Inferior wall myocardial infarction

Inferior Wall Myocardial Infarction
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Chest pain, shortness of breath, nausea, vomiting, diaphoresis
Complications	Heart failure, arrhythmias, cardiogenic shock
Onset	Sudden
Duration	Variable
Types	N/A
Causes	Coronary artery disease
Risks	Hypertension, smoking, diabetes mellitus, hyperlipidemia
Diagnosis	Electrocardiogram, cardiac biomarkers
Differential diagnosis	N/A
Prevention	N/A
Treatment	Percutaneous coronary intervention, thrombolysis, medications
Medication	N/A
Prognosis	Variable
Frequency
Deaths	N/A

Inferior wall myocardial infarction (IWMI) is a type of myocardial infarction (MI) that affects the inferior portion of the heart, typically involving the right coronary artery (RCA) or its branches. This condition is a medical emergency that requires prompt diagnosis and treatment to prevent significant morbidity and mortality.

Pathophysiology

Inferior wall myocardial infarction occurs when there is an interruption of blood supply to the inferior wall of the heart, usually due to an occlusion in the right coronary artery. The inferior wall is primarily supplied by the RCA in most individuals, although in some cases, the left circumflex artery may be involved, depending on the coronary dominance.

The interruption of blood flow leads to ischemia and subsequent necrosis of the myocardial tissue. This process results in the release of cardiac biomarkers such as troponin and creatine kinase-MB into the bloodstream, which are used in the diagnosis of MI.

Clinical Presentation

Patients with inferior wall myocardial infarction typically present with classic symptoms of myocardial infarction, including:

• Chest pain: Often described as a pressure or squeezing sensation, typically located in the substernal area and may radiate to the jaw, neck, shoulder, or arm.
• Shortness of breath
• Nausea and vomiting
• Diaphoresis (excessive sweating)

In some cases, patients may present with atypical symptoms, especially in elderly individuals or those with diabetes mellitus.

Diagnosis

The diagnosis of inferior wall myocardial infarction is primarily based on:

Electrocardiogram (ECG)

The ECG is a crucial tool in diagnosing IWMI. Characteristic findings include:

• ST-segment elevation in the inferior leads (II, III, and aVF)
• Reciprocal ST-segment depression in the anterior leads (I, aVL)

Cardiac Biomarkers

Elevated levels of cardiac biomarkers such as troponin and CK-MB confirm myocardial necrosis.

Imaging

Additional imaging, such as echocardiography, may be used to assess cardiac function and identify complications.

Management

The management of inferior wall myocardial infarction involves:

Acute Treatment

• Percutaneous coronary intervention (PCI): The preferred method for restoring blood flow.
• Thrombolysis: Used when PCI is not available.
• Antiplatelet therapy: Such as aspirin and clopidogrel.
• Anticoagulation: To prevent further thrombus formation.

Supportive Care

• Oxygen therapy
• Pain management with morphine
• Beta-blockers and ACE inhibitors to reduce cardiac workload and improve outcomes.

Complications

Complications of inferior wall myocardial infarction can include:

• Heart failure
• Arrhythmias, such as bradycardia or atrioventricular block
• Cardiogenic shock

Prognosis

The prognosis of inferior wall myocardial infarction varies depending on the extent of myocardial damage, the presence of complications, and the timeliness of treatment. Early intervention improves outcomes significantly.

Prevention

Preventive measures focus on reducing risk factors for coronary artery disease, including:

• Smoking cessation
• Blood pressure control
• Diabetes management
• Lipid management
• Lifestyle modifications such as diet and exercise

See Also

• Myocardial infarction
• Coronary artery disease
• Cardiology

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