Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary artery occlusion

Berry, Craig W.; Zalewski, Andrew; Kovach, Richard; Savage, Michael P.; Goldberg, Sheldon

doi:10.1016/0002-9149(89)91069-2

Cited by 111 publications

(36 citation statements)

References 14 publications

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“…In the present study the LCx constituted about half of cases with TO in the NSTEMI group. It has been shown that the presence of ST segment elevation detects acute occlusions of the LAD and RCA in 70% to 92% of cases, but only in 32% to 48% of cases for LCx-related myocardial infarction [17][18][19]. Greater attention of physicians should be placed in searching for ST-segment depression in leads V1-V3 as a marker LCx occlusion, especially in patients with ongoing symptoms [20].…”

Section: Discussionmentioning

confidence: 99%

Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation

et al. 2017

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A b s t r a c t Background:The prevalence and impact of total coronary occlusion of an infarct-related artery (IRA) on outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI) remain unclear. Aim:We evaluated the clinical significance of total coronary occlusion in NSTEMI patients. Methods:A total of 2767 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes, who underwent percutaneous coronary interventions, were analysed. The patients were divided into two groups according to preprocedural culprit vessel thrombolysis in myocardial infarction (TIMI) flows (TIMI flow 0 -total coronary occlusion [TO]: 728, 26.3% of the patients, and TIMI flow 1-3 -non-total occlusion [non-TO]: 2039, 73.7% of the patients).Results: Patients with total occlusion were younger, were more often current smokers, and had lower incidence of hypertension and diabetes mellitus. The left circumflex artery (LCx) was the major IRA in the TO group (48.1%), whereas the left anterior descending artery (LAD) was more commonly the IRA in the non-TO group (38.8%). Multivariate analysis revealed that LCx as the culprit lesion (OR ± 95 CI 1.54 [1.26-1.89], p < 0.0001) was an independent predictor of TIMI flow 0 in IRA. In-hospital and one-month mortality occurred more frequently in the TO group (4.0% vs. 1.7%, p = 0.0005 and 5.5% vs. 3.5%, p = 0.0175, respectively), no differences in the 12-, 24-, or 36-month mortalities were observed between these groups. Conclusions:Only LCx as a culprit lesion was an independent predictor of total occlusion in IRAs. The NSTEMI patients with TO had higher in-hospital and one-month mortalities, but their long-term outcomes were similar to those of non-TO patients.

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Section: Discussionmentioning

confidence: 99%

Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation

et al. 2017

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“…Due to simple geometry and positioning of the ECG leads along the anterior thorax, ECG changes from posterior ischemia are not well represented. During transient left-circumflcx-coronary-artery occlusion, only one third of the patients have been found to manifest significant STsegment changes [14], An advantage with VCG is that changes due to posterior isch emia of the myocardium are better repre sented than in scalar ECG [15], Thus, contin uous VCG might be better suited to monitor all infarct locations and also has the advan tage of being on-line.…”

Section: Discussionmentioning

confidence: 99%

Continuous Vectorcardiography in Patients with Chest Pain Indicative of Acute Ischemic Heart Disease

Lundin

Eriksson²,

Erhardt³

et al. 1992

Cardiology

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To assess the clinical usefulness of continuous on-line vectorcardiography (VCG), we studied 61 patients admitted to the coronary care unit (CCU) with chest pain, supposedly ischemic. Continuous VCG was performed for 24 h, monitoring QRS vector difference (QRS-VD), ST-change vector magnitude (STC-VM) and ST vector magnitude (ST-VM) measured 20 and 60 ms after the termination of the QRS complex. The patients were divided into four groups based on the final diagnosis; group A, 15 patients with normal exercise tests and extracardiac causes of chest pain; group B, 15 patients with unstable angina; group C, 15 patients with non-Q-wave myocardial infarction (MI); group D, 16 patients with Q-wave MI. Treatment was given according to a normal routine. Of 31 patients with MI, 16 received treatment with streptokinase. Groups A and B showed no significant permanent changes in QRS-VD, STC-VM or ST-VM. However, group B showed a higher occurrence of transient episodes (duration: 2 min-6 h) of a significant change of QRS-VD by > 15 µVs and of STC-VM, ST-VM 20 and ST-VM 60 by > 0.1 mV. Groups C and D showed both permanent changes and transient episodes for the studied vector parameters. Transient episodes were significantly fewer in group D than in group B. In patients with MI, the permanent change of vector parameters evolved more rapidly and reached a plateau earlier in those treated with streptokinase (QRS-VD: 178 ± 82 vs. 293 ± 100 min, p < 0.001; ST-VM 20: 142 ± 75 vs. 293 ± 89 min, p < 0.005). The magnitude of the end value for QRS-VD correlated with infarct size estimated by the maximal value of creatine kinase (r = 0.89; p < 0.001). We conclude that in patients admitted to the CCU with chest pain, continuous VCG monitoring early differentiates patients suffering from ischemic heart disease (IHD) from patients without IHD. It also differentiates patients with unstable angina from patients with MI.

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“…5 This a particularly true in the acute stage when prompt and accurate diagnosis of AMI is critical in determining the initiation of reperfusion therapy. 6 The major obstacle in the ECG diagnosis of posterior myocardial infarction lies in the absence of standard leads facing the posterior left ventricular wall, which results in failure to reveal ST segment elevation in a high proportion of patients with acute posterior infarction. Recently it was demonstrated that during acute inferior infarction, ST segment elevation in the posterior chest leads V7-V9 identifies those patients with concomitant posterior wall involvement.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the indication for thrombolytic therapy requires the presence of ST segment elevation in the standard 12-lead ECG. However, because ST segment elevation is not seen on the standard 12 lead ECG in up to 50% of patients with posterior or circumflex-related infarction 12,6 the presence of ST should be sought in leads V7-V9. This sub-group of AMI patients can be benefited from thrombolysis or PTCA.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study between 12 and 15 Lead Electrocardiograms for Evaluation of Acute Posterior Myocardial Infarction

Wahib

Islam²,

Haque

et al. 2012

Cardiovasc. j.

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Introduction:Ischaemic heart disease is a major health problem throughout the world. In the western countries 50% of all death are due to cardiovascular diseases, half of these are attributed to myocardial infarction. 1 In Bangladesh coronary artery disease is the third largest cause of death today. One survey by Malik et al 2 detected the prevalence rate of IHD as 3.3/ thousand and a multicentre study by Farid N et al 3 revealed prevalence of IHD as 14/thousand .The diagnosis of acute myocardial infarction requires a joint evaluation of the clinical aspects, the ECG and the serum enzyme activity. ST Segment of the electrocardiogram (elevation in the leads overlying the infarction and depression in the reciprocal leads) is altered very early in the course of AMI and is one of the indirect markers of myocardial damage. Latter on pathological Q wave and T wave inversion occur. But in many instances, it (about 50% of patients with AMI) does not show diagnostic ECG changes. 4 Moreover the standard 12 lead ECG is a relatively insensitive tool for detecting posterior myocardial infarction. 5 This a particularly true in the acute stage when prompt and accurate diagnosis of AMI is critical in determining the initiation of reperfusion therapy. 6 The major obstacle in the ECG diagnosis of posterior myocardial infarction lies in the absence of standard leads facing the posterior left ventricular wall, which results in failure to reveal ST segment elevation in a high proportion of patients with acute posterior infarction. Recently it was demonstrated that during acute inferior infarction, ST segment elevation in the posterior chest leads V7-V9 identifies those patients with concomitant posterior wall involvement. 7 It was shown that ST segment elevation is present solely in posterior chest leads in 3%-4% of all patients with AMI and in as many as 20% of Ami patients without ST segment elevation on the standard 12 lead. 8 Shlomi M et al 8 showed that in acute posterior myocardial infarction ST segment elevation was present in lead V7 and V9 in 91% and in lead V8 in 100% patients. Prominent R-wave appeared in lead V1 in 9% and in lead V2 in 44%. In 25% patients, on admission, no pathologic ST segment changes were noted in standard 12 lead ECG and the ST segment elevation in leads V7 through V9 was the only pathologic ST segment change.

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Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary artery occlusion

Cited by 111 publications

References 14 publications

Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation

Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation

Continuous Vectorcardiography in Patients with Chest Pain Indicative of Acute Ischemic Heart Disease

Comparative Study between 12 and 15 Lead Electrocardiograms for Evaluation of Acute Posterior Myocardial Infarction

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