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Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series

BACKGROUND: True isolated posterior myocardial infarction is an uncommon finding of acute coronary syndrome, with an incidence rate of 3–7%. The prevalence rates of isolated posterior myocardial infarction in men and women are 72% and 28%, respectively. This uncommon finding may be attributed to mul...

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Autores principales: Alsagaff, Mochamad Yusuf, Amalia, Rizki, Dharmadjati, Budi Baktijasa, Appelman, Yolande
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9420295/
https://www.ncbi.nlm.nih.gov/pubmed/36030271
http://dx.doi.org/10.1186/s13256-022-03570-w
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author Alsagaff, Mochamad Yusuf
Amalia, Rizki
Dharmadjati, Budi Baktijasa
Appelman, Yolande
author_facet Alsagaff, Mochamad Yusuf
Amalia, Rizki
Dharmadjati, Budi Baktijasa
Appelman, Yolande
author_sort Alsagaff, Mochamad Yusuf
collection PubMed
description BACKGROUND: True isolated posterior myocardial infarction is an uncommon finding of acute coronary syndrome, with an incidence rate of 3–7%. The prevalence rates of isolated posterior myocardial infarction in men and women are 72% and 28%, respectively. This uncommon finding may be attributed to multiple factors, such as unremarkable changes on 12-lead electrocardiography, a lack of awareness or knowledge, and an absence of diagnostic consensus, which leads to reperfusion delay and poor clinical outcomes. CASE SUMMARY: Herein, we report three cases of acute myocardial infarction presenting as isolated ST-segment elevation in the posterior leads (V7–V9): Asian men aged 57, 62, and 53 years, who presented with ST-segment depression in V1–V3 that resolved gradually. Coronary angiography revealed a total/critical occlusion of the proximal circumflex coronary artery in all three cases. Routine and accurate interpretations of 15-lead electrocardiography (12-lead with additional V7–V9) resulted in a better sensitivity for isolated posterior myocardial infarction diagnoses, followed by a timely and opportune primary percutaneous coronary intervention. CONCLUSIONS: Isolated posterior myocardial infarction is a rare but potentially fatal event that is often accompanied by atypical and subtle changes on 12-lead electrocardiography (especially in the V1–V3 precordial leads) and may remain undetected by physicians. Therefore, the comprehensive and routine application of posterior leads is a crucial addition to the standard diagnosis and management of acute coronary syndrome in patients with subtle ST-segment changes who do not fulfill the criteria for ST-elevation myocardial infarction.
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spelling pubmed-94202952022-08-29 Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series Alsagaff, Mochamad Yusuf Amalia, Rizki Dharmadjati, Budi Baktijasa Appelman, Yolande J Med Case Rep Case Report BACKGROUND: True isolated posterior myocardial infarction is an uncommon finding of acute coronary syndrome, with an incidence rate of 3–7%. The prevalence rates of isolated posterior myocardial infarction in men and women are 72% and 28%, respectively. This uncommon finding may be attributed to multiple factors, such as unremarkable changes on 12-lead electrocardiography, a lack of awareness or knowledge, and an absence of diagnostic consensus, which leads to reperfusion delay and poor clinical outcomes. CASE SUMMARY: Herein, we report three cases of acute myocardial infarction presenting as isolated ST-segment elevation in the posterior leads (V7–V9): Asian men aged 57, 62, and 53 years, who presented with ST-segment depression in V1–V3 that resolved gradually. Coronary angiography revealed a total/critical occlusion of the proximal circumflex coronary artery in all three cases. Routine and accurate interpretations of 15-lead electrocardiography (12-lead with additional V7–V9) resulted in a better sensitivity for isolated posterior myocardial infarction diagnoses, followed by a timely and opportune primary percutaneous coronary intervention. CONCLUSIONS: Isolated posterior myocardial infarction is a rare but potentially fatal event that is often accompanied by atypical and subtle changes on 12-lead electrocardiography (especially in the V1–V3 precordial leads) and may remain undetected by physicians. Therefore, the comprehensive and routine application of posterior leads is a crucial addition to the standard diagnosis and management of acute coronary syndrome in patients with subtle ST-segment changes who do not fulfill the criteria for ST-elevation myocardial infarction. BioMed Central 2022-08-28 /pmc/articles/PMC9420295/ /pubmed/36030271 http://dx.doi.org/10.1186/s13256-022-03570-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Alsagaff, Mochamad Yusuf
Amalia, Rizki
Dharmadjati, Budi Baktijasa
Appelman, Yolande
Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title_full Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title_fullStr Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title_full_unstemmed Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title_short Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
title_sort isolated posterior st-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9420295/
https://www.ncbi.nlm.nih.gov/pubmed/36030271
http://dx.doi.org/10.1186/s13256-022-03570-w
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