Onlineartikel 02.11.2015

Acute Myocardial Infarction

deutsche Version

67 year old female patient, with the following relevant medical history:

  • Hypertension
  • Hyperlipidemia


Anamnesis


The patient is admitted in the emergency room due to intense retrosternal pain and nausea. In the ECG a ST elevation in DII, DIII, and aVF can be observed. A primary PCI is performed. The coronariography shows a total occlusion of the distal RCA (Figure 1). A drug-eluting stent is implanted.


Myokardinfarkt Bild 1

Abbildung 1/ Figure 1

Credit:
DGK 2015

During the hospital stay a cardiac MRI is performed.

Video 1 shows cine imaging at rest. The left ventricle has a normal size (diameter 50 mm at end-diastole), is hypertrophied (basal septum 17 mm), and has a normal global function (EF 57%). A hypokinesia of the basal and medial inferior and inferoseptal segments (segments 3, 4, 8, and 9) can be observed. Figure 2 shows the location of the wall motion abnormalities.










Myokardinfarkt Bild 2

Abbildung 2/ Figure 2

Credit:
DGK 2015


T2-weighted Imaging 


A hyperintensity in the same segments can be observed in T2-weighted imaging. Figure 3 shows the location of the hyperintense regions.


Myokardinfarkt Bild 3

Abbildung 3/ Figure 3

Credit:
DGK 2015


Late-Gadolinium Enhancement


Figure 4 shows the delayed enhancement images of the patient. A transmural enhancement affecting the medial inferior and inferoseptal wall can be demonstrated.


Myokardinfarkt Bild 4

Abbildung 4/ Figure 4

Credit:
DGK 2015


Cine vs. T2 vs. Late-enhancement


Figure 5 shows the comparison between cine imaging, T2 weighted imaging, and delayed enhancement imaging.


Myokardinfarkt Bild 5

Abbildung 5/ Figure 5

Credit:
DGK 2015


Conclusion


In conclusion, the patient has wall motion abnormalities in the inferoseptal and inferior segments, together with myocardial edema, and transmural delayed enhancement in the same segments. The left ventricle function at rest is normal.