Myocardial-Infarct Extension Detected by Precordial ST-Segment Mapping

Reid, Philip R.; Taylor, D R; Kelly, David T.; Weisfeldt, Myron L.; Humphries, Julie; Ross, Richard S.; Pitt, Bertram

doi:10.1056/nejm197401172900302

Cited by 163 publications

(33 citation statements)

References 9 publications

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“…Thus, patients with and without infarct extension could be separated by the degree of a new ZST increase, the value of 0.6 mV/hr forming the distinction line. Our further investigations of the small changes in 2ST in group A patients have shown that a new rise of ZST of 0.25 mV/hr to 0.6 mV/hr occurred on 14 14 cases of severe angina in these patients were not followed by such an increase in 2ST. In 17 patients, serial CPK determination allowed calculation of infarct size.…”

Section: Methodsmentioning

confidence: 59%

“…MANY REPORTS HAVE EVALUATED therapeutic interventions in patients with acute myocardial infarction by precordial ST-segment mapping,"'' but only a few have been concerned with the spontaneous course of ST-segment elevation (2ST) during myocardial infarction by daily ST-segment mapping; [12][13][14][15][16][17] there are none with multiple measurements within the first hours after onset of chest pain, when therapeutic interventions are expected to have the best effect on minimizing final infarct size. Therefore, it is necessary to know the spontaneous course of ZST during this period for accurate interpretation of therapeutic intervention.…”

mentioning

confidence: 99%

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Spontaneous course of ST-segment elevation in acute anterior myocardial infarction.

Essen¹,

Merx²,

Effert³

1979

Circulation

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SUMMARY The spontaneous course of ST-segment elevation (2ZST) in 24 patients with acute anterior myocardial infarction (AMI) was studied by precordial ST-segment mapping, which was recorded at 2-hour intervals during the first 48 hours after admission. Change of 2ST between two registrations was expressed as mV/hr, and was compared with clinical and hemodynamic parameters, course of MB-CK curve, calculated infarct mass and arrhythmias. After an initial rapid increase, there was a decrease of ZST, which reaches a plateau-like curve approximately 12 hours after the onset of chest pain. A second new increase of ZST exceeding a value of 0.6 mV/hr correlates well with extension of necrosis, verified by re-elevation of MB-CK. During the first 2 days, extension of necrosis could be detected in 50% of our patients.As new ischemic episodes and extension of necrosis in AMI occur frequently and are promptly indicated by an increase of ZST, the physician should, while monitoring therapeutic interventions, concentrate on such a second increase rather than on a decrease of ZST (which may occur spontaneously), as has been suggested in most previous reports.MANY REPORTS HAVE EVALUATED therapeutic interventions in patients with acute myocardial infarction by precordial ST-segment mapping,"'' but only a few have been concerned with the spontaneous course of ST-segment elevation (2ST) during myocardial infarction by daily ST-segment mapping;12-17 there are none with multiple measurements within the first hours after onset of chest pain, when therapeutic interventions are expected to have the best effect on minimizing final infarct size. Therefore, it is necessary to know the spontaneous course of ZST during this period for accurate interpretation of therapeutic intervention.After improving the technique of precordial mapping so that accurate measurements within a relatively short period were possible without interfering greatly with the normal activity of the coronary care unit (CCU), we followed the spontaneous course of IST closely and redefined its diagnostic value. Materials and MethodsTwenty-four patients (19 male, five female), ages 26-81 years (mean age 59.5 years), were studied. All were admitted to the CCU within 24 hours (mean 4.8 hours) after the onset of acute chest pain. All had an ECG compatible with the diagnosis of acute transmural anterior myocardial infarction. Patients with initial signs of pericarditis (pericardial friction rub) or complete bundle branch block were excluded.Precordial mapping was performed with a flexible synthetic plate (32 X 24 cm) containing 48 silveroxydized copper electrodes. Contact diameter of elec-

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Section: Methodsmentioning

confidence: 59%

mentioning

confidence: 99%

Spontaneous course of ST-segment elevation in acute anterior myocardial infarction.

Essen¹,

Merx²,

Effert³

1979

Circulation

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“…Precordial ST-segment mapping provides a useful noninvasive approach for the assessment of acute directional changes in ischemic injury that appears to be a reliable clinical indicator of particular therapeutic interventions.14 29,[32][33][34][35][36][37][38][39] More rapid reductions of ST-segment elevations were observed in patients with the inhalation of oxygen39 and the use of drugs such as hyaluronidase,33 nitroglycerin (with and without phenylephrine37, 38), as well as with intra-aortic balloon counterpulsation,29 than in untreated patients. The same interventions have been shown to reduce infarct size in experimental animals, and these changes in the ST segment appear to correlate well with the salvage of myocardium.…”

Section: An Official Journal Oftle American Heart Association Editorimentioning

confidence: 99%

ST-segment mapping. Realistic and unrealistic expectations.

Braunwald¹,

Maroko²

1976

Circulation

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“…With the advent of sensitive and spedic el -'ographp u r p~s e~ Of this report m (1) to describe these new ECG Crite-…”

Section: Introductionmentioning

confidence: 99%

The clinical distinction between regional postinfarction pericarditis and other causes of postinfarction chest pain: Ancillary observations regarding the effect of lytic therapy upon the frequency of postinfarction pericarditis, postinfarction angina, and reinfarction

Oliva

Hammill

1994

Clinical Cardiology

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Summary:Recently two types of atypical T-wave evolution were recognized as electrocardiographic (ECG) markers of regional postinfmtion pencarditis. The sensitivity and specificitively. The major purpose of this investigation is to show how these ECG changes can be used to differentiate among postinfarction pericarditis, postinfarction angina, and reinfarction. Even appmpt-iately constructed serial monitor lead ECGs can be used to make this distinction. The ease of correctly Istinlizing a carefully elicited history and ECG criteria is discussed.In addition, a secondary objective was to assess the effect of lytictherapyontheincidenceofpostinfarctionpericardtis.Among the 200 patients in this study, lytic therapy halved the incidence of postinfarction pericarditis, which is in accord with the larger Gruppo Italian0 per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) study.tyofthesechangesforthisconditionwere looand77%,mp- guishingamongthethreecausesofpostinfarctionchestpainuti-

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Myocardial-Infarct Extension Detected by Precordial ST-Segment Mapping

Cited by 163 publications

References 9 publications

Spontaneous course of ST-segment elevation in acute anterior myocardial infarction.

Spontaneous course of ST-segment elevation in acute anterior myocardial infarction.

ST-segment mapping. Realistic and unrealistic expectations.

The clinical distinction between regional postinfarction pericarditis and other causes of postinfarction chest pain: Ancillary observations regarding the effect of lytic therapy upon the frequency of postinfarction pericarditis, postinfarction angina, and reinfarction

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