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2008, Number 3

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Arch Cardiol Mex 2008; 78 (3)

Left posterolateral extensive myocardial infarct. An electroanatomical comparison

Lomelí EC, Aranda A, Lorenzo NJA, Rosas PM, Guadalajara BJF, Medrano GA, Micheli A
Full text How to cite this article

Language: Spanish
References: 9
Page: 338-343
PDF size: 169.94 Kb.


Key words:

Left extensive postero-lateral infarction, Postero-lateral biventricular infarction, Electrocardiographic thoracic circle.

ABSTRACT

A complete ECG thoracic circle allows exploring some heart structures not explored by the conventional electrocardiogram. It provides a direct indication on the location of the damaged myocardium. In fact, posterolateral infarctions can be limited to the inferior third of the left ventricle or can cover the entire free left ventricular wall from the base up to the heart apex and can be univentricular or biventricular. On the other side, the unipolar thoracic leads and the high abdominal leads MD, ME, MI show the evolution of the signs of injury, characteristic of the acute stage of infarction, toward necrosis. We present the example of a 61-year-old man, whose ECG shows signs of subepicardial or transmural injury and of necrosis in the low precordial leads V5 and V6, as well as in the high left posterior leads V8 and V9. This fact suggests the presence of an acute extensive myocardial infarction extending from the base to the heart apex. Moreover, the moderate elevation of the RS-T segment from to V9R to V7R indicates the presence of subepicardial injury in the high posterior regions of the right ventricular wall. These electrocardiographic data were confirmed by the radioactive isotope study and, definitively, by the anatomical findings.


REFERENCES

  1. de Micheli A, Medrano GA, Iturralde P: El círculo torácico en la exploración eléctrica del corazón. Arch Inst Cardiol Mex 2000; 70(2): 187-198.

  2. Barbato E, Pileggi F, Debes CA, Fujioka T, Magalhães MS, Tranchesi J, et al: Study of the sequence of ventricular activation and the QRS complex of the normal human heart using direct epicardial leads. Am Heart J 1958; 55(6): 867-880.

  3. de Micheli A, Aranda A, Medrano GA: Acerca del valor diagnóstico de los hallazgos ECG indirectos de infarto miocárdico posterolateral basal izquierdo. Arch Cardiol Mex 2007; 77(2): 150-155.

  4. Brusca A, Gandolfo S, Lavezzaro G, Braguzzi E, Rosettani E, Actis Dato A: Il processo di attivazione del cuore umano. Nota I. L’ipertrofia del ventricolo destro. Mal Cardiovasc 1964; 5(4): 509-524.

  5. de Micheli A, Aranda A, Medrano GA: Infartos posterolaterales biventriculares. Un cotejo electro-anatómico. Arch Cardiol Mex 2005; 75 (Supl 3): S140-142.

  6. Medrano GA, de Micheli A: Necrosis posterior experimental del ventrículo derecho. Arch Inst Cardiol Mex 1978; 48(4): 708-734.

  7. Morgera F, Alberti E, Silvestri F, Pandullo C, Della Mea MR, Camerini F: Right precordial ST and QRS changes in the diagnosis of right ventricular infarction. Am Heart J 1984; 108: 13-18.

  8. Contreras R, Costero I: Localización de los infartos del miocardio en cortes topográficos del corazón. En Aterosclerosis y enfermedad coronaria. (Coord. I. Chávez). México. Ed. Interamericana S.A., 1960, pp. 69-78.

  9. de Micheli A, Medrano GA: Electrocardiograma y vectocardiograma en el infarto del miocardio. México. La Prensa Médica Mexicana, 1971, pp. 66-67.




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Arch Cardiol Mex. 2008;78