title: Inferior-septal myocardial infarction misdiagnosed as anterior-septal myocardial infarction: electrocardiographic, scintigraphic, and angiographic correlations.
abstract: OBJECTIVE
  To explore the infarct sites in patients with inferior wall acute myocardial infarction (AMI) concomitant with ST segment elevation in leads V1-V3 and leads V3R-V5R.
  
  
  METHODS
  Five patients diagnosed as inferior, right ventricular, and anteroseptal walls AMI at admission were enrolled. Electrocardiographic data and results of isotope 99mTc-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 V1-V3, V3R-V5R in all five patients. The magnitude of ST segment elevation was maximal in lead V1 and decreased gradually from lead V1 to V3 and from lead V1 to V3R-V5R. There was isotope 99mTc-MIBI myocardial perfusion imaging defect in inferior and basal inferior-septal walls. CAG showed that right coronary artery was infarct-related artery.
  
  
  CONCLUSIONS
  The diagnostic criteria for basal inferior-septal wall AMI can be formulated as follows: (1) ST segment elevates > or = 2 mm in lead V1 in the clinical setting of inferior wall AMI; (2) the magnitude of ST segment elevation is the tallest in lead V1 and decreases gradually from lead V1 to V3 and from lead V1 to V3R-V5R. With two conditions above, the basal inferior-septal wall AMI should be diagnosed.
authors.affiliation: Center for Diagnosis & Treatment of Coronary Heart Disease, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing. jilin.chen@263.net
authors.forename: Ji-lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Zuo-xiang
authors.initials: ZX
authors.lastname: He
authors.forename: Zai-jia
authors.initials: ZJ
authors.lastname: Chen
authors.forename: Jin-qing
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Yue-qin
authors.initials: YQ
authors.lastname: Tian
authors.forename: Shu-bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Rong-fang
authors.initials: RF
authors.lastname: Shi
authors.forename: Yi-da
authors.initials: YD
authors.lastname: Tang
authors.forename: Zong-lang
authors.initials: ZL
authors.lastname: Lu
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011877:Radionuclide Imaging