scholarly journals The de Winter Pattern as Pre-Anterior ST-Elevation-Myocardial-Infarction. “An Evolution Sequence”: A Case Report

2021 ◽  
Vol 42 (2) ◽  
Author(s):  
Muhammad Surya Tiyantara ◽  
Djoen Herdianto
Keyword(s):  
Myocardial Infarction ◽  
Troponin T ◽  
Previous History ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Evolution Sequence

Introduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI. Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit. Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome.

scholarly journals High risk electrocardiographic patterns in patients with acute coronary syndrome.

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.

The Value of Electrocardiographic Changes in Evaluating the Prognosis of Acute ST-Elevation Myocardial Infarction (STEMI) After PCI

2021 ◽  
Vol 7 (5) ◽  
pp. 1435-1442
Author(s):  
Yang Yang ◽  
Xiuyu Liang ◽  
Yuzhe Fan ◽  
Gendong Zhou ◽  
Xiaohong Zhang
Keyword(s):  
Myocardial Infarction ◽  
Evaluation Method ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Observation Group ◽  
St Segment Elevation ◽  
St Segment ◽  
Thrombolytic Effect ◽  
St Elevation ◽  
The Difference

To explore the relationship between the changes of ECG indexes and the prognosis after PCI in patients with acute ST-elevation myocardial infarction (STEMI), and to develop the evaluation method and analyze the advantages and characteristics. 420 patients with acute myocardial infarction (AMI) were admitted to our hospital from March 2017 to April 2020. They were divided into the observation group (ST segment elevation type) with 220 patients and control group (non-ST segment elevation type) with 200 patients according to whether ST segment elevation was or not. ECG was detected before and 1 hour after operation, evaluation of thrombolytic effect, 6-minute walking test and echocardiography were performed 3 months after operation. Compared with the control group, the ECG of the observation group showed St Compared with the control group, the thrombolytic effect of the observation group was significantly improved, and the difference was statistically significant (P < 0.05); compared with the control group, the thrombolysis effect of the observation group was significantly improved, the difference was statistically significant (P < 0.05); ECG index can effectively reflect the recovery of cardiac function after PCI in patients with acute STEMI, and can effectively indicate the improvement of symptoms in patients with AMI, which is worthy of clinical application.

scholarly journals Microfistulas Causing Diverse Regional Ischemia: Consecutive Inferior and Lateral ST-Elevation Myocardial Infarction

2020 ◽  
Vol 23 (10) ◽  
pp. 704-706
Author(s):  
Tufan Çınar ◽  
Yavuz Karabağ ◽  
İbrahim Rencuzogullari ◽  
Metin Cağdaş
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Type I ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Artery Fistulas ◽  
Clinical Consequences ◽  
Electrocardiographic Changes ◽  
St Elevation

Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing ST-segment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients.

scholarly journals A Comparative Study of St Segment Resolution between Diabetic and Non-Diabetic ST Segment Elevation Myocardial Infarction Patients following Streptokinase Thrombolysis

2019 ◽  
Vol 11 (2) ◽  
pp. 118-122
Author(s):  
Shahriar Iqbal ◽  
M Saiful Bari ◽  
MA Bari ◽  
Mirza Md Nazrul Islam ◽  
M Abdullah Al Shafi Majumder ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation ◽  
Prolong Hospital Stay

Background: One of the most effective and used (in our settings) methods of reperfusion of ST elevation myocardial infarction (STEMI) is administration of streptokinase (SK) infusion. This study was conducted with the aim to compare ST segment resolution between diabetic and non-diabetic patients with ST segment elevation myocardial infarction after thrombolysis by streptokinase. Methods: A total of 100 patients with ST elevation myocardial infarction with or without diabetes mellitus were studied from December 2016 to November 2017. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Results: Failed reperfusion (<30% ST resolution) was significantly higher in diabetic as compared to nondiabetic patients (42% vs. 12%, p <0.001). In hospital complications were more in diabetic patients who has failed reperfusion following streptokinase thrombolysis. Cardiogenic shock occurred in 44% and acute LVF in 30% patients and EF (46.54%) was significantly lower in diabetic patients and higher number of diabetic patients had prolong hospital stay than non-diabetic patients with STEMI. Conclusion: The outcome of thrombolytic therapy is adversely affected by diabetes mellitus in patients with ST-elevation myocardial infarction. Cardiovasc. j. 2019; 11(2): 118-122

scholarly journals A Comparative Study to Assess the Efficacy of Streptokinase in Diabetic Versus Non-Diabetic Acute ST Elevation Myocardial Infarction Patients

Esculapio ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 88-92
Author(s):  
Zeeshan Hassan ◽  
Nabeegh Rana ◽  
Bakhtawar Rana ◽  
Asif Iqbal ◽  
Ali Javaid Chughtai
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Comparative Study ◽  
St Elevation Myocardial Infarction ◽  
First Episode ◽  
P Value ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation

Objective: Prominent resolution in the ST segment elevation on electrocardiogram(ECG), thrombolysis at the infarction site restoring perfusion determines the effectiveness of the streptokinase therapy. Hyper- coagulable states and lack of efficacy with streptokinase is seen in diabetics. This study aimed to assess the thrombolytic efficacy of streptokinase in diabetic vs non-diabetics patients. Methods: A cross-sectional study was conducted at Cardiology Department of Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st September 2019 to 30th April, 2020. Total 504 patients of which 185 diabetics and 319 non-diabetic were selected. All the patients presenting with first episode of acute ST- elevation myocardial infarction were thrombolysed with 1.5million units of streptokinase within 12hours from the onset of their typical chest pain symptoms. A complete record of ECG changes was kept before and 90 min after thrombolysis with streptokinase. Chi- square test was applied and p value <0.05 was considered significant. Results: 89.19% diabetic patients had >70% resolution of ST segment changes in comparison to 95.61% non-diabetics. 16.76% of the diabetic patients had increased ST-segment elevation post thrombolysis (P- value 0.001). 8.11% and 10.81% reinfarction rates during hospital stay and at one month post-thrombolysis were recorded in diabetics. Reduced left ventricle Ejection Fraction was seen in 62.16% and 58.62% of the diabetic and non-diabetic patients(P-value<0.005). Conclusion: Comparatively decreased efficacy of streptokinase is seen in diabetic patients with reduced resolution of ST-segment. In correspondence with reduced left ventricle EF, re-infarction and stroke episodes. Key Words: Streptokinase, acute myocardial infarction, STEMI, diabetes mellitus, hypercoagulability, atherosclerosis. How to Cite: Hassan Z., Rana N., Rana B., Iqbal I., Chughtai J.I. A comparative study to assess the efficacy of streptokinase in diabetic versus non-diabetic acute ST elevation myocardial infarction patients. Esculapio 2021;17(01):88-92

scholarly journals Atypical electrocardiographic presentations of myocardial infarction with ST elevation - ST elevation myocardial infarction equivalents

2018 ◽  
Vol 71 (7-8) ◽  
pp. 241-246
Author(s):  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Milos Trajkovic ◽  
Tanja Popov ◽  
Aleksandra Ilic
Keyword(s):  
Myocardial Infarction ◽  
Clinical Symptoms ◽  
Coronary Artery Occlusion ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
T Waves

Introduction. Some patients with clinical symptoms and signs of acute myocardial and coronary artery occlusion have atypical electrocardiographic presentations - ST elevation myocardial infarction equivalents. Rapid recognition of these patterns is imperative, because the condition requires prompt reperfusion therapy following actual guidelines. De Winter pattern. Diagnostic criteria are: tall, prominent, symmetrical T-waves in the precordial leads, upsloping ST segment depression > 1 mm at the J-point in the precordial leads, absence of ST elevation in the precordial leads, ST segment elevation (0.5 mm - 1 mm) in aVR. ST Elevation in aVR. Electrocardiographic criteria include ST segment elevation in aVR ? 1 mm, ST segment elevation in aVR ? V1, and diffuse ST segment depression in lateral leads. Wellens syndrome. Wellens syndrome describes deeply inverted or bi?phasic T-waves in leads V2 - V3, highly specific for significant stenosis of the left anterior descending artery. Posterior infarction. Posterior infarction is confirmed with ST segment depression ? 0,5 mm in leads V1 - 3 and ST segment elevation ? 0.5 mm in posterior leads (V7 - V9). Conclusion. There are many electrocardiographic patterns that physicians should promptly recognize as clinical myocardial infarction with ST segment elevation equivalents in order to perform urgent reperfusion therapy for better prognosis and survival in these patients.

Sign in / Sign up

Export Citation Format

Share Document