From the Guidelines
A septal infarct on an EKG is a medical emergency that requires immediate attention, as it indicates myocardial damage in the septal region of the heart, typically due to coronary artery disease affecting the septal branches of the left anterior descending artery. The implications of a septal infarct on an EKG are significant, as it can lead to conduction abnormalities, septal rupture, or ventricular septal defects, and is often part of a larger anterior wall infarction. According to the 2020 ESC guidelines for the management of acute coronary syndromes 1, patients with acute chest pain and persistent ST-segment elevation, which may include those with septal infarcts, require immediate reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolytic therapy.
Key Considerations
- Septal infarcts are typically identified by Q waves in leads V1 and V2, along with possible loss of R wave progression in the precordial leads
- Management includes antiplatelet therapy, anticoagulation, pain control, and urgent cardiac catheterization to determine if revascularization is needed
- Long-term treatment typically involves dual antiplatelet therapy, statins, beta-blockers, and ACE inhibitors
- Regular follow-up with cardiology is essential, including echocardiography to assess for complications
Treatment Approach
- Antiplatelet therapy: aspirin 325mg initially, then 81mg daily
- Anticoagulation: heparin
- Pain control: as needed
- Urgent cardiac catheterization: to determine if revascularization is needed
- Long-term treatment: dual antiplatelet therapy (aspirin 81mg daily plus clopidogrel 75mg daily for up to 12 months), statins (such as atorvastatin 40-80mg daily), beta-blockers (metoprolol 25-100mg twice daily), and ACE inhibitors (lisinopril 5-40mg daily) 1.
From the Research
Implications of a Septal Infarct on an EKG
- A septal infarct can lead to various electrocardiographic findings, including the disappearance of septal Q waves and reciprocal ST segment depression in the inferior leads 2.
- Isolated septal myocardial infarction can exhibit ST-segment elevations in leads V1 and V2 3, 4.
- The electrocardiographic manifestations of isolated septal myocardial infarction can be similar to those of an anteroseptal myocardial infarction, but with distinct differences 4.
- Septal infarction can also lead to arrhythmias, including atrio-ventricular (AV) block, as a result of occlusion of septal perforator arteries 5.
Diagnostic Challenges
- Isolated septal myocardial infarction can be difficult to diagnose due to its small infarction size and anatomical variations 3.
- Nuclear imaging, such as myocardial perfusion-metabolism mismatch, can be a useful tool for diagnosing isolated septal myocardial infarction 3.
- Echocardiography and angiography may not always be able to confirm the diagnosis of isolated septal myocardial infarction 3.
Clinical Significance
- Septal infarction can lead to serious complications, including heart failure and complete heart block 5.
- Ventricular septal defects, a rare complication of acute myocardial infarction, can have a high mortality rate if left untreated 6.
- Prompt diagnosis and treatment of septal infarction are crucial to prevent long-term cardiac damage and improve patient outcomes 5, 6.