Milenko Cankovic

Posterior wall myocardial infarction: A case report

Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia [1, 2]. Acute ST elevation myocardial infarction (STEMI) is diagnosed based on clinical presentation, newonset persistent elevation registered on electrocardiogram (ECG) in at least two leads i.e. transitory ST elevation longer than 20 minutes, and positive cardiospecific enzymes [3]. In certain cases chest pain along with the signs of ischemia on ECG and cardiospecific enzymes can have origins other than coronary, like in myopericarditis [4]. Equivalents to ST elevation myocardial infarction represent a great diagnostic problem. They are: ST segment elevation in aVR lead indicating left main coronary artery stenosis, the left bundle branch block in myocardial infarction, and posterior myocardial infarction [5, 6]. In Summary Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1−V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1−V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

First application of automated external defibrilator in Serbia: Case report

INTRODUCTION Sudden cardiac death is an unexpected natural death from cardiac causes. It is the most common and first manifestation of coronary artery disease. It accounts for 50% of mortality from cardiovascular disease in the United States of America and other developed countries, so measures that can reduce it are an important medical task. CASE REPORT A 55-year old man suddenly lost consciousness at the train station in Novi Sad. An eyewitness provided first aid and ventricular fibrillation was converted to sinus rhythm by means of the automated external defibrillator. Emergency Medical Service Novi Sad soon arrived, continued resuscitation procedure, and transported the patient to the Cardiac Care Unit, who was then diagnosed with acutedmyocardial infarction and primary percutaneous coronary intervention was performed. Resuscitative hypothermia was applied in acute phase to prevent further brain injury. During further hospitalization the patient was stable, woke up from coma and early rehabilitation measures were implemented. After six months the patient had normal physical activities and there was no left ventricular segmental hypokinesia on echo cardiography. CONCLUSION The application of all four chains of survival is important in increasing the survival rate of patients with sudden cardiac arrest.