Dilemma of localization of culprit vessel by electrocardiography in acute myocardial infarction

Thrudeep, S.; Geofi, George; George, Rupesh; Abdulkhadar, Said Mohamed

doi:10.1016/j.ihj.2015.07.053

Cited by 7 publications

(4 citation statements)

References 3 publications

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“…The term "aVR sign" has been coined to phrase the combination between the simultaneous STE in aVR and ST depressions in many other leads [70]. The severe LMC stenosis-but not LMC occlusion-(or an equivalent bulk of severe stenoses of all coronary arteries) is the best known among the wilderness of causes of the aVR sign [70,71,72] along with other life-threatening (proximal acute aortic dissection whose intimal flap shrouds the orifice of the left main coronary every now and again [73], pulmonary embolism [70,73,74], myocarditis [70] early status after cardiac resuscitation (where only the long-standing aVR STE is predictive for coronary stenoses) [26], haemorrhagic shock [70] Brugada syndrome and its related phenocopies [73] or non-life-threatening pathologies (acute pericarditis) [73], paroxysmal supraventricular tachycardia (an orthodromic atrioventricular reentrant tachycardia using an accessory pathway is more likely than atrioventricular nodal reentrant by the aforesaid description, except the absence of ST depression in aVL [78,79]; 3) severe proximal LAD stenosis, hinted either by an STE in V1 higher than the STE in aVR [71] or by a less than 1 ratio between the modulus of the ST depression in DII and the STE in V2 [76]. Although ranked as a STEMI equivalent [1] instead of STEMI, the LMC near-occlusion delineated by the STE in aVR portends the same ominous prognosis as any STEMI [1] and calls for the same imperative percutaneous coronary intervention.…”

Section: Stemi Equivalents and Hoverings: Left Main Coronary Severe S...mentioning

confidence: 99%

ST Segment Elevation

Lucaci¹

2022

Romanian Journal of Cardiology

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As the earliest indirect sign of an acute coronary occlusion arriving against non-operative collateral heart vessels, the unabating ST segment elevation accounts for the acute coronary syndrome asking for mandatory and immediate reperfusion therapy. The geography of the ST segment elevations usually enables one to identify the culprit artery and to guess its likely occlusion site, as pivotal pieces of the necessary vital risk forecasting, along with somehow expected occurring arrhythmias. Aside from the classical ST segment elevation myocardial infarction (STEMI) pattern, a handful of distinctive non-ST elevation appearances of the acute coronary occlusion also need imperative reperfusion therapy, thus qualifying themselves as STEMI equivalents. The early forthcoming of ST elevation during an acute transmural ischaemic episode, as well as the wide availability of the electrocardiogram, make it an invaluable diagnostic tool. Yet many confounding factors are able to limit the diagnostic sensibility of ST elevation (as for example its customary absence in the conventional leads in some cases of circumflex artery occlusion, or the casual mutual cancellation of the transmural ST vectors from opposite ventricular walls), the accuracy of the electrocardiographic localisation of the occlusion site (due to coronary anatomic variants, concomitant new or old coronary lesions elsewhere, previous coronary artery bypass grafts), as well as its specificity for transmural ischaemia (by virtue of a well-known manifold of non-ischaemic causes). While the STEMI patient must be offered undelayed reperfusion therapy, the non-ischaemic ST elevation one should be kept away from the haemorrhagic risk of a useless invasive procedure.

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Section: Stemi Equivalents and Hoverings: Left Main Coronary Severe S...mentioning

confidence: 99%

ST Segment Elevation

Lucaci¹

2022

Romanian Journal of Cardiology

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“…De ining the age of an infarction: Acute infarction manifests ST segment elevation in a lead with a pathologic Q wave. Old or age indeterminate infarction manifests a pathologic Q wave, with or without slight ST segment elevation or T wave abnormalities [21][22][23][24][25][26][27].…”

Section: Lead Avrmentioning

confidence: 99%

Localization of the occluded vessel in acute myocardial infarction

Rafla¹,

Kamal²

2020

J Cardiol Cardiovasc Med

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This is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis.

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Section: Introductionmentioning

confidence: 99%

“…Cardiologists use the electrocardiogram (ECG) and cardiac biomarkers widely for diagnosis, management, and prognosis of AMI, because of its simplicity, safety, easy accessibility, and low cost (10,11). Complete coronary artery occlusion causes elevated ST, whereas nonobstructive lesion leads to ST depression (11). A combination of symptoms, ECG changes, and cardiac biomarkers, such as troponin, creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) is used to diagnose of AMI (8,12).…”

Section: Introductionmentioning

confidence: 99%

ST-Segment Elevation Myocardial Infarction with Normal Coronary Arteries Angiography

Motedayen

Khederlou

2020

Multidiscip Cardio Annal

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: Myocardial infarction (MI) is the most frequent cause of ischemic heart death. MI is generally assumed to be due to arterial thrombosis superimposed on an atherosclerotic plaque in an epicardial coronary artery. Total occlusion of an epicardial coronary artery leads to ST elevation, while non-occlusive lesion leads to ST depression. We hereby have reported a case of ST-segment elevation myocardial infarction with normal coronary arteries angiography. A 35-year-old man presented with typical chest pain, nausea, vomiting and cold sweating. ECG obtained at admission and 30 minutes later revealed sinus tachycardia with ST-segment elevations (> 2 mm) in leads V2-V5. Cardiac biomarkers including creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) and troponin high sensitive were elevated. The standard treatment for MI including pain relief, aspirin, thrombolysis if indicated and beta blockade were begun for the patient. STEMI was confirmed and thus, angiography was performed. Coronary angiography revealed normal coronary arteries without any angiographic evidence of stenosis, coronary artery dissection, embolism, plaque rupture or vasospasm.

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Dilemma of localization of culprit vessel by electrocardiography in acute myocardial infarction

Cited by 7 publications

References 3 publications

ST Segment Elevation

ST Segment Elevation

Localization of the occluded vessel in acute myocardial infarction

ST-Segment Elevation Myocardial Infarction with Normal Coronary Arteries Angiography

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