Anterolateral ST segment depression in acute inferior myocardial infarction: Angiographic and clinical implications

Roubin, Gary S.; Shen, Wei-Feng; Nicholson, M. L.; Dunn, Richard F.; David, T.; J, Phillip

doi:10.1016/0002-8703(84)90274-6

Cited by 76 publications

(19 citation statements)

References 12 publications

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“…[15][16][17][18][19][20][21][22][23][24][25][26] According to Peterson et al 25 , there is marginal correlation of magnitude of precordial depression of ST segment with the magnitude of elevation of ST segment in inferior AMI. Contrary to the above narrated studies, we observed that multivessel disease was more common in patients having depression of ST segment in leads V4-6 (83.6%) compared to 56.8% in Group I (V1-3) with acute inferior MI thus indicating the association of depression of ST segment in anterior leads with CAD.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Abbas¹,

Riaz²,

Javaid³

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of multivessel coronary artery disease (CAD) in patients suffering from inferior wall acute myocardial infarction (AMI) having ST segment depression in anterior chest leads. The presence of precordial ST depression during acute inferior wall myocardial correlates well with multivessel CAD. Precordial ST-segment depression in acute inferior wall MI is related to anterior injury due to LAD stenosis and these patients tend to have more severe CAD. Key words:Acute inferior wall myocardial infarction, ST segment depression, coronary angiography, multivessel coronary artery disease. Article Citation: Abbas S, Riaz R, Javaid I, Hameed N. Coronary artery disease; acute inferior wall myocardial infarction with ST segment depression in anterior chest leads. Professional Med J 2017;24(7):935-941.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Abbas¹,

Riaz²,

Javaid³

et al. 2017

TPMJ

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“…[1][2][3][4][5][6][7][8] As part of a study looking at partial-thickness ischemia in an experimental animal model, 9 we observed that ST depression accompanied some episodes of full-thickness ischemia and not others. The literature reflecting experimental infarction has shown that full-thickness ischemia was associated with a region of epicardial ST elevation over the ischemia with minimal changes elsewhere.…”

mentioning

confidence: 80%

Epicardial ST Depression in Acute Myocardial Infarction

Yong

et al. 1999

Circulation Research

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Abstract-The presence of electrocardiographic ST depression in acute infarction remains controversial and poorly explained. A combined animal and modeling study was performed to evaluate the source of ST changes in acute infarction. In anaesthetized sheep, small infarcts showed uniform ST elevation over the infarction whereas larger infarcts showed marked ST depression over the normal myocardium in addition to the ST elevation. These findings were replicated by bidomain models of the heart. A hollow sphere was used to model a gradually increasing infarct, and this showed that there was a decrease in the ratio of ST elevation to ST depression as the infarct was increased. The current flowing out of the heart must be identical to the current flowing back into the heart. This means that any infarction will produce ST depression as well as ST elevation, the ratio between the two being related to the size of the infarction. Small infarction is associated with a small region of ST elevation and minor ST depression of the remaining myocardium, and as the infarct region increases, the amplitude of the epicardial ST elevation falls and the amplitude of the ST depression increases. Infarction size is proportional to both the height of the ST depression on the epicardium and the strength of the epicardial ST segment dipole. (Circ Res. 1999;85:959-964.)Key Words: electrocardiography Ⅲ epicardial potential Ⅲ acute infarction Ⅲ bidomain model Ⅲ ST depression T he origins and significance of ST depression associated with acute myocardial infarction are poorly understood and controversial. [1][2][3][4][5][6][7][8] As part of a study looking at partial-thickness ischemia in an experimental animal model, 9 we observed that ST depression accompanied some episodes of full-thickness ischemia and not others. The literature reflecting experimental infarction has shown that full-thickness ischemia was associated with a region of epicardial ST elevation over the ischemia with minimal changes elsewhere. 10 -16 This discrepancy between clinical observation and experimental results has been more fully evaluated by detailed epicardial, endocardial, and body surface ECG mapping of acute infarction in different territories and of different sizes in an experimental sheep model. The electrical changes were correlated with regional blood flow measured by fluorescent microspheres. To explain the results of the experimental infarction, we have developed several levels of a bidomain model based on that described by Tung, 17 including a hollow thick-walled sphere, and a finite element model of the heart that replicated the experimental observations. Materials and Methods Experimental AnimalsA total of 33 sheep were randomized into three groups. Transmural ischemia was achieved by completely ligating the obtuse marginal branch (OM) in group 1, the proximal left circumflex coronary artery (LCX) in group 2, and the proximal left anterior descending coronary artery (LAD) in group 3 for a minimum of 20 minutes. The epicardial ST potential fields were re...

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“…However, the significance of the precordial ST-segment depression is less than clear. Initially, it was believed that the anterior ST-segment 53 Roubin et a153 studied 84 consecutive survivors of a first inferior infarction with angiography and ventriculography. The prevalence of significant stenosis (more than 70%) in the LAD was significantly higher in the group with precordial ST-segment disease (36% vs. 3%, p<0.05), as was the prevalence of multivessel disease (53% vs. 6%,p<0.01).…”

Section: U Clinical Progress Series Inferior Myocardial Infarctionmentioning

confidence: 99%

Inferior myocardial infarction. High-risk subgroups.

Berger¹,

Ryan²

1990

Circulation

260

154

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Anterolateral ST segment depression in acute inferior myocardial infarction: Angiographic and clinical implications

Cited by 76 publications

References 12 publications

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Epicardial ST Depression in Acute Myocardial Infarction

Inferior myocardial infarction. High-risk subgroups.

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