A new electrocardiographic pattern indicating inferior myocardial infarction

Aslanger, Emre; Yıldırımtürk, Özlem; Şimşek, Barış; Sungur, Azmi; Cabbar, Ayça Türer; Bozbeyoğlu, Emrah; Karabay, Can Yücel; Smith, Stephen W.; Değertekin, Muzaffer

doi:10.1016/j.jelectrocard.2020.04.008

Cited by 27 publications

(30 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It leads us to ignore other ECG variables, such as the preceding QRS-complex, the T-wave, or even the morphology of ST-segment itself. However, ACO can be reliably recognized with the help of many ECG findings other than the STE cutoffs recommended by the 4 th universal definition of MI, such as minor STE not fulfilling STEMI criteria (41), STE disproportionate to preceding QRS (42,43), unusual patterns with contiguous leads showing opposite ST deviations (44,45), and some patterns not showing STE at all (46,47). The universal definition does in fact mention that there are other ECG findings of ACO than STE, which supports the argument that the name of ACO-MI should not be STEMI, but rather occlusion MI (OMI).…”

Section: Stemi/nstemi Paradigm Focuses Only On St-segmentmentioning

confidence: 99%

Time for a new paradigm shift in myocardial infarction

Aslanger

Meyers

Smith

2021

Anatolian J Cardiol

Self Cite

View full text Add to dashboard Cite

The ST-elevation myocardial infarction (STEMI)/non-STEMI paradigm per the current guidelines has important limitations. It misses a substantial proportion of acute coronary occlusions (ACO) and results in a significant amount of unnecessary catheterization laboratory activations. It is not widely appreciated how poor is the evidence base for the STEMI criteria; the recommended STEMI cutoffs were not derived by comparing those with ACO with those without and not specifically designed for distinguishing patients who would benefit from emergency reperfusion. This review aimed to discuss the origins, evidence base, and limitations of STEMI/non-STEMI paradigm and to call for a new paradigm shift to the occlusion MI (OMI)/non-OMI.

show abstract

Section: Stemi/nstemi Paradigm Focuses Only On St-segmentmentioning

confidence: 99%

Time for a new paradigm shift in myocardial infarction

Aslanger

Meyers

Smith

2021

Anatolian J Cardiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, ST-segment elevation in lead aVR indicates an acute left main coronary artery occlusion[ 3 ] and leads V2 and aVL ST elevations indicate occlusion of the first diagonal artery[ 4 ]. Besides, de Winter pattern[ 5 ], Wellens syndrome, and Aslanger syndrome[ 6 ] among other ECG patterns, also draw the attention of clinic practitioners. However, due to the absence of classic ECG manifestations of AMI, identification of high-risk patients with these special ECG patterns is often delayed.…”

Section: Discussionmentioning

confidence: 99%

Entire process of electrocardiogram recording of Wellens syndrome: A case report

Tang¹,

Li²,

Liang³

et al. 2022

WJCC

View full text Add to dashboard Cite

BACKGROUND Wellens syndrome is an electrocardiogram (ECG) pattern seen in high-risk patients with unstable angina pectoris. It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack; however, the mechanism for this condition remains unclear. CASE SUMMARY A 47-year-old male patient experienced repeated, unprovoked episodes of chest pain for > 20 d, with worsening during the previous day. On the day of admission, he experienced episodes of paroxysmal chest pain lasting more than 30 min, in addition to radiating pain to the left arm and exertional dyspnea. The patient presented to the emergency department with no chest pain or other discomfort at that time. ECG at presentation showed sinus tachycardia and T-wave changes, which were identified as Wellens syndrome when combined with previous ECG findings. ECGs and myocardial enzymology examinations were normal when angina was present, but the ECG showed inverted or biphasic T-waves when angina was absent. After percutaneous coronary intervention, the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0, 1, and 2, but normal T-waves on day 3. The ECGs showed no subsequent ischemic ST-T-wave changes. CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.

show abstract

“…Third, there might be other types of STEMI-equivalent ECGs that are not addressed in our study. de Winter’s T waves [ 42 ], the South African Flag sign [ 43 ], and the Aslanger pattern [ 44 ] are some of the ECG findings known to represent acute coronary occlusion. These findings were not included in our study because none of the study population presented with such ECG findings.…”

Section: Discussionmentioning

confidence: 99%

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Choi

Kim

et al. 2022

JCM

View full text Add to dashboard Cite

Background: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. Methods: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. Results: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80–122) vs. 81 (70–88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632–13.490, p = 0.004). Conclusions: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.

show abstract

A new electrocardiographic pattern indicating inferior myocardial infarction

Cited by 27 publications

References 14 publications

Time for a new paradigm shift in myocardial infarction

Time for a new paradigm shift in myocardial infarction

Entire process of electrocardiogram recording of Wellens syndrome: A case report

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Contact Info

Product

Resources

About