Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction

Sadanandan, Saihari; Hochman, Judith S.; Kolodziej, A W; Criger, Douglas A.; Ross, A. R.; Selvester, Ronald H.; Wagner, Galen S.

doi:10.1016/s0002-8703(03)00369-7

Cited by 53 publications

(39 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7,8 Theoretically, the farther away the leads are from the right ventricle, the smaller is the ST-segment displacement. Sandanandan et al 1 found that a greater sum of the ST-segment in inferior leads and the ST-segment displacement in V 1 ≥ V 3 differentiate RCA from LAD as the infarct-related artery in combined ST-segment elevation in anterior and inferior leads (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

Jim¹,

Chan²,

Tang³

et al. 2009

Clinical Cardiology

View full text Add to dashboard Cite

Background:The clinical and angiographic findings of patients suffered from acute myocardial infarction (MI) and presented with combined ST elevation in both anterior and inferior leads remain unclear. Hypothesis: These patients might have ≥1 coronary arteries occluded. Methods: From January 2002 to December 2006, 49 consecutive patients were found to have ST elevation in both anterior and inferior leads during myocardial infarction. Patients who had left circumflex artery occlusion (acute or chronic) were excluded. These patients were divided into 4 types according to the infarct-related artery (IRA) and status of the contralateral vessel patency: left anterior descending artery (LAD) as the IRA with a patent right coronary artery (RCA) (type 1A, n = 25); LAD as IRA with an occluded RCA (type 1B, n = 1); RCA as IRA with a patent LAD (type 2A, n = 19); and RCA as IRA with an occluded LAD (type 2B, n = 4). Results: Single vessel occlusion (type A angiographic pattern) was found in 90% of patients. Type 1A patients had a larger infarct size than that of 2A. ST elevation in V 2 ≥ V 3 identified RCA as the IRA with a high specificity (92%) and sensitivity (74%). Type 2B patients (2-vessel occlusion) had a larger infarct size than that of 2A; however, no electrocardiogram (ECG) criteria could reliably differentiate them. Conclusion: In a real world situation, single vessel occlusion is found in the majority of cases of combined ST elevation in anterior and inferior leads. ST elevation in V 2 ≥ V 3 distinguishes RCA against LAD as the IRA with high accuracy.

show abstract

Section: Discussionmentioning

confidence: 99%

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

Jim¹,

Chan²,

Tang³

et al. 2009

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Anterior ST segment elevation MI (STEMI) is caused by total occlusion of the left anterior descending (LAD) coronary artery at different levels. In the literature, LAD is classified two groups according to termination (1)(2)(3)(4)(5). The normal anatomic pattern in most individuals (6), which is approximately 3/4 of all patients, is for the LAD to course around the apex and terminates along the diaphragmatic area of the left ventricle; some researchers call this a wrapped LAD.…”

Section: Introductionmentioning

confidence: 99%

“…The normal anatomic pattern in most individuals (6), which is approximately 3/4 of all patients, is for the LAD to course around the apex and terminates along the diaphragmatic area of the left ventricle; some researchers call this a wrapped LAD. In the other 1/4 of patients, the LAD does not reach the diaphragmatic area, terminating at the LV apex or before the apex; this is called a non-wrapped LAD (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…Although myocardial damage in regard to termination of LAD coronary artery can be shown by electrocardiography (ECG) criteria (1)(2)(3)(4), the localization and extensity of the myocardial injury was not correlated with ECG, echocardiographic, and angiographic findings (7,8). Inferior ST elevation during acute anterior myocardial infarction and ECG findings related to the termination and localization of the LAD coronary artery lesion in patients with anterior MI have been defined in the literature (1)(2)(3)(4)(5)9).…”

Section: Introductionmentioning

confidence: 99%

“…Inferior ST elevation during acute anterior myocardial infarction and ECG findings related to the termination and localization of the LAD coronary artery lesion in patients with anterior MI have been defined in the literature (1)(2)(3)(4)(5)9). In addition, the localization, extensity of the myocardial injury, and possible effect on ventricular function have not yet been determined elaborately by imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of termination of the left anterior descending coronary artery (wrapped or non-wrapped property) on tissue Doppler echocardiography findings in patients with anterior myocardial infarction: an observational study

Sönmez¹,

Vatankulu²,

Kayrak³

et al. 2012

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

Objective: We aimed to evaluate effect of termination property of left anterior descending (LAD) on tissue Doppler echocardiography (TDE) parameters in patients experiencing their first anterior myocardial infarction (AMI) who had undergone successful primary percutaneous coronary intervention (PCI) Methods: A prospective, cross-sectional observational study was performed. Eighty-four patients were enrolled in the study. Echocardiography was performed during the first three days of AMI. Conventional TDE measurements were obtained from right ventricular (RV) and four left ventricular (LV) walls: for the systolic function -mitral annular TDE systolic velocity -Sm, for diastolic function -mitral annular TDE early and late diastolic velocities -Em, Am, transmitral early and late diastolic velocities ratio -E/A, and combined systolic and diastolic function -myocardial performance index (MPI). Coronary arteries were evaluated and patients were divided into two groups (non-wrapped LAD and wrapped LAD) according to the termination properties. Student-t, Mann-Whitney U and Chi-square tests, bivariate Pearson and Spearman correlation analyses were used for statistical analysis. Results: Baseline characteristics and conventional echocardiographic parameters of the patients were similar. There was a statistically significant difference for the anterior wall Sm parameter, whereas there was no substantial difference for Em, Am and MPI values. The anterior wall Sm was more affected in patients with non wrapped LAD than in patients with wrapped LAD (6.70±1.66 and 7.44±1.66 cm/s; p=0.036,).The anterior Sm parameter was uniquely correlated with LAD termination status when compared with other independent parameters (r=0.236, p=0.036). Conclusion:We showed that termination of LAD is important for the anterior wall systolic functions in the early stage of AMI treated successfully. ( Original Investigation Özgün Araşt›rma 465ÖZET Amaç: Primer perkütan koroner girişim ile başarılı tedavi edilen anteriyor miyokart enfarktüs (AME) hastalarında sol ön inen koroner arter (LAD) sonlanımının doku Doppler ekokardiyografi(DDE) bulgularına etkisinin değerlendirilmesi amaçlandı.Yöntemler: Çalışma enine kesitli gözlemsel prospektif olarak planlandı. Seksen dört hasta çalışmaya dahil edildi. Hastalara ilk üç gün içinde ekokardiyografik değerlendirme yapıldı. Klasik DDE parametreleri sağ ventrikül (RV) lateral duvar ve sol ventriküle (LV) ait dört duvardan alındı. DDE parametreleri olarak; sistolik fonsiyonların değerlendirilmesinde -DDE mitral annüler sistolik hız değeri -Sm, diyastolik fonksiyonların -DDE mitral annüler erken ve E/A değerleri, kombine sistolik ve diyastolik fonksiyonların değerlendirilmesinde -miyokart performans indeksi (MPI) değeri kullanıldı. LAD sonlanım özelliğine göre iki gruba (sarılı olan ve olmayan LAD) ayrıldı. İstatistiksel analizde Student-t, Mann-Whitney U ve Ki-kare testleri, Pearson ve Spearman bivaryasyon korelasyon analizleri kullanıldı.

show abstract

Acute Myocardial Infarction With Diffuse ST-Segment Elevation

2021

View full text Add to dashboard Cite

A patient in their sixties with history of hypertension but no other cardiac history presented with 2 hours of severe substernal chest pain, diaphoresis, and lightheadedness. The patient's heart rate was 68 beats per minute and their blood pressure was 112/78 mm Hg. Cardiac examination revealed distant heart sounds but no murmur or gallop. The Figure, A demonstrates the 12-lead electrocardiogram (ECG) taken on admission. In addition to probable left ventricular hypertrophy, it showed first-degree atrioventricular (AV) block and ST-segment elevation both in the inferior and in the anterior leads. The patient underwent emergency cardiac catheterization, which revealed single-vessel disease with acute thrombotic occlusion.Questions: What was the most likely culprit vessel? Why was it important to establish the probable infarct location even before the patient was sent to the catheterization laboratory?

show abstract

Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction

Cited by 53 publications

References 29 publications

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

Angiographic and Clinical Implications of Combined ST‐segment Elevation in Anterior and Inferior Leads in Acute Myocardial Infarction

Effect of termination of the left anterior descending coronary artery (wrapped or non-wrapped property) on tissue Doppler echocardiography findings in patients with anterior myocardial infarction: an observational study

Acute Myocardial Infarction With Diffuse ST-Segment Elevation

Contact Info

Product

Resources

About