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Lateral STEMI Infarction

Lateral STEMI infarction

Vascular Supply of the Lateral Wall

Heart coronary artery, Left circumflex branch, Lateral wall of left ventricle, first diagonal branch (D1) of LAD

Lateral Infarction

Lateral STEMI infarction categories, anterolateral, inferior-posterior-lateral-isolated lateral STEMI

ECG and Lateral STEMI

ECG isolated lateral STEMI infarction, ST elevation (I, aVL), reciprocal change (III, aVF)
  • ST elevation (I, aVL) ≥ 1mm
  • Reciprocal ST depressions (III, aVF)

  • Isolated lateral STEMI is very rare
  • Lateral STEMI is most often seen in combination with:

Isolated Upper Lateral STEMI

ECG and electrical vector, isolated lateral STEMI, D1 occlusion

Antero-lateral STEMI

ECG anterolateral STEMI infarction, STEMI due to proximal LAD occlusion
  • Occurs due to proximal occlusion of the LAD
  • Ischemic vector points between (aVR, aVL)

  • ECG and Antero-lateral STEMI

Infero-posterior-lateral STEMI

Inferior posterior lateral STEMI due to RCx occlusion

Posterior lateral STEMI due to proximal RCx occlusion
ECG acute postero-lateral STEMI infarction, ST elevation (V5-V6), ST depression (V1-V3)

Acute Posterior-Lateral STEMI

  • Sinus Rhythm
  • Atrial Extrasystole
  • Lateral STEMI
    • ST elevations (V5-V6)
  • Posterior Wall STEMI
    • ST depressions (V1-V3)
    • The patient should be fitted with posterior leads V7-V9
  • On coronary angiography:
    • A: Proximal occlusion of ramus circumflexus (RCx)
    • B: RCx after PCI and stent placement


Isolated high lateral STEMI infarction, proximal occlusion non-dominant ramus circumflexus
ECG acute isolated lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (III, aVF), sinus bradycardia

Acute Lateral STEMI

Coronary angiogram proximal occlusion left circumflex artery (LCx)
Coronary angiogram after percutaneous coronary intervention (PCI) and stenting

Coronary Angiography



Left anterior descending artery (LAD) occlusion proximal DI, and distal S1
ECG antero-lateral STEMI infarction, ST elevation (V2-V5, I, aVL), reciprocal ST depression (II, III, aVL), culprit artery - vessel: LAD between S1 and D1

Acute Antero-lateral STEMI

  • Sinus Rhythm
  • Anterior STEMI
    • ST elevations (V2-V5)
  • Lateral STEMI
    • ST elevations (I, aVL)
  • Reciprocal ST depressions (II, III, aVF)
  • This is an occlusion of the LAD between S1 and D1
    • ST elevations (V2-V4, I, aVL)
    • ST depressions (II, III, aVF)
      • Depression in III > II


Left anterior descending artery (LAD) occlusion proximal 1st septal (S1) and first diagonal (D1) branch
ECG acute antero-lateral STEMI, proximal left anterior descending artery (LAD), proximal to D1, S1

Acute Antero-lateral STEMI



Left anterior descending artery, culprit artery - first diagonal branch of LAD
ECG isolated high lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (V1-V3), culprit vessel - first diagonal branch (D1) of LAD

Acute Isolated High Lateral STEMI

  • Sinus Rhythm
  • ST Elevations (I, aVL)
  • Reciprocal ST Depressions (III, aVF, V1-V3)
  • The patient had a coronary angiography showing occlusion of the first diagonal branch of the LAD


Left anterior descending artery, culprit artery - first diagonal branch of LAD
ECG isolated high lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (V1-V3), culprit vessel - first diagonal branch (D1) of LAD

Acute Isolated High Lateral STEMI



Left anterior descending artery, culprit artery - first diagonal branch of LAD
ECG subacute high lateral STEMI infarction, ST elevation (I, aVL), pathological Q wave (aVL)

Subacute Isolated High Lateral STEMI

  • Sinus Rhythm
  • ST Elevations (I, aVL)
  • The subacute stage is indicated by:
    • Pathological Q Waves (aVL)
    • Negative T Waves (I, aVL)
  • Reciprocal ST Depressions are not present
    • Because these are only observed in the acute stage of STEMI infarction


Posterior lateral inferior STEMI due to proximal LCx occlusion
ECG acute infero-postero-lateral STEMI infarction

Acute Inferior-Posterior-Lateral STEMI




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Lateral STEMI Infarction

Lateral STEMI infarction

Vascular Supply of the Lateral Wall

Heart coronary artery, Left circumflex branch, Lateral wall of left ventricle, first diagonal branch (D1) of LAD

Lateral Infarction

  • Isolated lateral STEMI is very rare
    • It must involve an occlusion of a terminal lateral branch
      • Most commonly D1 (first diagonal branch)
  • The lateral wall is supplied by branches from LAD and LCx
    • In the case of an occlusion, an infarction occurs beyond the occlusion
  • Most common combinations of lateral infarction:
Lateral STEMI infarction categories, anterolateral, inferior-posterior-lateral-isolated lateral STEMI

ECG and Lateral STEMI

  • ST elevation (I, aVL) ≥ 1mm
  • Reciprocal ST depressions (III, aVF)


  • Isolated lateral STEMI is very rare
  • Lateral STEMI is most often seen in combination with:
ECG isolated lateral STEMI infarction, ST elevation (I, aVL), reciprocal change (III, aVF)

Isolated Upper Lateral STEMI

  • Occurs due to occlusion of D1
  • Ischemic vector points towards (aVL, I)


  • ECG and Upper Lateral STEMI
    • ST elevations (I, aVL)
    • Reciprocal ST depressions (III, aVF)
 ECG and electrical vector, isolated lateral STEMI, D1 occlusion

Antero-lateral STEMI

  • Occurs due to proximal occlusion of the LAD
  • Ischemic vector points between (aVR, aVL)

  • ECG and Antero-lateral STEMI

ECG anterolateral STEMI infarction, STEMI due to proximal LAD occlusion

Infero-posterior-lateral STEMI

  • Occurs due to proximal RCx occlusion
  • Ischemic vector points down-back-laterally

  • ECG and Infero-posterior-lateral STEMI
    • ST elevations in the posterior leads (V7-V9) ≥ 0.5mm
    • ST elevations in the inferior leads (II, III, aVF)
    • ST elevations in the lateral leads (I, aVL, V5-V6)
Inferior posterior lateral STEMI due to RCx occlusion


ECG acute postero-lateral STEMI infarction, ST elevation (V5-V6), ST depression (V1-V3)

Acute Posterior-Lateral STEMI

  • Sinus Rhythm
  • Atrial Extrasystole
  • Lateral STEMI
    • ST elevations (V5-V6)
  • Posterior Wall STEMI
    • ST depressions (V1-V3)
    • The patient should be fitted with posterior leads V7-V9
  • On coronary angiography:
    • A: Proximal occlusion of ramus circumflexus (RCx)
    • B: RCx after PCI and stent placement
 Posterior lateral STEMI due to proximal RCx occlusion


ECG acute isolated lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (III, aVF), sinus bradycardia

Acute Lateral STEMI

  • Sinus Bradycardia
  • Indicated ST elevations (I, aVL)
  • The patient had a proximal occlusion of ramus circumflexus (RCx) on coronary angiography
    • The inferior and posterior walls had extensive collateral supply
    • The patient had a dominant right coronary artery
      • RCx does not supply the inferior wall
 Isolated high lateral STEMI infarction, proximal occlusion non-dominant ramus circumflexus
Coronary angiogram proximal occlusion left circumflex artery (LCx) Coronary angiogram after percutaneous coronary intervention (PCI) and stenting

Coronary Angiography



ECG antero-lateral STEMI infarction, ST elevation (V2-V5, I, aVL), reciprocal ST depression (II, III, aVL), culprit artery - vessel: LAD between S1 and D1

Acute Antero-lateral STEMI

  • Sinus Rhythm
  • Anterior STEMI
    • ST elevations (V2-V5)
  • Lateral STEMI
    • ST elevations (I, aVL)
  • Reciprocal ST depressions (II, III, aVF)
  • This is an occlusion of the LAD between S1 and D1
    • ST elevations (V2-V4, I, aVL)
    • ST depressions (II, III, aVF)
      • Depression in III > II
 Left anterior descending artery (LAD) occlusion proximal DI, and distal S1


ECG acute antero-lateral STEMI, proximal left anterior descending artery (LAD), proximal to D1, S1

Acute Antero-lateral STEMI

  • Sinus Rhythm
  • ST Elevations (V1-V4, I, aVL, aVR)
    • Anterior STEMI (V1-V4, aVR)
    • Lateral STEMI (I, aVL)
  • Reciprocal ST Depressions (II, III, aVF)
  • This is an occlusion of the LAD proximally from S1 and D1
    • ST elevations (V1-V4, I, aVL, aVR)
      • V1 > 2mm
      • aVL > aVR
    • Reciprocal ST depressions (II, III, aVF)
      • Depression in III > II
  • Left Anterior Fascicular Block
 Left anterior descending artery (LAD) occlusion proximal 1st septal (S1) and first diagonal (D1) branch


ECG isolated high lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (V1-V3), culprit vessel - first diagonal branch (D1) of LAD

Acute Isolated High Lateral STEMI

  • Sinus Rhythm
  • ST Elevations (I, aVL)
  • Reciprocal ST Depressions (III, aVF, V1-V3)
  • The patient had a coronary angiography showing occlusion of the first diagonal branch of the LAD
 Left anterior descending artery, culprit artery - first diagonal branch of LAD


ECG isolated high lateral STEMI infarction, ST elevation (I, aVL), reciprocal ST depression (V1-V3), culprit vessel - first diagonal branch (D1) of LAD

Acute Isolated High Lateral STEMI

 Left anterior descending artery, culprit artery - first diagonal branch of LAD


ECG subacute high lateral STEMI infarction, ST elevation (I, aVL), pathological Q wave (aVL)

Subacute Isolated High Lateral STEMI

  • Sinus Rhythm
  • ST Elevations (I, aVL)
  • The subacute stage is indicated by:
    • Pathological Q Waves (aVL)
    • Negative T Waves (I, aVL)
  • Reciprocal ST Depressions are not present
    • Because these are only observed in the acute stage of STEMI infarction
 Left anterior descending artery, culprit artery - first diagonal branch of LAD


ECG acute infero-postero-lateral STEMI infarction

Acute Inferior-Posterior-Lateral STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation II > III (indicates RCx Occlusion)
  • Lateral STEMI
    • ST Elevations (I, V5-V6)
  • Posterior STEMI
    • ST Depressions (V1-V3)
    • Ratio in V2 R/S > 1
    • The patient should be fitted with posterior leads (V7-V9)
  • The patient had a proximal occlusion of the dominant RCx
 Posterior lateral inferior STEMI due to proximal LCx occlusion



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers