STEMI equivalent ECG changes in NSTEMI

Summary Objectives: In this work we studied the temporal evolution of changes in the electrocardiogram (ECG) as a consequence of the induced ischemia during prolonged coronary angioplasty, comparing the time course of indexes reflecting depolarization and those reflecting repolarization. Methods: We considered both local (measured at specific points of the ECG) and global (obtained from the Karhunen-Loève transform) indexes. In particular, the evolution of Q, R and S wave amplitudes during ischemia was analyzed with respect to classical indexes such as ST level. As a measurement of sensitivity we used an Ischemic Changes Sensor (ICS), which reflects the capacity of an index to detect changes in the ECG. Results: The results showed that, in leads with low-amplitude ST-T complexes, the S wave amplitude was more sensitive in detecting ischemia than was the commonly used index ST60. It was found that in such leads the S wave amplitude initially exhibited a delayed response to ischemia when compared to ST60, but its performance was better from the second minute of occlusion. The global indexes describing the ST-T complex were, in terms of the ICS, superior to the S wave amplitude for ischemia detection. Conclusions: Ischemic ECG changes occur both at repolarization and depolarization, with alterations in the depolarization period appearing later in time. Local indexes are less sensitive to ischemia than global ones.

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Mechanisms of angina in patients with biopsy-proven viral myocarditis: insights from intracoronary acetylcholine testing

European Heart Journal ◽

10.1093/ehjci/ehaa946.2063 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Seitz ◽

V Martinez Pereyra ◽

A Hubert ◽

K Klingel ◽

R Bekeredjian ◽

...

Keyword(s):

Coronary Arteries ◽

Coronary Spasm ◽

Viral Myocarditis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Funding Source ◽

Pathophysiological Mechanism ◽

Ecg Changes ◽

Ventricular Ejection Fraction ◽

Microvascular Spasm

Abstract Background Patients with myocarditis often present with angina pectoris despite unobstructed coronary arteries. The underlying pathophysiological mechanism of angina in these patients remains to be elucidated. Coronary artery spasm is a well-known cause of angina in patients with unobstructed coronary arteries. In this study, we sought to assess the frequency of coronary vasomotor disorders in patients with biopsy-proven viral myocarditis. Methods In total, 700 consecutive patients who underwent endomyocardial biopsy for suspected myocarditis between 2008 and 2018 were retrospectively screened. Of these patients, viral myocarditis was confirmed in 303 patients defined as histological/immunohistological evidence of myocardial inflammation and presence of viral genome confirmed by PCR. Of these patients, 34 patients had angina despite unobstructed coronary arteries and underwent intracoronary acetylcholine (ACh) provocation testing in search of coronary spasm. Epicardial spasm was defined as acetylcholine-induced reproduction of the patient's symptoms associated with ischemic ECG changes and >90% epicardial vasoconstriction. Microvascular spasm was defined as symptom reproduction and ECG changes in the absence of significant epicardial vasoconstriction. Results Patients were 49±16 years old, 62% were male and left ventricular ejection fraction was 54±16%. Most frequent viruses were parvovirus B19 (PVB19, 59%) and human herpes virus 6 (HHV6, 26%), 2 patients had combined PVB19/HHV6 infection and 3 patients other herpesviruses (CMV, EBV, VZV). Epicardial spasm was observed in 10 patients (29%) during ACh testing and microvascular spasm was found in 11 patients (32%). The rate of coronary spasm (epicardial and microvascular) was higher in the PVB19 subgroup compared to HHV6 (80% vs. 33%, p=0.031). In particular, there was a higher prevalence of microvascular spasm in PVB19 compared to HHV6 (45% vs. 0%, p=0.018). Conclusion We observed a high prevalence of microvascular and epicardial spasm in patients with biopsy-proven viral myocarditis suggesting coronary spasm as a potential underlying mechanism for angina in these patients. Microvascular spasm was most often observed in patients with PVB19-associated myocarditis. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Robert-Bosch-Stiftung; Berthold-Leibinger-Stiftung

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Can indicators of myocardial damage predict carbon monoxide poisoning outcomes?

BMC Emergency Medicine ◽

10.1186/s12873-021-00405-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hitoshi Koga ◽

Hideki Tashiro ◽

Kouta Mukasa ◽

Tomohiro Inoue ◽

Aya Okamoto ◽

...

Keyword(s):

Carbon Monoxide ◽

Qt Interval ◽

Troponin I ◽

Morphological Changes ◽

Carbon Monoxide Poisoning ◽

Myocardial Damage ◽

Qt Dispersion ◽

Ecg Changes ◽

Corrected Qt Interval ◽

Logistic Analysis

Abstract Background Carbon monoxide causes electrical, functional, and morphological changes in the heart. It is unclear, however, whether the indicators of myocardial damage can predict the patient’s prognosis after carbon monoxide poisoning. This retrospective study aimed to investigate the relationship between the carboxyhemoglobin level and electrocardiographic (ECG) changes and whether the ECG changes and troponin I levels are related to the patient’s prognosis after carbon monoxide poisoning. Methods Carboxyhemoglobin, troponin I, and ECG parameters were measured in 70 patients with carbon monoxide poisoning. The QT and RR intervals were measured for each ECG lead in all patients, and the corrected QT interval and corrected QT dispersion were calculated. Results The correlation between the maximum corrected QT interval and the carboxyhemoglobin level was significant (P = 0.0072, R2 = 0.1017), as were the relationships between QT dispersion and carboxyhemoglobin (P < 0.001, R2 = 0.2358) and the corrected QT dispersion and carboxyhemoglobin (P < 0.001, R2 = 0.2613). The multivariate logistic analysis showed that the significant predictors of sequential disability were corrected QT dispersion (P = 0.0042), and troponin I level (P = 0.0021). Conclusions Patients’ prognosis following carbon monoxide poisoning can be predicted based on corrected QT dispersion and the troponin I level. Patients with myocardial damage should be monitored not only for their cardiovascular outcome but also for their neurological outcome and their prognosis.

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Does everybody with mildly elevated HsTnT without ECG changes have a high risk of cardiovascular events and mortality?

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100838 ◽

2021 ◽

Vol 35 ◽

pp. 100838

Author(s):

Yasar Sattar ◽

Talal Almas ◽

Monil Majmundar ◽

Waqas Ullah ◽

M. Chadi Alraies

Keyword(s):

High Risk ◽

Cardiovascular Events ◽

Ecg Changes

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A MASQUERADING ECG: LACOSAMIDE ASSOCIATED ECG CHANGES MIMICKING AN INFERIOR STEMI

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03221-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1865

Author(s):

Aaron Brick ◽

Alexis Tumolo ◽

R. Kevin Rogers ◽

Peter Sottile ◽

Aaron Strobel

Keyword(s):

Ecg Changes

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The mortal cause of sudden ECG changes in patients with chronic aortic insufficiency: Aortic dissection

Interventional Medicine and Applied Science ◽

10.1556/1646.10.2018.50 ◽

2019 ◽

Vol 11 (1) ◽

pp. 68-70

Author(s):

Mahmut Yesin ◽

Turgut Karabağ ◽

Macit Kalçık ◽

Süleyman Karakoyun ◽

Metin Çağdaş ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Signs And Symptoms ◽

Aortic Insufficiency ◽

Ecg Changes ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

High Index Of Suspicion

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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