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ST depression in I, aVL in STEMI inferior

Antonio H Frangieh, Slayman Obeid, Jelena-Rima Ghadri, Yoichi Imori, Fabrizio D'Ascenzo, Marc Kovac, Frank Ruschitzka, Thomas F Lüscher, Firat Duru, Christian Templin
BACKGROUND: ECG criteria differentiating Takotsubo cardiomyopathy (TTC) from mainly anterior myocardial infarction (MI) have been suggested; however, this was in small patient populations. METHODS AND RESULTS: Twelve-lead admission ECGs of consecutive 200 TTC and 200 MI patients were compared in dichotomized groups based on the presence or absence of ST-elevation MI (STEMI versus STE-TTC and non-ST elevation MI versus non ST-elevation-TTC). When comparing STEMI and STE-TTC, ST-elevation in -aVR was characteristic of STE-TTC with a sensitivity/specificity of 43% and 95%, positive predictive value (PPV) 91%, and a negative predictive value (NPV) 62% (P<0...
June 13, 2016: Journal of the American Heart Association
Xin Huang, Sachin K Ramdhany, Yong Zhang, Zuyi Yuan, Gary S Mintz, Ning Guo
OBJECTIVES: In acute inferior ST-segment elevation myocardial infarction (STEMI), multiple criteria have been proposed to predict the culprit artery based on the 12-lead electrocardiogram (ECG). We assessed the utilities of 11 traditional and 2 new criteria to devise a new ECG algorithm to localize the culprit artery in acute inferior STEMI. METHODS: We analyzed electrocardiographic and angiographic findings of 194 consecutive patients with acute inferior STEMI to devise a new ECG algorithm, further validated in another cohort of 80 patients with acute inferior STEMI...
September 2016: American Journal of Emergency Medicine
Ishaq Mohammed, Mohamad Sadek El Zaatari, Nikos Tyrogalas, M I Khalid
Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction...
August 12, 2014: BMJ Case Reports
Edward Y Wei, Ravi S Hira, Henry D Huang, James M Wilson, MacArthur A Elayda, Scott R Sherron, Yochai Birnbaum
OBJECTIVES: Patients with ST elevation (STE) in ≥ 2 leads or ST depression (STD) confined to V₁-V₄ are defined as potential STE myocardial infarction (STEMI). We evaluated the incidence of missed STEMI over an 11-month period. METHODS: Consecutive patients with a discharge diagnosis of non STEMI were retrospectively evaluated. Clinical data, ECG and angiographic data were reviewed. RESULTS: Of the 198 patients screened, 140 were included...
November 2013: Journal of Electrocardiology
Quan Li, Kang-an Cheng, Li-xian Sun, Jian-hua Yan, Yi-hua Lu, Hong-yan Chen, Jian-ling Yan, Ling Li, Quan Fang, Zhong-jie Fan
OBJECTIVE: To explore the characteristics of ST-segment deviation in patients with acute ST elevation myocardial infarction(STEMI)having only one vessel lesion in either left circumflex artery (LCX) or right coronary artery (RCA). METHODS: All AMI (acute myocardial infarction) patients were admitted into Peking Union Medical College Hospital from January 1996 to March 2009. They underwent coronary angiography (CAG). And the IRA (infarction-related artery) was either LCX or RCA without other coronary artery stenosis...
June 14, 2011: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Ravi S Hira, James M Wilson, Yochai Birnbaum
OBJECTIVES: Inferior ST-elevation myocardial infarction (I-STEMI) caused by proximal occlusion of the left circumflex artery (LCx) or right coronary artery (RCA) is associated with poor outcomes. We tested two new electrocardiographic (ECG) algorithms to identify proximal RCA (P-RCA), proximal LCx (P-LCx), or distal RCA or LCx in I-STEMI. METHODS: In 135 patients with I-STEMI, 115 (85.2%) had RCA occlusion [49 (36.3%) with P-RCA occlusion] and 15 (11.1%) had LCx occlusion [4 (2...
May 2011: Coronary Artery Disease
Johanne Neill, Colum Owens, Mark Harbinson, Jennifer Adgey
BACKGROUND: Many patients with non-ST elevation myocardial infarction (NSTEMI) may have posterior STEMI, which should be emergently treated with reperfusion strategies but is difficult to identify by 12-lead ECG. OBJECTIVES: To compare the initial ECG and body surface map (BSM) for the diagnosis of posterior MI as verified by single-photon emission computed tomography (SPECT) and cTroponin T. METHODS: Patients with chest pain greater than 20 min at rest with either ST depression of at least 0...
November 2010: Coronary Artery Disease
Mohammed Almansori, Paul Armstrong, Yuling Fu, Padma Kaul
BACKGROUND: Electrocardiograms (ECGs) are essential in identifying the type and location of acute myocardial infarction. In the setting of inferior wall myocardial infarction (IWMI), identification of the right coronary artery (RCA) as the culprit artery is important because of the potential complications associated with its involvement. OBJECTIVES: To evaluate previous ECG criteria used for the identification of RCA involvement and validate them in the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT 4 PCI) cohort; and to develop an improved simplified score to identify RCA involvement...
June 2010: Canadian Journal of Cardiology
Niels J Verouden, Kurdo Barwari, Karel T Koch, José P Henriques, Jan Baan, René J van der Schaaf, Marije M Vis, Renée B van den Brink, Jan J Piek, Jan G Tijssen, Robbert J de Winter
AIMS: Aim of this study was to investigate the diagnostic accuracy of the conventional electrocardiogram (ECG) algorithm [ST-segment elevation (STE) in lead III exceeding that in lead II combined with ST-segment depression in lead I or aVL] for identification of the infarct-related artery (IRA) in a large cohort of patients undergoing primary percutaneous coronary intervention (PCI) for inferior wall STE myocardial infarction (STEMI). METHODS AND RESULTS: We included 1131 patients with inferior STEMI, who underwent primary PCI between 2000 and 2007 and of whom a pre-procedural 12-lead ECG was available, recorded immediately prior to PCI...
November 2009: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Kai-Hung Cheng, Chih-Sheng Chu, Kun-Tai Lee, Ho-Ming Su, Tsung-Hsien Lin, Wen-Chol Voon, Sheng-Hsiung Sheu, Wen-Ter Lai
OBJECTIVE: In reperfusion strategy for ST-elevation myocardial infarction (STEMI), emergency surgical bypass grafting might be considered for patients with significant multivessel coronary diseases complicated by cardiogenic shock. The culprit lesions in STEMI can be predicted from electrocardiographic (ECG) findings. However, whether the complexity of coronary artery lesions in STEMI can be predicted from characteristic ECG findings remained unclear. MATERIALS AND METHODS: The initial 12-lead ECG parameters in each lead recording from patients with STEMI receiving primary percutaneous coronary intervention within 12 hours were retrospectively analyzed...
January 2008: American Journal of Emergency Medicine
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