Inferior-septal myocardial infarction misdiagnosed as anterior-septal myocardial infarction: electrocardiographic, scintigraphic, and angiographic correlations.
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.
Chen
Ji-lin
JL
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
He
Zuo-xiang
ZX
Chen
Zai-jia
ZJ
Yuan
Jin-qing
JQ
Tian
Yue-qin
YQ
Qiao
Shu-bin
SB
Shi
Rong-fang
RF
Tang
Yi-da
YD
Lu
Zong-lang
ZL
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