From the Guidelines
An old inferior infarct on an EKG is a sign of a previous heart attack and requires ongoing management with standard post-myocardial infarction therapy to reduce the risk of future cardiac events. This includes medications such as aspirin 81mg daily, a statin like atorvastatin 40-80mg daily, and often a beta-blocker such as metoprolol 25-100mg twice daily, as well as lifestyle modifications like smoking cessation, regular exercise, and a heart-healthy diet 1. The presence of an old inferior infarct indicates coronary artery disease, specifically involving the right coronary artery in most cases, and signals increased risk for future cardiac events, making aggressive risk factor modification and medication adherence particularly important. Some key points to consider in the management of an old inferior infarct include:
- The use of ACE inhibitors like lisinopril 5-40mg daily, especially if there's reduced heart function, as recommended by the European Society of Cardiology 1
- Regular follow-up with a cardiologist, including periodic stress tests and echocardiograms to assess heart function
- The importance of medication adherence and lifestyle modifications in reducing the risk of future cardiac events
- The need for ongoing monitoring and management of coronary artery disease, including the right coronary artery, which is often involved in inferior infarcts. It is essential to note that the management of an old inferior infarct is focused on reducing the risk of future cardiac events and improving overall cardiovascular health, rather than treating the infarct itself, as it is a sign of a previous event.
From the Research
Old Inferior Infarct in the EKG
- An old inferior infarct in the EKG is typically characterized by Q waves in leads II, III, and aVF, indicating a previous myocardial infarction in the inferior wall of the heart 2.
- The management of patients with a history of myocardial infarction, including those with old inferior infarcts, often involves the use of evidence-based treatments such as aspirin, beta-blockers, ACE inhibitors, and statins to reduce the risk of recurrent infarction and mortality 3, 4.
- In elderly patients, the presentation and treatment of myocardial infarction can be complex due to comorbidities, functional and socioeconomic status, and individual biologic variability, requiring clinicians to extrapolate evidence-based results from cardiovascular trials 2, 5.
- The use of combination therapy with aspirin, ACE inhibitors, and statins has been shown to reduce 1-year mortality in patients after acute myocardial infarction, supporting a polypill approach to increase drug compliance and reduce mortality 4.
- Beta-blockers and ACE inhibitors are commonly used in combination across the spectrum of cardiovascular diseases, including hypertension, arrhythmias, angina pectoris, and heart failure, due to their complementary actions on the sympathetic nervous system and renin-angiotensin-aldosterone system 6.