Role of electrocardiogram in identifying the infarct related artery in acute myocardial infarction and to correlate it with 2D echo and coronary angiogram

Background: The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to study the role of ECG in identifying the infarct related artery in acute ST elevation MI and to correlate its findings with 2 D ECHO and Coronary angiogram.Methods: A total of 100 patients who presented with acute ST elevation MI were randomly selected for the study. After admission all the patients underwent ECG, CPK, CK-MB levels, 2D ECHO and CAG. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and the ECG findings were then correlated with 2D ECHO and CAG to identify the Sensitivity, Specificity, Positive predictive value and Negative predictive value of ECG in identifying the infarct related artery.Results: Fifty-two (52%) patients had an Anterior wall MI, forty-two patients (42%) had an evidence of Inferior wall MI and Six patients (6%) were found to have Antero inferior wall MI in the study group. Thirty-eight (38%) had evidence of SVD, forty-six patients (46%) had DVD and Sixteen patients (16%) had TVD. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LAD artery occlusion were 60.5%, 100%, 100% and 44.4% respectively. Sensitivity, Specificity, PPV and NPV of ECG in identifying the RCA artery occlusion were 78.5%, 100%, 100% and 78.5% respectively. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LCx artery occlusion were 26%, 96%, 86% and 60% respectively.Conclusions: ECG was found to be a sensitive and specific tool in identifying the infarct related Coronary artery in acute ST elevation MI.

Download Full-text

Primary percutaneous coronary intervention in ‘early’ latecomers with ST-segment elevation acute myocardial infarction: the role of the infarct-related artery status

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0b013e32834038d8 ◽

2011 ◽

Vol 12 (1) ◽

pp. 13-18 ◽

Cited By ~ 8

Author(s):

Alessandro Fontanelli ◽

Carlo Bonanno

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Segment Elevation ◽

St Segment ◽

Percutaneous Coronary ◽

Infarct Related Artery ◽

Elevation Acute Myocardial Infarction

Download Full-text

Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

Journal of Nepal Medical Association ◽

10.31729/jnma.2031 ◽

2013 ◽

Vol 52 (191) ◽

Author(s):

Rabindra Simkhada

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Inferior Wall ◽

St Segment Elevation ◽

St Segment ◽

Infarct Related Artery ◽

St Elevation ◽

The Mean ◽

St Segments ◽

Lesion Severity

Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________

Download Full-text

Role of Coronary Prognostic Index, and Thrombolysis, in ST Segment Elevation Myocardial Infarction

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/452 ◽

2021 ◽

Vol 10 (29) ◽

pp. 2212-2216

Author(s):

Amol Andhale ◽

Anuj Varma ◽

Sourya Acharya ◽

Samarth Shukla ◽

Anuj Chaturvedi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Coronary Artery ◽

Prognostic Index ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

St Elevation

Angioplasty is considered superior to fibrinolytic therapy in acute myocardial infarction (AMI) if the patient receives it within the therapeutic window. It is unclear if such advantages are available for patients who need to travel from a community hospital to a facility where invasive care is available, since primary thrombolysis often re-establishes coronary artery blood flow in patients with ST elevation acute myocardial infarction (STEMI). At the most severe end of the range of acute coronary syndromes is ST - segment elevation myocardial infarction (STEMI), which generally occurs when a fibrin-rich thrombus fully occludes an epicardial coronary artery. The diagnosis of STEMI is based on clinical features and persistent ST-segment elevation as evidenced by 12 - lead electrocardiography. Patients with STEMI should have a quick reperfusion treatment evaluation and a reperfusion strategy should be performed immediately following contact with the system. All patients with AMI who had chest pain within 12 hours were evaluated. The detailed history of chest pain, character, and radiation, had been taken in terms of duration from the beginning of chest pain in minutes. After 10 minutes, patients were given 10 mg of sublingual isosorbide dinitrate and repeated ECG. Patients were excluded if chest pain or ST elevation was resolved after 10 minutes of nitrate administration. In the analysis only those cases in which chest pain and ST shift were not resolved following sublingual nitrates. Serum CKMB estimates have been performed. All patients were treated with 1.5 million IU streptokinase in 100 ml of normal saline for more than 45 minutes. Clinical assessment for 2 hours every half hour was done to evaluate: 1. Chest pain reduction in a subjective scale percentage and to assess changes in the Killip class. 2. Continuous ECG monitoring of reperfusion rhythm occurrences. Patients are assessed at the end of 2 hours of follow-up for: a. Percentage reduction in subjective chest pain a. A 12 lead ECG to identify changes in the ST height c. Repeat CK-MB estimate. Patients with thrombolysis were classified into two classes on the basis of presence or absence of SCR at the end of two hours of initiation. Those with successful reperfusion were grouped into the SCR Group and into the SCR (negative) Group without successful reperfusion. Coronary prognostic index is a set of questionnaires which prognosticate the outcome in AMI. This review describes the role of Coronary Prognostic Index and thrombolysis in patients of STEMI. KEY WORDS ECG, AMI, STEMI, Angioplasty

Download Full-text

High risk electrocardiographic patterns in patients with acute coronary syndrome.

Archivos Peruanos de Cardiología y Cirugía Cardiovascular ◽

10.47487/apcyccv.v2i1.82 ◽

2020 ◽

Vol 2 (1) ◽

pp. 25-34

Author(s):

Diego Echeverri- Marín ◽

Cristhian Felipe Ramirez Ramos ◽

Andrés Miranda-Arboleda ◽

Gustavo Castilla-Agudelo ◽

Clara Saldarriaga-Giraldo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Reperfusion Therapy ◽

Early Reperfusion ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Acute Coronary Occlusion ◽

St Segment ◽

St Elevation ◽

Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

Download Full-text

Acute diagonal-induced ST-elevation myocardial infarction and electrocardiogram-guidance in the era of primary coronary intervention: New insights into an old tool

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619828291 ◽

2019 ◽

Vol 9 (8) ◽

pp. 827-835 ◽

Cited By ~ 1

Author(s):

Rami Abu Fanne ◽

Michael Kleiner Shochat ◽

Avraham Shotan ◽

Aharon Frimerman ◽

Emad Maraga ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Intervention ◽

Artery Occlusion ◽

Acute Ischemia ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Depression ◽

Timi Flow ◽

St Segment ◽

St Elevation

Background: Previous studies, published before the advent of primary reperfusion, described the electrocardiographic features of ST-segment elevation myocardial infarction (STEMI) caused by total diagonal artery occlusion, as demonstrated at pre-discharge coronary angiography. We aimed to assess the electrocardiographic and echocardiographic features in STEMI unequivocally attributed to a diagonal lesion in the era of primary coronary intervention. Methods: The electrocardiograms and echocardiograms of patients sustaining STEMI caused by diagonal artery involvement were compared with those of patients with STEMI attributed to proximal or mid left anterior descending artery (LAD) lesions. ST-segment deviations were measured at four different points in each lead and analyzed against TIMI flow and SNuH score. The electrocardiographic and echocardiographic features of each group were mapped. Results: In contrast to previous studies claiming an ever-present incidence of at least 1-mm ST-segment elevation in leads I and aVL with diagonal STEMI, we report 86% of any ST-elevation in leads I, aVL and V2 (64–71% for ST-elevation >1 mm). Both higher SNuH score and pre-intervention TIMI flow were associated with larger lateral ST-elevations (85.7% and 86.4–95.5%, respectively). Higher prevalence of ST-depression in the inferior leads reflecting reciprocal changes was observed in patients with diagonal-induced STEMI (57–76% vs. 24–51% in LAD obstructions, p <0.05). Conclusion: The most sensitive and predictive sign for acute ischemia was any degree of ST-deviation measured 1 mm beyond the J point. ST-elevations in I, aVL and V2, sparing V3-V5, strongly favor isolated diagonal lesion. Proximal LAD lesion lacking ST-segment elevations in leads I and aVL is primarily due to wraparound LAD anatomy.

Download Full-text