scholarly journals Prediction of the Site of Coronary Artery Lesion in Acute Inferior Myocardial Infarction with Right Sided Precordial Lead (V4r)

1970 ◽  
Vol 4 (1) ◽  
pp. 46-52
Author(s):  
MS Alam ◽  
M Ullah ◽  
SU Ulabbi ◽  
MM Haque ◽  
R Uddin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wave Group ◽  
Precordial Lead ◽  
Inferior Myocardial Infarction ◽  
Group Iii ◽  
T Wave ◽  
Group I ◽  
St Segment ◽  
Group Ii ◽  
Acute Inferior Myocardial Infarction

Background: The patient with inferior wall AMI, site of culprit lesions is an important determinant of outcome. Patient with RV infarction have a poor prognosis whereas those with occlusion of LCX have a good prognosis. Early diagnosis and treatment substantially reduce cardiac events particularly in high-risk patients. V4R can be used as to locate the site of obstruction. Materials and methods: 81 patients with acute inferior myocardial infarction admitted to the coronary care unit (CCU) within 12 hours after the onset of chest pain who underwent coronary angiogram were included in the study. Standard 12-lead ECG with right precordial lead V4R was recorded. Patients were categorized into within 3 groups according to early changes of V4R-Group- I - ST-segment elevation > 1 mm and positive T- wave, Group-II- ST-segment iso-electric and positive T-wave, Group-III- ST-segment depression >1 mm and negative T -wave. Results: In group I patients, highest percentage of the patients had lesion in proximal RCA (97.2%); whereas in group II patients, highest percentage in the distal RCA (89.7%) followed by LCX (41.4%) and in group III patients, highest percentage also in LCX (100.0%) followed by LAD (56.3%). Based on analysis of sensitivity and specificity, it was revealed that in group I patients of ECG finding suggested 100.0% sensitivity, 97.8% specificity and 98.8% accuracy. In group II patients, 92.9% sensitivity, 94.3% specificity and 93.8% had accuracy. In case of group III patients, 93.8% sensitivity, 98.5% specificity and 97.5% accuracy. Conclusion: The configuration of the ST-T segment in lead V4R is a sensitive and specific tool to recognize the occluded vessel in acute inferior MI whether it is proximal RCA, distal RCA or LCX. Since it is an inexpensive method, it can be readily used to locate the site of occlusion in AMI - Inferior. Keywords: Coronary artery disease; Myocardial infarction;, Lead V4r. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9389 Cardiovasc. J. 2011; 4(1): 46-52

scholarly journals In-Hosptal Outcome and Angiographic Findings in Acute Inferior Myocardial Infarction with ST-Segment Elevation in Posterior Chest Leads ( V7, V8, V9 ) Following Thrombolytic Therapy

2017 ◽  
Vol 31 (2) ◽  
pp. 58-64
Author(s):  
Mohamed Haneef ◽  
Abdullah Al Shafi Majumder ◽  
M Atahar Ali ◽  
Md Shafiqur Rahman Patwary ◽  
Md Arifur Rahman
Keyword(s):  
Myocardial Infarction ◽  
Adverse Outcome ◽  
Posterior Wall ◽  
Inferior Myocardial Infarction ◽  
St Segment Elevation ◽  
Group I ◽  
St Segment ◽  
Group Ii ◽  
Vessel Score ◽  
Acute Inferior Myocardial Infarction

Background: Electrocardiographic diagnosis of a posterior wall myocardial infarction is difficult to accomplish by the standard 12-lead ECG. Early detection of posterior wall involvement in an inferior myocardial infarction is of paramount importance for the therapeutic outcome. The aim of this study is to assess the role of ST segment elevation in posterior wall leads (V7, V8, V9) on the admission ECG of acute inferior myocardial infarction, for the diagnosis of posterior wall myocardial infarction and the identification of infarct related artery as well as in-hospital outcome following thrombolysis.Methods: A total of 90 patients with acute inferior MI were enrolled by purposive sampling. On the basis of ST segment elevation in posterior leads (V7,V8,V9), study subjects were categorized into two groups: 45 patients of acute inferior MI with ST segment elevation in posterior leads as group I and 45 patients of acute inferior MI without ST segment elevation in posterior leads as group II. Coronary angiography was done during index hospital admission. Interpretation of coronary angiogram was done by visual estimation by two cardiologists to assess the severity of coronary artery disease. Severity of coronary stenosis was graded according to the number of major epicardial vessel with significant stenosis by vessel score and Friesinger score. After CAG, patients were evaluated for in hospital adverse outcome like heart block, cardiogenic shock, arrhythmia, and death.Results: Patients of PMI and non PMI groups were similar in terms of age and sex. Smoking and dyslipidemia (p=0.05) were significantly higher in PMI group. Mean RBS and Troponin-I difference were significantly (p<0.05) higher in group I. Majority of patients had ejection fraction 45-55% in both groups. Patients in group I showed more normal LVEF, than group II, which was statistically significant. This study provided the evidence that the ST segment elevation in posterior leads associated with more left circumflex (LCX) and posterior left ventricular brass (PLVB) involvement. Majority of the patients had vessel score 2, Friesinger score 5-10 in group I and vessel score 1, Friesinger score 1-4 in group II.Conclusion: ST segment elevation in posterior chest leads (V7, V8, V9) were associated with more in-hospital adverse outcome than those who had inferior MI alone. This group of patients had more PLVB involvement. Recording of posterior precordial leads appear to be beneficial for risk stratification and to locate the site of lesion in patients admitted with acute inferior myocardial infarction. Since it is inexpensive method, it may be used in any hospital.Bangladesh Heart Journal 2016; 31(2) : 58-64

scholarly journals Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations.

Circulation ◽  
1982 ◽  
Vol 66 (4) ◽  
pp. 732-741 ◽  
Author(s):  
R S Gibson ◽  
R S Crampton ◽  
D D Watson ◽  
G J Taylor ◽  
B A Carabello ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Acute Inferior Myocardial Infarction

scholarly journals Detection and Characterization of Prevotella Intermedia and Its In Vitro Susceptibility to Selected Antimicrobial Agents in Chronic Periodontitis and Acute Myocardial Infarction

2019 ◽  
Vol 3 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Deepa Anumala ◽  
Mohan Kumar Pasupuleti ◽  
Ravindra Reddy Nagireddy
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chronic Periodontitis ◽  
Antimicrobial Agents ◽  
Prevotella Intermedia ◽  
Causative Role ◽  
In Vitro Susceptibility ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background: Periodontal disease has been reported to play a causative role in acute myocardial infarction (AMI), which may add to the various risk factors associated with coronary heart disease. The objective of the present study was to investigate the presence of Prevotella intermedia – an established periodontal pathogen – in subgingival plaque samples of chronic periodontitis and AMI patients in order to identify a possible association, and to evaluate the susceptibility of Prevotella intermedia to nine antimicrobial agents. Methods: After undergoing screening for eligibility, a total of 50 subjects were included in the present study. Twenty patients were diagnosed with AMI and generalized chronic periodontitis (Group I), 20 patients were diagnosed with only AMI (Group II), and 10 subjects were healthy controls (Group III). The isolated Prevotella intermedia strains were tested for susceptibility to bacitracin, chloramphenicol, penicillin G, polymyxin, gentamycin, neomycin, tetracycline, cefotaxime, and cefoxitin using an antibiotic zonescale to determine minimum inhibitory concentrations (MICs). Results: Periodontal pathogens were identified by phenotypic and enzymatic methods. The mean bacterial load of Prevotella intermedia species was higher in Group I compared to Group II and Group III. It was also found that pencillin G, gentamycin, neomycin, tetracycline, cefotaxime, and cefoxitin inhibited 90% of Prevotella intermedia, whereas bacitracin, chloramphenicol, and polymyxin inhibited 80% of Prevotella intermedia. Thus, only 10% of Prevotella intermedia were resistant to these antibiotics. Conclusion: The present study confirms that Prevotella intermedia is associated with chronic periodontitis and AMI.

scholarly journals Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression

2017 ◽  
pp. 180-9
Author(s):  
Jaya Suganti ◽  
Abdullah Afif Siregar ◽  
Harris Hasan
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Multiple Logistic Regression Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Bivariate Analysis ◽  
P Value ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Increased Risk ◽  
Acute Inferior Myocardial Infarction

Background: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.

scholarly journals 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

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 ST–segment 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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