk stratification.Methods: We conducted a prospective analysis of acute inferior wall myocardial infarction patients. One hundred patients were categorised into two groups according to the culprit artery: group I, right coronary artery (RCA) and group II, left circumflex coronary artery (LCX), with 50 patients in each group. A comparative study was performed between the two groups, comprising the following data outputs: electrocardiogram (ECG) changes that could help determine the culprit artery, cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications. The same patients were divided into two groups according to the presence or absence of 1 mm ST depression in lead aVR. A comparison analysis was performed between the two groups including: cardiac enzyme levels, echocardiographic findings, coronary angiography findings and in-hospital complications.Results: ST depression in aVR ≥ 1 mm predicted the LCX as a culprit artery with sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) recorded at 66%, 84%, 80.5% and 71.2%, respectively. Also, patients with ST depression in aVR ≥ 1 mm showed significantly higher cardiac enzyme levels, indicating larger infarct size, with mean peak creatinine kinase (CK) = 1560 (1057-2375) IU/L versus 970 (613-1683) IU/L, (P value = 0.014), lower ejection fraction (Ef) with mean Ef = 47.93 ± 8.04 versus 54.66 ± 6.52, (P value < 0.001) and more significant mitral regurgitation: 17 (41.5%) patients versus 11 (18.6%) patients (P value = 0.012). Regarding in-hospital complications, there were no significant differences.Conclusions: ST depression of >1 mm in lead aVR predicts LCX as the infarct related artery and is a predictor of poor outcome in patients with inferior myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Right ventricle (RV) involvement causes acute systolic and diastolic functional alterations in the RV in patients after inferior myocardial infarction (IMI), which may result in an increase in left ventricle (LV) end‐diastolic and right atrial (RA) pressure. In our study, we sought to evaluate RA volumes and mechanical functions using real‐time three‐dimensional echocardiography (RT3DE) in IMI patients with or without RV involvement. Methods: Ninety‐six consecutive patients with IMI (mean age: 59.7 ± 10.2 years, 60 female) were included. RV myocardial involvement (RVMI) was defined as the presence of a culprit lesion at the proximal portion of the first RV marginal branch in coronary angiography. The study population was divided into two groups: IMI (58.3%) and IMI + RVMI (41.7%). Patients were evaluated using conventional two‐dimensional echocardiography (2DE) and RT3DE. Results: In RT3DE measurements, IMI + RVMI patients had significantly higher RA phasic volumes and worse conduit mechanical function. A receiver operating characteristic (ROC) curve analysis revealed that an RT3DE RA maximum volume (Vmax) index > 27.9 mL/m2 was an independent predictor of RV involvement in patients after acute IMI, with a sensitivity of 80.0% and a specificity of 89.3%. Conclusions: Right ventricle involvement may cause an increase in RA phasic volumes and deterioration of conduit function in patients with acute IMI. [ABSTRACT FROM AUTHOR]

Objective: In the presence of inferior myocardial infarction (MI), ST depression (STD) in lead I has been claimed to be accurate for diagnosis of right ventricular (RV) MI. We sought to evaluate this claim and also whether ST Elevation (STE) in lead V1 would be helpful, with or without STD in V2.Methods: Retrospective study of consecutive inferior STEMI, comparing ECGs of patients with, to those without, RVMI, as determined by angiographic coronary occlusion proximal to the RV marginal branch. STE and STD were measured at the J-point, relative to the PQ junction. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.Results: Of 149 patients with inferior STEMI, 43 (29%) had RVMI and 106 (71%) did not. There was no difference in the presence or absence of at least 0.5 mm STD in Lead I between patients with (37/43, 86%) vs. without RVMI (85/106, 80%, p = 0.56). In those with, vs. without, RVMI, (15/43, 35%) had STE in V1, versus (17/106, 16%) (p = 0.015). Specificity of STE in V1 for RVMI was 84%; sensitivity was 35%. Sensitivity was higher without (69%), than with (35%), STD in V2.Conclusion: Among inferior STEMI, the presence of any ST depression in lead I does not help to diagnose RVMI. ST elevation ≥0.5 mm in lead V1 is specific for RVMI, and moderately sensitive only if concomitant STD ≥ 0.5 mm in V2 is not present. Although STE in V1 is quite specific, overall the diagnostic characteristics of the standard 12‑lead ECG are inadequate to definitively diagnose, or exclude, RVMI, as defined angiographically. [ABSTRACT FROM AUTHOR]

The aim of our study was to examine the pathophysiology of ST depression (STD) in leads V1–V3 in the setting of inferior ST elevation myocardial infarction (iSTEMI) through the perspective of cardiac magnetic resonance (CMR). Methods: Differences in myocardial area at risk (MaR), infarct size, ejection fraction and myocardial segment involvement by CMR were compared in MITOCARE trial patients with first iSTEMI with ST elevation (STE), STD or no ST changes (NST) in V1–V3. The frontal plane projection of the inferior wall MaR in relationship to the anterior/posterior chest wall was calculated and compared between groups. Results: Fifty-six patients were included. Patients with STD (n = 38) and STE (n = 5) in V1–V3 had significantly larger mean MaR compared to NST (n = 13; 32 ± 7%LV, 36 ± 10%LV and 26 ± 6%LV, respectively; p = 0.01). STD in leads V1–V3 was associated with more apical inferior and mid inferoseptal involvement and had a larger mean frontal plane projection of MaR compared with NST (24 ± 6%LV vs. 20 ± 6%LV, p = 0.04). Conclusion: STD in V1–V3 in iSTEMI is associated with larger MaR, more extension into the inferoseptal segments and likely results from greater frontal plane projection of the MaR, leading to reciprocal changes on the electrocardiogram. [ABSTRACT FROM AUTHOR]

Objective: We aim to determine the correlation between ST-segment changes in leads V4-V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI).Design: Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4-V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement.Results: Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4-V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups.Conclusion: Our study suggests that in iSTEMI, ST changes in the precordial leads V4-V6 correlates with greater myocardial injury and distribution of myocardium at risk. [ABSTRACT FROM AUTHOR]

Aims Ischaemic mitral regurgitation (IMR) is consequence of left ventricular (LV) remodelling after myocardial infarction. In some cases, the mitral valve enlarges to compensate for LV remodelling and tenting, improving its coaptation; a process termed 'plasticity'. We sought to identify clinical and echocardiographic factors associated with plasticity in patients with chronic inferior myocardial infarction (CII). Methods and results This study included 91 revascularized CII patients and 46 controls. Plasticity and IMR severity were evaluated by 2D transthoracic echocardiography. Compared with controls, CII patients were older (59 vs. 25 years) and mostly men (80% vs. 46%), both P < 0.001. Chronic inferior myocardial infarction patients also had significant LV remodelling: larger LV volumes, larger mitral tenting areas, larger coaptation depths, longer mitral leaflets and chords, and worse mitral regurgitation (all P ≤ 0.03). Of 91 CII patients, 60 had mitral plasticity (longer anterior and posterior leaflets and longer posterior chords, all P < 0.001), despite not exhibiting significantly larger LV volumes, tenting area or coaptation depth, when compared with patients with no plasticity. Contralateral (anterior) papillary muscle-to-annulus length tended to be increased in CII plasticity patients (P = 0.05). Also they had less moderate and severe IMR (both P < 0.04) compared with non-plasticity CII patients. Multivariate analysis demonstrated independent associations between plasticity and smoking [odds ratio (OR) 0.03, 0.002-0.57; P = 0.019], duration of type-2 diabetes (OR 1.19, 1.007-1.42; P = 0.04) and haemoglobin (OR 2.17, 1.25-3.76; P = 0.005). Conclusion Mitral plasticity results in less moderate and severe IMR. Longer time-duration of diabetes mellitus and higher haemoglobin level are independently associated with mitral plasticity, while smoking independently associates with no plasticity. Increased anterior papillary muscle-to-annulus length in CII patients with plasticity suggests complex LV remodelling mechanisms are involved in plasticity. [ABSTRACT FROM AUTHOR]

This case report aims to present the importance of cardiac evaluation in patients with advanced colorectal cancer and how to adjust the treatment according to cardiac pathology. A 60-year-old female patient, with a personal history of breast cancer, presented in our clinic in August 2020 with resected rectal adenocarcinoma, with poorly differentiate histology obtained from the surgical specimen (June 2020). She received adjuvant therapy with capecitabin (six cycles) and radiotherapy. In July 2022, the PET scan revealed enlarged retroperitoneal lymph nodes with high metabolic activity. In October 2022, the patient received radiotherapy at the level of adenopathies in the renal hilumadenopathies with a total dose of 30 Gy, with good tolerance. In November 2022, she started chemotherapy with FOLFOX and bevacizumab. Suddenly after that, she was diagnosed with inferior myocardial infarction. Given the cardiac pathology and the oncological treatment, the patient was considered to be at a very high risk for cardiac toxicity. The cardiologist recommended close surveillance of the cardiac function, stopping the therapy with known cardiac toxicity (coronary vasospasm) such as fluoropyrimidines and continuing bevacizumab with caution. Every three months, she had a cardiac evaluation and the patient was stationary, without severe cardiac dysfunction. The oncological treatment continued since February 2023, but it was adjusted (only oxaliplatin 85 mg/m² and bevacizumab, initially 5 mg/kg b.w., and then an increased dose at 7.5 mg/kg b.w.). The evolution was favorable, the imagistic evaluation from May 2023 showing the regression of the retroperitoneal adenopathies. Currently, she is at the 11th series with oxaliplatin in monotherapy, with good tolerance. Fluoropyrimidines, such as fluorouracil, are associated with vasospasm and can produce myocardial infarction, especially in patients with poor adherence to cardiological treatment. There is a high recommendation for cardiac function monitoring in patients receiving oncological treatment. [ABSTRACT FROM AUTHOR]

BackgroundBradycardia on presentation is frequently observed in patients with right coronary artery ST‐segment elevation myocardial infarction, but it is largely unknown whether it predicts poor angiographic or clinical outcomes in that patient population. We sought to determine the prognostic implications of admission heart rate (AHR) in patients with ST‐segment elevation myocardial infarction and a right coronary artery culprit lesion. Methods and ResultsWe analyzed 1460 patients with ST‐segment elevation myocardial infarction and a right coronary artery culprit lesion enrolled in the randomized HORIZONS‐AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial who underwent primary percutaneous coronary intervention. Patients presenting with high‐grade atrioventricular block were excluded. Outcomes were examined according to AHR range (AHR 100 beats per minute). Angiographic analysis showed no significant association between AHR and lesion location or complexity. On multivariate analysis, admission bradycardia (AHR