PM209 Correlation Of The Ecg Changes (St Segment Depression With Or Without T Wave Inversion In Lateral Leads 1, Avl.V4-V6) With Coronary Angiographic Findings In Acs Patients

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

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P3713Positive troponin levels and electrocardiographic findings in acute ischemic stroke

European Heart Journal ◽

10.1093/eurheartj/ehz745.0567 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N D C Zareba ◽

M Urdapilleta ◽

C E Sandoval ◽

S S Garcia Zamora ◽

S F Ameriso ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Ecg Changes ◽

Troponin Elevation ◽

Severe Stroke ◽

T Wave ◽

Wave Inversion ◽

St Segment

Abstract Background Troponin elevation and ECG changes are frequent findings in patients with acute ischemic stroke (AIS). The pathophysiology of these findings is still debated. Purpose To assesss the prevalence of electrocardiographic (ECG) changes and troponin elevation in AIS and to determine if these findings correlate with stroke severity. Methods Observational, retrospective study among AIS patients admitted to our stroke unit between October 2016 and December 2018. ECG was performed at admission and 24 hours later. Troponin levels were obtained after 6 hours of stroke symptoms onset. The NIH Stroke Scale (NIHSS) was performed by stroke neurologists. Results We included 744 consecutive patients (58% male), aged 66.8 years ±16.6 SD. Main vascular risk factors were hypertension (62%), dyslipidemia (49%), type 2 diabetes (18%), smoking (16%) and coronary artery disease (CAD) (17%). Twelve patients (1.6%) died during the hospitalization. Almost a half of patients (48.7%) had abnormal ECG. The most frequent ECG findings were: long QTc (26%), pathologic Q wave (18%), atrial fibrillation (AF) (9.4%), T wave inversion (5%), left-bundle bunch block (LBBB) (4%) and ST segment depression (2%). Patients who had a history of CAD had abnormal ECG findings more frequently than those who had not. (71% vs 44%, p<0.001). Thirteen percent of patients had positive troponin levels and 6% presented severe strokes (defined as a NIHSS >15). In the univariate analysis, positive troponin was associated with ST segment depression (p=0.01), T wave inversion (p<0.01), LBBB (p<0.01) and AF (p<0.01). Patients with severe strokes had more frequent ECG abnormalities (p=0.002) and positive troponin levels (p<0.001). LBBB and AF were also associated with severe stroke (p=0.002 and p<0.0001 respectively). Conclusions ECG changes are prevalent in acute stroke. T wave inversion, ST segment depression, AF and LBBB are associated with high troponin levels, potentially suggesting underlying CAD. High troponin levels, LBBB and AF are associated with severe stroke. Patients with acute stroke may have underlying cardiovascular disease and may benefit from cardiologic evaluation.

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Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽

10.1161/circ.118.suppl_18.s_947-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Anastasios Athanasiadis ◽

Birke Schneider ◽

Johannes Schwab ◽

Uta Gottwald ◽

Ellen Hoffmann ◽

...

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Wall Motion ◽

Apical Ballooning ◽

Left Ventricular ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

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ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0320 ◽

2018 ◽

pp. 1298-1301

Author(s):

Federico Migliore ◽

Sebastiano Gili ◽

Domenico Corrado

Keyword(s):

Left Ventricular ◽

Stunned Myocardium ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

Qt Interval Prolongation ◽

St Segment ◽

Reversible Left Ventricular Dysfunction ◽

Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

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Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease

Cardiovascular Journal ◽

10.3329/cardio.v9i2.32426 ◽

2017 ◽

Vol 9 (2) ◽

pp. 135-141

Author(s):

Sambhu Kumar Mallick ◽

Mahboob Ali ◽

Amal Kumar Chowdhury

Keyword(s):

Coronary Artery ◽

Predictive Value ◽

Left Main ◽

Stenotic Lesion ◽

Coronary Syndrome ◽

T Wave ◽

Wave Inversion ◽

Group I ◽

St Segment ◽

Group Ii

Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high STsegment changes score (>18 mm (100%) &/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality & morbidity.Cardiovasc. j. 2017; 9(2): 135-141

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EFFECT OF OXYGEN SUPPLEMENTATION ON LOW LANDERS ON ASCENDING TO HIGH ALTITUDE WITH PRECORDIAL ECG CHANGES WITHOUT HIGH ALTITUDE ILLNESS

10.36106/ijar/6108430 ◽

2020 ◽

pp. 1-4

Author(s):

Surabhi Venkata Satya Krishna ◽

MG Vishnoi ◽

S. Nagamanju

Keyword(s):

High Altitude ◽

Hypobaric Hypoxia ◽

Pulmonary Vasculature ◽

Ecg Changes ◽

Oxygen Supplementation ◽

Coronary Syndrome ◽

T Wave ◽

Wave Inversion ◽

High Altitude Illness ◽

Pressure Changes

High altitude syndromes are illnesses attributed directly to hypobaric hypoxia. Hypobaric Hypoxic pressure changes in the right side of the heart with ECG changes in right precordial leads are seen in cases like High Altitude Pulmonary Edema (HAPE), Pulmonary Thormboembolism (PTE) and thrombotic cause in acute coronary syndrome (ACS). Cases of these mimics with T wave inversion in precordial chest leads are seen in low landers on induction into high altitude without any high altitude illness, ACS or PTE. These findings may reflect asymptomatic pressure changes in the heart and pulmonary vasculature due to hypobaric hypoxia of high altitude to the point where they are not manifested. High altitude environment is itself being a procoagulant state compounded with hypobaric hypoxia, if these changes are not addressed in time and not treated with oxygen supplementation, these individuals may present at a later stage with HAPE or SAMS. We hypothesized that oxygen supplementation can reverse these changes. Intervention study with oxygen supplementation @ 6/min intermittently over 12 hr/day was given in all those individuals who have T wave inversion in precordial ECG meeting inclusion criteria over a week. The study was conducted at peripheral hospital 11000ft in Himalayan ranges over a period of 06 months. 100 % of cases had shown normalization of T waves in response to oxygen supplementation. However 02 individuals had recurrence of ECG changes and they were deinducted to plains. None of them developed high altitude illness over next 06 months of followup.

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A New Method for Detecting Myocardial Ischemia Based on ECG T-Wave Area Curve (TWAC)

Frontiers in Physiology ◽

10.3389/fphys.2021.660232 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ronghua Li ◽

Xiaoye Zhao ◽

Yinglan Gong ◽

Jucheng Zhang ◽

Ruiqing Dong ◽

...

Keyword(s):

Myocardial Ischemia ◽

Clinical Manifestations ◽

Preliminary Test ◽

New Method ◽

Test Results ◽

Ecg Changes ◽

T Wave ◽

Disability Rate ◽

St Segment ◽

Sensitivity Specificity

In recent years, coronary heart disease (CHD) has become one of the main diseases that endanger human health, with a high mortality and disability rate. Myocardial ischemia (MI) is the main symptom in the development of CHD. Continuous and severe myocardial ischemia will lead to myocardial infarction. The clinical manifestations of MI are mainly the changes of ST-T segment of ECG, that is, ST segment and T wave. Nearly one third of patients with CHD, however, has no obvious ECG changes. In this paper, a new method for detecting MI based on the T-wave area curve (TWAC) was proposed. Through observation and analysis of clinical data, it was found that there exist significant correlation between the morphology of TWAC and MI. The TWAC morphology of normal subject is smooth and gentle, while the TWAC morphology of patients with coronary stenosis is mostly jagged, and the curve becomes more severe with more severe stenosis. The preliminary test results show that the sensitivity, specificity, and accuracy of the proposed method for detecting MI are 84.3, 83.6, and 84%, respectively. This study shows that the TWAC based approach may be an effective method for detecting MI, especially for the CHD patients with no obvious ECG changes.

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Positivization of T wave with or without ST segment elevation in patients with unstable angina. Coronary angiographic findings and in-hospital prognosis

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a062156 ◽

1987 ◽

Vol 8 (1) ◽

pp. 31-37 ◽

Cited By ~ 6

Author(s):

R. F. LEWIN ◽

S. SCLAROVSKY ◽

I. ROSENBERG ◽

B. STRASBERG ◽

A. ARDITTI ◽

...

Keyword(s):

Unstable Angina ◽

St Segment Elevation ◽

T Wave ◽

St Segment ◽

Angiographic Findings

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Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401812010001 ◽

2018 ◽

Vol 12 (1) ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Hitesh Raheja ◽

Vinod Namana ◽

Kirti Chopra ◽

Ankur Sinha ◽

Sushilkumar Satish Gupta ◽

...

Keyword(s):

Cardiac Arrhythmias ◽

Alcohol Intoxication ◽

P Wave ◽

Acute Alcohol Intoxication ◽

Qrs Complex ◽

Qtc Prolongation ◽

Ecg Changes ◽

T Wave ◽

St Segment ◽

Electrocardiogram Ecg

Background: Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature. Objective: Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes. Methods: A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review. Results: Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions. Conclusion: The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.

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