Infarct topography refers to the precise location of the area of myocardium affected during an acute infarction. Understanding topography is essential for diagnosis, treatment and prognosis, since each area of the heart is associated with different clinical manifestations and risks.
The terminology currently used to identify the walls of the heart was proposed by Bayés de Luna in 2006. This classification links specific patterns of Q waves (or their equivalents) on the electrocardiogram (ECG) to the location of the infarction, based on cardiac magnetic resonance studies. This method allows an accurate correlation between electrocardiographic changes and myocardial anatomy, making it easier to identify the affected wall, whether anterior, inferior, lateral or septal.
Infarct Topography Based on Magnetic Resonance Imaging
| Leads | Name | Most likely culprit artery |
|---|---|---|
| V1-V2 | Septal | Septal branch of the left anterior descending artery |
| V1-V2 through V3-V6 | Anteroapical | Mid left anterior descending artery |
| V1-V2 through V3-V6, I, aVL | Extensive anterior | Proximal left anterior descending artery |
| aVL and/or I (sometimes V2-V3) | Mid-anterior | First diagonal branch |
| I, aVL, V5, V6 | Lateral | Proximal circumflex artery |
| II, III, aVF | Inferior | Right coronary or circumflex artery |
| II, III, aVF + I, aVL, V5, V6 | Inferolateral | Right coronary or circumflex artery |
References
- Bayés de Luna A, Wagner G, Birnbaum Y, Nikus K, et al. A New Terminology for Left Ventricular Walls and Location of Myocardial Infarcts That Present Q Wave Based on the Standard of Cardiac Magnetic Resonance Imaging. Circulation. 2006;114(16):1755–60.
- Bayés de Luna A. New heart wall terminology and new electrocardiographic classification of Q-wave myocardial infarction based on correlations with magnetic resonance imaging. Rev Esp Cardiol. 2007;60(7):683–9.
- Bayés de Luna A. Location of Q-wave myocardial infarction in the era of cardiac magnetic resonance imaging techniques: An update. J Electrocardiol. 2007;40(1):69–71.
