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.

scholarly journals Clinical examples of microcirculation disorders in acute myocardial infarction

2016 ◽  
Vol 15 (1) ◽  
pp. 56-64
Author(s):  
K. A. Kireev ◽  
A. V. Krasnopeev
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Fatal Outcome ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Angiographic Result

Objective. To improve the results of acute myocardial infarction (AMI) treatment. Material and methods. We have analyzed 2 clinical cases of unfavorable course of AMI. Results. The middle aged patient who had ST segment elevation acute coronary syndrome received immediate full reperfusion therapy (thrombolysis and stenting). It was performed early in the course of the disease and demonstrated good angiographic result. Postoperatively there were no typical evolution of ECG signs of AMI. By the end of the first day we registered stent thrombosis with fatal outcome. Cause of death: acute left ventricular failure. The area of infarcted cardiac muscle was about 40 %, in the projection of the apex of the left ventricle the acute aneurysm was formed. Perhaps this situation has been associated with disorders of microcirculation in the infarcted area, which can be potentially neutralized by inhibitors 2b/3a receptors of platelets. This drug was given to this patient too late (during rethrombosis). In another observation (with the same circumstances) the inhibitor of IIb/IIIa GP receptors was given during the early postoperative period, what was followed by the natural course of AMI. Conclusion. These examples demonstrate the need of additional antiplatelet support (inhibitor IIb/IIIa GP receptors) in such clinical situations.

scholarly journals ST elevation myocardial infarction equivalent - De Winter T-wave electrocardiography pattern

2018 ◽  
Vol 71 (7-8) ◽  
pp. 265-269
Author(s):  
Igor Ivanov ◽  
Anastazija Stojsic-Milosavljevic ◽  
Vladimir Ivanovic ◽  
Milos Trajkovic ◽  
Aleksandra Vulin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Therapy ◽  
Proper Treatment ◽  
Anterior Myocardial Infarction ◽  
St Segment Elevation ◽  
T Wave ◽  
St Segment ◽  
Number Of Patients ◽  
St Elevation

Introduction. Rapid diagnosis of acute myocardial infarction is essential for proper treatment and reduction of patient mortality. Electrocardiography plays an important role in its diagnosis. Acute myocardial infarction with ST segment elevation requires urgent reperfusion therapy, that is, primary percutaneous coronary revascularization. A small number of patients with acute myocardial infarction have ST segment depression in one or more leads, whereas ST segment elevation in augmented vector right the electrocardiogram is characteristic for a myocardial infarction without ST elevation, but the clinical course and the severity of disease correspond to the anterior myocardial infarction with ST segment elevation. De Winter T-wave electrocardiography. One of these forms is known as de Winter T-wave pattern, characterized by ST segment depression at the J-point (> 1 mm) in the precordial leads, the absence of ST segment elevation in the precordial leads, high peaked and symmetrical T-waves in the precordial leads and, in most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented vector right. These patients have occlusion of the left main coronary artery, occlusion of the proximal segment of the anterior descending artery, or a severe multivessel coronary disease. Patients with this electrocardiographic pattern, which is equivalent to acute myocardial infarction with ST segment elevation, require consideration of emergency reperfusion therapy due to high mortality, compared to other patients with acute myocardial infarction without ST elevation. Primary percutaneous intervention is recommended, or if there is no catheterization laboratory nearby, fibrinolytic therapy may be considered. Because of the lack of clear recommendations, treatment decisions are made individually, from case to case. Conclusion. We need large pro?spective studies with this specific electrocardiographic pattern to provide quick recognition and proper treatment of the anterior myocardial infarction with ST elevation.

Apical hypertrophic cardiomyopathy treated as ST-elevation myocardial infarction

CJEM ◽  
2017 ◽  
Vol 20 (S2) ◽  
pp. S51-S55 ◽  
Author(s):  
Christopher J. Parr ◽  
Rajat Sharma ◽  
Philip J. Garber
Keyword(s):  
Myocardial Infarction ◽  
Hypertrophic Cardiomyopathy ◽  
St Elevation Myocardial Infarction ◽  
Apical Hypertrophic Cardiomyopathy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Coronary Arterial Disease ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiographic Findings

AbstractElectrocardiographic changes resulting from apical hypertrophic cardiomyopathy may mimic an acute coronary syndrome. A 67-year-old Sudanese male without cardiac risk factors presented to hospital with chest pain and electrocardiographic findings of septal ST-segment elevation, ST-segment depression in V4-V6, and diffuse T-wave inversion. He was treated as an acute ST-elevation myocardial infarction with thrombolytics. There was no cardiac biomarker rise and coronary angiography did not reveal evidence of significant coronary arterial disease. Ventriculography, transthoracic echocardiography, and cardiac magnetic resonance imaging were consistent with apical hypertrophic cardiomyopathy. The patient was discharged three days later with outpatient cardiology follow-up. We highlight the clinical and electrocardiographic findings of apical hypertrophic cardiomyopathy, with an emphasis on distinguishing this from acute myocardial infarction.

scholarly journals New concept: occlusion (OMI) and non-occlusion myocardial infarction (NOMI)

2021 ◽  
pp. 19-23
Author(s):  
V. А. Skybchyk ◽  
О. S. Pylypiv
Keyword(s):  
Myocardial Infarction ◽  
Coronary Occlusion ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Acute Coronary Occlusion ◽  
St Segment ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
St Elevation

The article deals with an important problem of managing patients with myocardial infarction (MI). It’s known that the greatest benefit of immediate invasive intervention obtains patients with acute occlusion of the coronary arteries (or subocclusion). However, numerous studies have shown that up to 30 % of patients classified as non-ST segment elevation myocardial infarction (NSTEMI) are consistently found to have missed acute coronary occlusion. At that time, a number of patients with «benign» ST elevation undergo unnecessary catheterisation +/- reperfusion therapy that increases the risk of complications. In 2018 Meyers P., Weingart S. and Smith S. noted that ST elevation on ECG is most likely an unreliable tool for detecting patients that will benefit from immediate percutaneous coronary intervention (PCI) and that a shift is required to a more reliable paradigm for detecting acute coronary occlusion, than the concept ST-elevation myocardial infarction. The authors introduced us to the new concept of Occlusion Myocardial Infarction (OMI) and Non-Occlusion Myocardial Infarction (NOMI). In this article we discuss five examples of ECG with occlusive myocardial infarction (OMI).

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