PANCREATITIS-INDUCED ACUTE ST SEGMENT ELEVATION AND REGIONAL WALL MOTION ABNORMALITY

Post myocardial infarction (MI) short and long term clinical outcome is largely determined by the size of the infarcted area. It is generally assumed that as the lead involvement in the 12 lead electrocardiography (ECG) is less in anteroseptal ST segment elevation myocardial infarction (AS-STEMI), where ST segment elevation (STE) is limited to leads V1 to V3, myocardial damage is likely to be less. This study was intended to assess regional wall motion abnormality (RWMA) in acute anteroseptal STEMI patients. 90 patients with AS-STEMI admitted in between October 2012 and September 2013, were included. For each patient, a transthoracic echocardiogram (TTE) was performed within 24-48 hours of MI and was interpreted by an independent investigator blinded to the patient’s ECG data.The mean (± SD) age of the patients was 51.57 (± 12.02) years with mean (± SD) age of the patients was 52.58 (± 12.02) years with a range of 23 - 80 years. There were 91.1% male and 8.9% female. The mean (± SD) EF% was 38.80 %( ± 5.78). All the segments of left ventricle, except basal and mid inferolateral segments, were affected in anteroseptal STEMI. So, the term AS-STEMI may be a misnomer, as it implies that only the anteroseptal segments of the left ventricle are involved. This study shows that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region and may be it is as much extensive as extensive anterior myocardial infarction. So, any patients with anterior wall involvement should be treated with utmost importance. University Heart Journal Vol. 15, No. 1, Jan 2019; 28-33

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17 Diagnostic value of post-systolic Index in non-ST-segment elevation acute coronary syndrome without regional wall motion abnormality

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)30255-x ◽

2015 ◽

Vol 7 (3) ◽

pp. 241

Author(s):

Nadia Dammene Debbih ◽

Redouane Nedjar ◽

Abdelghani Bachir Cherif ◽

Mohamed Adel Bouraghda ◽

Mohamed Chettibi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Wall Motion Abnormality ◽

Wall Motion ◽

Regional Wall Motion ◽

Diagnostic Value ◽

Regional Wall Motion Abnormality ◽

Regional Wall ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

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Echocardiographic comparison of regional wall motion abnormality between patients with acute anteroseptal and acute extensive anteior ST segment elevation myocardial infarction

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v41i1.30232 ◽

2016 ◽

Vol 41 (1) ◽

pp. 35-40 ◽

Cited By ~ 1

Author(s):

Tunaggina Afrin Khan ◽

Abdul Wadud Chowdhury ◽

HI Lutfur Rahman Khan ◽

M. Guffar Amin ◽

Khandker Mohammed Nurus Sabah ◽

...

Keyword(s):

Myocardial Infarction ◽

Wall Motion Abnormality ◽

Wall Motion ◽

Myocardial Damage ◽

Regional Wall Motion ◽

Regional Wall ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Regional Dysfunction

Post myocardial infarction (MI) short and long term clinical outcome is largely determined by the size of the infarcted area. It is generally assumed that as the lead involvement in electrocardiography (ECG) is less in anteroseptal ST segment elevation myocardial infarction (AS-STEMI), where ST segment elevation (STE) is limited to leads V1 to V3, myocardial damage is likely to be less; and in extensive anterior STEMI (EA-STEMI), as theSTE extends further upto V6, the myocardial damage is likely to be more. This study was intended to compare regional wall motion abnormality (RWMA) between acute anteroseptal STEMI and acute extensive anterior STEMI patients. 90 patients with AS-STEMI and 106 patients with EA-STEMI, admitted in between October 2012 and September 2013, were included. For each patient, a transthoracic echocardiogram (TTE) was performed within 24-48 hours of MI and was interpreted by an independent investigator blinded to the patient's ECG data. No differences were observed between the two groups in baseline characteristics; except AS-STEMI group had more patients with diabetes and EA-STEMI group had more patients with family history of coronary artery disease. Distribution, extent of wall motion abnormalities and mean number of total involved segments were similar between patients with AS-STEMI and those with EA-STEMI (p>0.05). Regarding regional dysfunction, the apical septal (99.1% vs. 92.2%, p<0.05) and apical (76.4% vs. 60.0%, p<0.05) segments were the only two segments that were affected significantly more in patients with EA-STEMI than in patients with AS-STEMI. So, the term AS-STEMI may be a misnomer, as it implies that only the anteroseptal segments of the left ventricle are involved. This study shows that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region. So, any patients with anterior wall involvement, either anteroseptal or extensive anterior STEMI, should be treated with equal importance.

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Flecainide toxicity with high pacemaker capture thresholds and associated takotsubo syndrome

BMJ Case Reports ◽

10.1136/bcr-2021-243326 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243326

Author(s):

Dario Manley-Casco ◽

Stephanie Crass ◽

Rana Alqusairi ◽

Steven Girard

Keyword(s):

Wall Motion Abnormality ◽

Wall Motion ◽

Apical Ballooning ◽

Persistent Atrial Fibrillation ◽

Regional Wall Motion ◽

Left Ventricular ◽

Regional Wall Motion Abnormality ◽

Regional Wall ◽

Ventricular Response ◽

Bicarbonate Infusion

We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.

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