Isolated mid-anterior myocardial infarction: a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of ST-depression

Sclarovsky, Samuel; Birnbaum, Yochai; Solodky, Alejandro; Zafrir, Nili; Wurzel, M.; Rechavia, Eldad

doi:10.1016/0167-5273(94)90115-5

Cited by 47 publications

(28 citation statements)

References 30 publications

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“…In anterior myocardial infarction, ST depression in the inferior leads is reciprocal to involvement of the basal anterolateral region, supplied by the first diagonal branch and represented by ST elevation in leads I and aVL. [89][90][91][92] In patients with inferior myocardial infarction, ST depression in lead aVL is a pure reciprocal change and is found in almost all patients, 93 and ST depression in leads V1-V3 probably do not represent "ischaemia at a distance", but rather reciprocal changes due to more posterior, inferoseptal, apical, or lateral left ventricular involvement. 44 49 50 57-59 94-98 In contrast, among patients with inferior myocardial infarction, ST depression in leads V4-V6 is associated with concomitant left anterior descending coronary artery stenosis or three vessel disease.…”

Section: Identifying "Ischaemia At a Distance"mentioning

confidence: 99%

The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

Birnbaum

Drew

2003

Postgraduate Medical Journal

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The electrocardiogram is considered an essential part of the diagnosis and initial evaluation of patients with chest pain. This review summarises the information that can be obtained from the admission electrocardiogram in patients with ST elevation acute myocardial infarction, with emphasis on: (1) prediction of infarct size, (2) estimation of prognosis, and (3) the correlations between various electrocardiographic patterns and the localisation of the infarct and the underlying coronary anatomy.

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Section: Identifying "Ischaemia At a Distance"mentioning

confidence: 99%

The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

Birnbaum

Drew

2003

Postgraduate Medical Journal

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“…1-7 In addition, such an ECG presentation has been documented along with a total occlusion of the first diagonal branch, in which case it represents subendocardial ischemia of the border zone surrounding the area of mid-anterior transmural ischemia; it is recorded in leads V4-V5 and sometimes in V3 along with STE in leads aVL and V2 and sometimes in I. [2][3][4][5]8 This ECG pattern has been presented by Pruitt et al 9 whereas, later on, De Servi et al 10 recorded it following ergometrine maleateinduced subtotal LADA occlusion. Sclarovsky et al 2 showed that 86% of the patients with precordial STD and positive T wave had a significant LADA or diagonal branch stenosis.…”

Section: Commentmentioning

confidence: 99%

Preinfarction angina entailing precordial ST segment depression with positive T wave

Ανδρέου

Georgiou

Avraamides

2011

Journal of Cardiovascular Medicine

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A 46-year-old male, cigarette smoker with dyslipidemia was admitted because of atypical chest pain associated with nonspecific T wave abnormalities in leads III and aVF. Serial cardiac enzyme evaluation, including troponin, was negative and he was discharged home following absence of exercise-induced ischemia. Three days later, he was readmitted because of acute rest angina. His ECG recorded during pain displayed a heart rate (HR) of 68 beats/min, ST segment depression (STD) with positive and peaked T waves in leads I, II, aVL and V2-V6 and absence of ST segment elevation (STE) in the posterior leads (Fig. 1a). Medical therapy resulted in abolishment of angina and STD resolution, but inverted T waves in leads III and aVF. About 1 h later, angina recurred in association with STD and peaked positive T waves in leads V2-V6, loss of R wave in V2, a Q wave in V3, subtle STE in lead III, pseudonormalization of the T wave in aVF and STD in I and aVL (Fig. 1b). Echocardiography during this phase displayed left anterior descending artery (LADA)-related segmental akinesia. Angina continued despite maximally tolerated medical therapy and provided the acute ischemic ECG changes, we recommended urgent coronary angiography. However, the patient expressed his preference to have this examination done in a private hospital, thus immediate transfer was arranged. Unfortunately, a precatheterization ECG was not performed, but provided that the angiogram displayed a total proximal LADA occlusion (Fig. 2) without collateral flow, we presumed that the ECG showed an STE pattern. The left circumflex (LCx) artery contained an intermediate proximal stenosis, whereas the dominant right coronary artery (RCA) was free of atherosclerosis (Fig. 2). The LADA was successfully tackled with a sirolimus-eluting stent. Creatine kinase and creatine kinase-myocardial band isoenzyme peaked at 3127 IU/l (reference value: 26-171 IU/l) and 247 IU/l (reference value: 0-25 IU/l), respectively. The patient was discharged home following a 6-day uneventful hospital course and ECG evidence of a Q wave anterior myocardial infarction (MI) (Fig. 3). The dobutamine stress echocardiogram performed to assess the functional significance of the LCx artery stenosis was negative, thus this lesion was deferred. CommentThe ECG pattern of precordial STD with positive T wave is an unusual manifestation of acute ischemic heart disease. It has been ascribed to regional subendocardial ischemia of the anterior wall produced by a subtotal occlusion or total occlusion with collateral flow of the LADA, in which case it is maximally recorded in leads V2-V4. [1][2][3][4][5][6][7] In addition, such an ECG presentation has been documented along with a total occlusion of the first diagonal branch, in which case it represents subendocardial ischemia of the border zone surrounding the area of mid-anterior transmural ischemia; it is recorded in leads V4-V5 and sometimes in V3 along with STE in leads aVL and V2 and sometimes in I. [2][3][4][5]8 This ECG pattern has been presented by Pruitt e...

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“…For these associations there is fairly good correlation with previously published data, 96 but for the somewhat controversial segments 12 and 16 the results differ. In the study by Meléndez-Ramirez, 103 the most sensitive leads for segment 12 and 16 were V 2 and V 8 and I, III, and aVF, respectively, while I and aVL were the most frequently involved leads in the study by Ortiz-Pérez. Actually, in the latter study, leads II, III, and aVF were involved in only 5-10% of the cases when segment 16 showed CMR changes.…”

Section: Ecg and Cmr Correlationmentioning

confidence: 99%

“…This coincides with the previously published paper on that by Sclarovsky et al, and is also supported by the paper of Meléndez-Ramirez et al showing that leads I and V 2 were among the most sensitive ECG leads to detect involvement of segments 12 and 16, typical for first diagonal branch occlusion in STEMI patients. 103, 104 The term true posterior MI was introduced by Grant and Murray to refer to the basal part of the LV wall positioned on the diaphragm. 105 In 1964, Perloff defined the criteria for this clinical entity as the presence of an R/S ratio of >1 and an R-wave duration >40 ms in lead V 1 .…”

Section: New Terminology For the LV Walls And Location Of Q-wave Mimentioning

confidence: 99%

“…103 They included 91 patients with a first STEMI with reperfusion therapy within 12 hours from symptom onset, who had a CMR study (mean 3 days after the ischemic event). The highest sensitivities for the ECG leads compared to the different segments (1-17) were: V 2 for basal anterior and anteroseptal, III and aVF for basal inferoseptal, III for basal inferior and inferolateral, V 7 -V 9 for basal anterolateral, V 2 and V 3 for midanterior and anteroseptal, III and aVF for midinferoseptal, inferior, and inferolateral, V 2 and V 8 for midanterolateral, V 2 -V 4 for apical anterior and septal, II, III, and aVF for apical inferior and lateral, and V 2 -V 4 for apex.…”

Section: Ecg and Cmr Correlationmentioning

confidence: 99%

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Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Rinta-Kiikka

Tuohinen

Ryymin

et al. 2014

Noninvasive Electrocardiol

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Background:Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging.Methods: The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy.Results: Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments.Conclusion: No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.

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Isolated mid-anterior myocardial infarction: a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of ST-depression

Cited by 47 publications

References 30 publications

The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis

Preinfarction angina entailing precordial ST segment depression with positive T wave

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

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