scholarly journals Understanding ST equivalents on ECG

2021 ◽  
pp. 52-57
Author(s):  
Quoc Bao Tran ◽  
Anh Khoa Phan ◽  
Anh Binh Ho
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Cut Point ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Electrocardiogram Ecg

Acute coronary syndrome (ACS) is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. Even though the detection of a rise and/or fall of cTn values with at least one value above the 99th percentile URL is the key in diagnose of ACS, the role of electrocardiogram (ECG) still plays an important role in ACS simply because of its sensitivity and specificity. In clinical practice, ST-Elevation Myocardial infarction (STEMI) is easy for physicians and cardiologists to identify. STEMI is defined by new ST-elevation at the J-point in the absence of left ventricular hypertrophy and bundle branch block with two contiguous leads with cut-point: ≥ 1mm in all leads other than V2-V3 where the following cut-point apply: ≥ 2mm in men ≥ 40 years; ≥2.5mm in men < 40 years, or ≥ 1.5mm in women regardless of age. 

scholarly journals Apparent ST elevation in right bundle branch block pseudo-mimicking myocardial infarction

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982774 ◽  
Author(s):  
Itsuro Kazama ◽  
Toshiyuki Nakajima
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Cardiac Death ◽  
Close Monitoring ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
St Elevation

We report a case of right bundle branch block, in which the patient’s symptoms and the electrocardiogram findings mimicked those of acute coronary syndrome. In this case report, we stress the significance of apparent ST segment elevation in right bundle branch block. The differential diagnosis is important because right bundle branch block is often complicated with acute coronary syndrome. In addition, right bundle branch block with an ST segment elevation in the specific leads can be a predictor of sudden cardiac death. In such cases, close monitoring of the electrocardiogram findings and careful observation of the patient’s symptoms would be necessary.

scholarly journals Utility of shock index in 24,636 patients presenting with acute coronary syndrome

2019 ◽  
Vol 9 (6) ◽  
pp. 546-556 ◽  
Author(s):  
Ayman El-Menyar ◽  
Khalid F Al Habib ◽  
Mohammad Zubaid ◽  
Alawi A Alsheikh-Ali ◽  
Kadhim Sulaiman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Shock Index ◽  
Coronary Syndrome ◽  
High Shock ◽  
St Elevation

Background: Shock index is a bedside reflection of integrated response of the cardiovascular and nervous systems. We aimed to evaluate the utility of shock index (heart rate/systolic blood pressure) in patients presenting with acute coronary syndrome (ACS). Methods: We analyzed pooled data from seven Arabian Gulf registries; these ACS registries were carried out in seven countries (Qatar, Bahrain, Kuwait, UAE, Saudi Arabia, Oman and Yemen) between 2005 and 2017. A standard uniform coding strategy was used to recode each database using each registry protocol and clinical research form. Patients were categorized into two groups based on their initial shock index (low vs. high shock index). Optimal shock index cutoff was determined according to the receiver operating characteristic curve (ROC). Primary outcome was hospital mortality. Results: A total of 24,636 ACS patients met the inclusion criteria with a mean age 57±13 years. Based on ROC analysis, the optimal shock index was 0.80 (83.5% had shock index <0.80 and 16.5% had shock index ≥0.80). In patients with high shock index, 55% had ST-elevation myocardial infarction and 45% had non-ST-elevation myocardial infarction. Patients with high shock index were more likely to have diabetes mellitus, late presentation, door to electrocardiogram >10 min, symptom to Emergency Department > 3 h, anterior myocardial infarction, impaired left ventricular function, no reperfusion post-therapy, recurrent ischemia/myocardial infarction, tachyarrhythmia and stroke. However, high shock index was associated significantly with less chest pain, less thrombolytic therapy and less primary percutaneous coronary intervention. Shock index correlated significantly with pulse pressure ( r= −0.52), mean arterial pressure ( r= −0.48), Global Registry of Acute Coronary Events score ( r =0.41) and Thrombolysis In Myocardial Infarction simple risk index ( r= −0.59). Shock index ≥0.80 predicted mortality in ACS with 49% sensitivity, 85% specificity, 97.6% negative predictive value and 0.6 negative likelihood ratio. Multivariate regression analysis showed that shock index was an independent predictor for in-hospital mortality (adjusted odds ratio (aOR) 3.40, p<0.001), heart failure (aOR 1.67, p<0.001) and cardiogenic shock (aOR 3.70, p<0.001). Conclusions: Although shock index is the least accurate of the ones tested, its simplicity may argue in favor of its use for early risk stratification in patients with ACS. The utility of shock index is equally good for ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. High shock index identifies patients at increased risk of in-hospital mortality and urges physicians in the Emergency Department to use aggressive management.

scholarly journals Corrected QT Interval Prolongations in Patients with non–ST-Elevation Acute Coronary Syndrome

2019 ◽  
Author(s):  
Maryam Nabati ◽  
Zahra Dehghan ◽  
Bahareh Kalantari ◽  
Jamshid Yazdani
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Qtc Interval ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background: The presence of different risk groups among patients with the non–ST-elevation acute coronary syndrome indicates the need for new tools to establish early diagnoses and prognostic stratifications. The role of prolonged corrected QT (QTc) intervals in myocardial ischemia has yet to be thoroughly assessed. The purpose of our study was to assess the significance of QTc prolongations during acute non–ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. Methods: The QTc interval was measured in 205 patients admitted with NSTEMI or unstable angina to the Coronary Care Unit of Fatemeh Zahra Hospital between 2014 and 2015. On that basis, the patients were divided into those with normal (<440 ms) and the ones with prolonged (≥440 ms) QTc intervals. Echocardiography and coronary angiography were performed within 48 to 72 hours after hospitalization. A logistic regression model was applied to assess the predictors of left ventricular systolic dysfunction. Results: The mean age of the patients was 58.21±10.72 years, and men comprised 51% of the participants. Overall, a QTc interval prolongation of ≥440 ms was present in 45 subjects (21.95% of the patients), which was significantly associated with a previous myocardial infarction (MI) (P=0.024), a minimum ST depression of 1 mm in the inferior leads (P=0.006), and a maximum left ventricular ejection fraction of 35% (P=0.018). Furthermore, among the different electrocardiographic variables, only a prolonged QTc interval (OR=0.275, 95% CI=0.078–0.976; and P=0.046) was inversely associated with the left ventricular systolic function. Conclusion: Our study showed that prolonged QTc intervals can be used as a useful risk marker for identifying high-risk patients with the acute coronary syndrome.

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

scholarly journals Myocardial Bridging, the Hidden Risk Factor for Ischemia

2021 ◽  
Author(s):  
Vincenzo C Happach ◽  
Gerald T Delk ◽  
Latha Ganti
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Military Service ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Service Member ◽  
Myocardial Bridging ◽  
Coronary Syndrome ◽  
Military Service Member

ABSTRACT Myocardial bridging is an uncommon cause of a quite common emergency department complaint for chest pain and is often associated with left ventricular hypertrophy. We present a case of an otherwise healthy middle-aged U.S. military service member who presented with acute coronary syndrome which was ultimately determined to be the result of myocardial bridging.

Role of Left Ventricular Dyssynchrony in Predicting Remodeling after ST Elevation Myocardial Infarction

2011 ◽  
Vol 29 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Burak Turan ◽  
Fatih Yilmaz ◽  
Tansu Karaahmet ◽  
Kursat Tigen ◽  
Bulent Mutlu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Dyssynchrony ◽  
Ventricular Dyssynchrony ◽  
St Elevation
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