Persistent precordial "hyperacute" T-waves signify proximal left anterior descending artery occlusion Verouden, N.J.; Koch, K.T.; Peters, R.J.; Henriques, J.P.; Baan, J.; van der Schaaf, R.J.; Vis, M.M.; Tijssen, J.G.; Piek, J.J.; Wellens, H.J.; Wilde, A.A.; de Winter, R.J. Published in: Heart DOI:10. 1136/hrt.2009.174557 Link to publication Citation for published version (APA):Verouden, N. J., Koch, K. T., Peters, R. J., Henriques, J. P., Baan, J., van der Schaaf, R. J., ... de Winter, R. J. (2009). Persistent precordial "hyperacute" T-waves signify proximal left anterior descending artery occlusion. Heart, 95(20), 1701 -1706 . DOI: 10.1136 /hrt.2009 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 11 May 2018Persistent precordial ''hyperacute'' T-waves signify proximal left anterior descending artery occlusion The standard 12-lead electrocardiogram (ECG) remains the most important clinical tool for the timely identification and management of patients with acute myocardial infarction. 1 Accurate recognition of characteristic changes in the pattern of the QRS-complex, ST-segments and T-waves associated with acute proximal occlusion of a large epicardial coronary artery is essential in predicting the amount of myocardium at risk and guides decisions regarding the need for immediate reperfusion therapy. [2][3][4] In the early days of reperfusion therapy, patients would only qualify for thrombolytic therapy when there was unequivocal evidence of acute transmural ischaemia with cumulative STsegment deviation of 12-15 mm present on the ECG. 5Nowadays, primary percutaneous coronary intervention (PCI) within 2 hours of first medical contact for acute transmural myocardial infarction is the preferred treatment for reperfusion. 6 According to the current guidelines, primary PCI should be performed in patients with a clinical presentation of ST-segment elevation myocardial infarction (STEMI) within 12 hours of symptom onset and persistent ST-segment elevation at the Jpoint in at least two contiguous lead with cut-offs of >2 mm in lead V2-V3 and >1 mm in the remaining leads. [7][8][9] In the region serviced by our centre, a 12-lead ECG is recorded in patients with chest pain either on admission in the referring hospital or in the ambulance. This ECG is tra...

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Objective-To determine the eVect of brief early exposure to cows' milk on atopy in the first 2 years of life. Design-Double blind, placebo controlled, randomised feeding intervention trial (Bokaal study). Setting-Dutch midwifery practices. Participants-1533 breast fed neonates. Intervention-Exposure to cows' milk protein (n = 758) or a protein free placebo (n = 775) during the first 3 days of life. Main outcome measures-Clinical atopic disease and any positive radioallergosorbent (RAST) tests at 1 year of age. Results-Atopic disease in the first year was found in 10.0% (cows' milk) v 9.3% (placebo) of the children, with a relative risk of 1.07; in the second year, atopic disease was found in 9.6% v 10.2%, respectively, with a relative risk of 0.94. Per protocol analysis showed similar results. Any RAST positive test was found in 9.4% (cows' milk) v 7.9% (placebo) of children, with a relative risk of 1.19. Stratified analysis for high family risk of allergy showed a doubled incidence of atopic disease but no eVect from the intervention. Conclusion-Early and brief exposure to cows' milk in breast fed children does not increase the risk of atopic disease in the first 2 years. (Arch Dis Child 1998;79:126-130)