scholarly journals Incidence of 'Precordial ST-Segment Depression' in Acute Inferior Myocardial Infarction

1970 ◽  
Vol 6 (1) ◽  
pp. 21-22
Author(s):  
Md Mobashir Khalil ◽  
AKM Fazlur Rahman ◽  
Chowdhury Meshkat Ahmed ◽  
Shah Md Iqbal ◽  
KMHS Sirajul Haque
Keyword(s):  
Myocardial Infarction ◽  
Age Group ◽  
Inferior Myocardial Infarction ◽  
Younger Patients ◽  
St Segment Elevation ◽  
St Segment ◽  
Number Of Patients ◽  
Group 2 ◽  
Acute Inferior Myocardial Infarction ◽  
Group 1

Patients of acute inferior myocardial infarction, in addition to the ST segment elevation in inferior leads often have ST segment depression in the precordial leads. This study was performed to observe the incidence of these ‘reciprocal’ ST changes. One hundred consecutive acute inferior myocardial infarction patients were included in the study. They were further allocated to two electrocardiographic groups. Group 1 consisted of patients of acute inferior myocardial infarction with precordial ST segment depression & Group 2 consisted of patients of acute inferior myocardial infarction without precordial ST segment depression. Among the 100 consecutive patients, a large number of patients were included in group 1 (76%). Significant number of patients of group 1 belonged to the age group of above 60 years compared to group 2 (27.6% vs. 4.2%; p < .02). Conversely significantly higher number of younger patients ≤ 40 years belonged to group 2 (41.7% vs. 11.9%; p < .01). Mean ST segment elevation (mm) was also significantly higher in group 1 than group 2 (4.07 ± 1.93 vs. 2 ± 0.78; p <.001). The patients of acute inferior myocardial infarction thus show a significant number of ST segment depression in their precordial leads. In different studies these subset of patients showed increased morbidity and mortality. Key words: acute inferior myocardial infarction; precordial ST segment depression. DOI: 10.3329/uhj.v6i1.7185University Heart Journal Vol.6(1) 2010 pp.21-22

CLINICAL HEMODYNAMIC STUDY OF RECIPROCAL ST SEGMENT CHANGES IN ACUTE INFERIOR MYOCARDIAL INFARCTION

2021 ◽  
pp. 29-32
Author(s):  
Mohammad Wajid Hussain ◽  
Kumar Sourav ◽  
Binay Kumar ◽  
Debarshi Jana
Keyword(s):  
Myocardial Infarction ◽  
P Value ◽  
Inferior Myocardial Infarction ◽  
Aggressive Approach ◽  
St Depression ◽  
Depression Group ◽  
St Segment ◽  
Group 2 ◽  
Acute Inferior Myocardial Infarction ◽  
Group 1

Objective: To investigate the clinical signicance of reciprocal ST segment depression on the presenting electrocardiogram in patients with acute inferior myocardial infarction. Design And Setting: A prospective, randomized, controlled single center study done in the medicine department of JLNMCH, Bhagalpur, Bihar. Subjects: Forty consecutive patients with acute inferior myocardial infarction were enrolled in this study divided into two groups, 20 patients with reciprocal ST depression (group 1) and 20 patients without such depression (group 2). Interventions: All patients were investigated with serial ECG, cardiac biomarkers, echocardiography and coronary angiography. Results: There was no signicant difference in the proportion of coronary disease risk factors in patients in group 1, versus those in group 2. Patients in group 1 had signicant higher degree ST elevation (in inf. Leads) than patients in group 2, higher levels of peak total CPK and CKMB was also seen. In addition patients in group 1 developed complication more frequently than those in group 2. Although no statistically signicant difference between the two groups was seen as regard the ejection fraction sought by echocardiography, it did show a higher incidence of mitral regurge in group 1 [14 (70%)] versus 6 (30%) in group 2 with P value of 0.01. In group 1 left ante-rior descending artery lesions was signicantly more frequent than in group 2 with P value < 0.001, also multivessel disease was signicantly more frequent in group 1. Conclusion: The signicance of reciprocal ST depression on the electrocardiogram during the course of inferior MI remains uncertain, opinion is divided as to whether it is a benign electrical phenomenon or a sign of a greater myocardial necrosis and more frequent left coronary artery dis-ease, from our study we support the latter opinion. This simple ECG nding may be used to differ-entiate high risk patients for a more aggressive approach.

The Neutrophil to Lymphocyte Ratio (NLR) Is Associated With Residual Syntax Score in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽  
2020 ◽  
pp. 000331972095855
Author(s):  
Serkan Kahraman ◽  
Hicaz Zencirkiran Agus ◽  
Yalcin Avci ◽  
Nail Guven Serbest ◽  
Ahmet Guner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Independent Predictor ◽  
Syntax Score ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Group 2 ◽  
Residual Syntax Score ◽  
Group 1

The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (<2.59) and group 2 with high NLR (>2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.

scholarly journals Case Report: Acute Inferior Myocardial Infarction with Single-Lead ST Segment Elevation

2002 ◽  
Vol 9 (3) ◽  
pp. 154-158
Author(s):  
YS Sia ◽  
YT Wong
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Early Recognition ◽  
Morbidity And Mortality ◽  
Inferior Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
Acute Inferior Myocardial Infarction

This article illustrates a patient who presented with acute inferior myocardial infarction with only isolated ST segment elevation in Lead III. Brief review on the electrocardiographic interpretation was discussed. Early recognition and management is the key to prevent morbidity and mortality.

scholarly journals Comparison of ST segment Changes in Lead aVR with in-Hospital Outcomes in Patients with First attack of Acute Inferior ST Segment Elevation Myocardial Infarction

2019 ◽  
Vol 11 (2) ◽  
pp. 123-128
Author(s):  
Mohammad Jalal Uddin ◽  
M Saiful Bari ◽  
MA Bari ◽  
Mirza Md Nazrul Islam ◽  
M Abdullah Al Safi Majumder ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Inferior Myocardial Infarction ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Group A ◽  
Lead Avr ◽  
Group B ◽  
Acute Inferior Myocardial Infarction

Background: Inferior wall ST segment elevation myocardial infarction is considered to be at lower risk than anterior wall STEMI except in some cases. The aim of our study was to evaluate the relationships between on admission ST segment changes in lead aVR and short term in-hospital outcomes in acute isolated inferior myocardial infarction undergoing thrombolysis. Methods: Total 107 of first attack of inferior STEMI patients were included and all were thrombolysed by streptokinase. The sample population were divided into three groups based on the condition of ST segment in lead aVR on admission and in hospital outcomes were observed: Group –A: ST segment elevation ≥0.5 mm; Group –B: ST segment depression ≥0.5 mm; Group-C: Iso-electric ST segment. Results: 6.54% of study population had ST segment elevation in lead aVR, 53.27% had ST segment depression in lead aVR and 41.12% had isoelectric ST segment in lead aVR. During hospital stay mortality rates of patients of Group A, Group B and Group C were 33.3%, 5.3% and 4.5 % respectively; rates of cardiogenic shock were 33.3%, 8.8% and 2.3% respectively; heart failure rates were 50.0%, 15.8% and 4.5% respectively; rates of recurrent angina after thrombolysis were 66.7%, 33.3% and 6.8% respectively in three groups and the mean LVEF were 40.17, 48.61 and 52.50 respectively. Conclusion: The on admission-isoelectric ST segment in lead aVR in acute inferior myocardial infarction predicted better in-hospital outcomes in comparison to ST segment elevation and ST segment depression in aVR. On the other hand, ST segment elevation in lead aVR predicted worse in-hospital outcomes than ST segment depression in acute inferior myocardial infarction in spite of reperfusion by thrombolytic. Cardiovasc. j. 2019; 11(2): 123-128

scholarly journals Correlation of ECG Changes with Coronary Angiographic Findings in Acute Inferior Myocardial Infarction

2017 ◽  
Vol 29 (2) ◽  
pp. 33-37 ◽  
Author(s):  
Kazi Shamim Al Mamun ◽  
Anisul Awal ◽  
AKM Manzur Murshed
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Inferior Myocardial Infarction ◽  
Significant Stenosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Acute Inferior Myocardial Infarction

The determination of infarct related artery in acute inferior myocardial infarction is extremely important for the prediction the amount of myocardium at risk and guide decisions regarding urgency of revascularization. Urgent decision may facilitate management and prevention of complication. Our objective was to Identification of the infarct related artery involving either right coronary artery (RCA) or left circumflex artery (LCX) in acute inferior wall myocardial infarction using electrocardiographic criteria and comparing with angiographic finding. This prospective, observational study was done in Chittagong Medical College Hospital from June 2013 to May 2014. A total of 112 Patients with acute inferior myocardial infarction were included in this study. The electrocardiogram of these patients evaluated for ST segment elevation in lead III exceeding that in lead II (i.e. a ratio of ST elevation in lead III/elevation in lead II > 1) and S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL as a prediction for right coronary artery occlusion. If criteria are negative, LCX obstruction is likely. Coronary angiogram was done within 2-6 weeks in cath lab, department of cardiology, CMCH to identify the culprit artery. The infarct related artery (IRA) was identified from total occlusion or significant stenosis (> 70%) of the RCA or LCX or their major branches, or from arteriographic evidence of intraluminal thrombosis. To minimize the chance of misclassifying the culprit artery, patients with significant stenosis of both the RCA and the LCX were excluded from the study. The study population consisted of 112 patients (94 male and 18 female) with a mean ± SD age of 51 ± 8.6 years. On coronary angiography, the culprit artery was shown to be the RCA in 92 patients and the LCX in 20 patients. It was evident that the degree of ST segment elevation in lead III was significantly higher in right coronary artery group (92 patients) vs left circumflex group (20 patients) 3.16±1.14mm vs 1.35±0.24mm (p<0.001) respectively. While its comparable in lead II 2.18±0.95mm vs 1.7±0.34mm (p>0.05). In respect to leads AVL, we found that deeper ST segment depression was in right coronary artery group as compared to left circumflex group 1.11±0.25mm vs 0.2 ±0.34mm (p<0.001). ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 98%, sensitivity 97%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 96%, sensitivity 95%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 85%). It is possible to predict the culprit artery whether right coronary artery or left circumflex by examining the surface electrocardiography in patients with acute inferior myocardial infarction.Medicine Today 2017 Vol.29(2): 33-37

P2711Prevalence of collateral circulation and its importance on the development of reperfusion injury in patients with acute myocardial infarction with ST-segment elevation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y A Quispe-Villca ◽  
C Martinez-Sanchez ◽  
A Arias-Mendonza ◽  
F Azar-Manzur ◽  
S Mendoza-Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Magnetic Resonance ◽  
Reperfusion Injury ◽  
Collateral Circulation ◽  
St Segment Elevation ◽  
Reperfusion Damage ◽  
St Segment ◽  
Group 2 ◽  
Group 1

Abstract Prevalence of collateral circulation and its importance on the development of reperfusion injury in patients with acute myocardial infarction with st segment elevation treated with primary percutaneous coronary angioplasty Introduction In myocardial infarction with ST-segment elevation, early restoration of flow is the most important objective, but there is a possibility that reperfusion may induce ischemia-reperfusion injury. There is little information about the relationship of collateral circulation and reperfusion damage in patients with infarction, which is the reason for our study. Objective: To determine the prevalence of collateral circulation and its importance in the development of microvascular occlusion and intramyocardial hemorrhage evaluated by magnetic resonance imaging in patients with acute myocardial infarction with ST-segment elevation. Methods Observational, analytical study, retrospective cohort. Methods From March 2008 to April 2017, 359 patients were included and they were over 18 years of age with acute myocardial infarction with ST-segment elevation undergoing primary angioplasty who had magnetic resonance imaging. It was classified into 2 groups of patients: Group 1 (309 patients, without collateral circulation) and group 2 (50 patients, with collateral circulation). The presence or absence of collateral circulation was determined by coronary angiography and reperfusion injury (microvascular obstruction and intramyocardial hemorrhage) was evaluated by magnetic resonance. The x2 test was used to compare the categorical variables and the Mann-Whitney U test for continuous numerical variables. Results Of 359 patients, 50 (13.9%) patients had collateral circulation. The presence of reperfusion damage by magnetic resonance was compared. Patients in group 1 had reperfusion injury in 73.8% and group 2, 70.0% (p: 0.57). Presence or absence of reperfusion injury in patients with and without collateral circulation No Collateral circulation Collateral circulation “p” value n=309 (%) n=50 (%) Reperfusion inury 0.57   No 81 (26.2%) 15 (30.0%)   Yes 228 (73.8%) 35 (70.0%) Microvascular Obstruction 0.59   No 81 (26.4%) 15 (30.0%)   Yes 226 (73.6%) 35 (70.0%) Myocardial Hemorrhage 0.24   No 189 (61.4%) 35 (70.0%)   Yes 119 (38.6%) 15 (30.0%) Conclusions In the present study it is demonstrated that the presence of collateral circulation did not influence the reperfusion damage, so the collateral circulation does not protect the myocardium from reperfusion injury. Prospective studies were needed to confirm this results. Acknowledgement/Funding Carlos Slim Fundation

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