Improved detection of posterior myocardial wall ischemia with the 15-lead electrocardiogram

Khaw, Kenneth; Moreyra, Abel E.; Tannenbaum, Alan K.; Hosler, Maryhelen; Brewer, Timothy J.; Agarwal, Jai B.

doi:10.1016/s0002-8703(99)70020-7

Cited by 33 publications

(8 citation statements)

References 18 publications

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“…Matetzky et al [8]demonstrated the detection of acute posterior wall MI by isolated ST segment elevation in leads V7–V9 in patients presenting with chest pain without ST elevation on the standard 12-lead ECG. Khaw et al [18]reported detection of myocardial ischemia with 3 posterior chest leads during percutaneous transluminal coronary angioplasty of the left circumflex artery in 49% of patients while the standard 12-lead ECG revealed this finding in only 32%.…”

Section: Discussionmentioning

confidence: 99%

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

et al. 2004

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Background: A number of innovative approaches have been investigated for their value in the early detection of acute ischemia or infarction in patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac origin. Prior investigations have demonstrated the utility of adding right precordial and posterior chest leads to the standard 12-lead electrocardiogram (ECG) for identifying right ventricular and posterior wall infarctions in the ED. Hypothesis: To assess the utility of additional ECG leads in low-risk patients presenting to the ED with symptoms suggestive of acute coronary syndromes who are managed in a chest pain evaluation unit (CPEU). Methods: We studied low-risk patients who presented to the ED with chest pain compatible with myocardial ischemia. Low-risk patients were identified by a normal 12-lead ECG, no arrhythmias or hemodynamic instability, and one negative serum cardiac troponin I. Patients were admitted to the CPEU where a 16-lead ECG was recorded by the addition of 2 right-sided precordial leads (V4R, V5R) and 2 posterior leads (V8, V9) to the standard 12-lead ECG. Results: The 16-lead ECG system was applied to 316 consecutive patients. The study group was a middle-aged population with equal numbers of men and women and an average of 2 cardiac risk factors per patient. The 16-lead ECG demonstrated evidence of myocardial injury in only 1 patient and no evidence of ischemia in any of the 316 patients. Conclusion: In patients presenting to the ED with chest pain and evidence of low clinical risk by our criteria, the addition of both right-sided precordial and posterior chest leads to the standard 12-lead ECG did not provide additional information for risk stratification.

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Section: Discussionmentioning

confidence: 99%

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

et al. 2004

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“…It should also be noted that the probability that the patient has a diagnosis of NeP is > 90% if the DN4 score is 5 (93%) or 6 (98.5%). 31 The overall accuracy of the DN4 as a screening test for NeP compares favourably with other 34,35 The DN4 screening test has been translated into Arabic and validated in Middle East populations. 21 Given the prevalence of NeP in the MER among high risk groups, such as diabetes patients, screening for NeP is highly recommended by the current expert panel.…”

Section: Nep: Diagnosismentioning

confidence: 99%

Guidelines for the Pharmacological Treatment of Peripheral Neuropathic Pain: Expert Panel Recommendations for the Middle East Region

et al. 2010

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Neuropathic pain (NeP) has been the focus of extensive basic and clinical research over the past 20 years. This has led to an increased understanding of underlying pathophysiological mechanisms and the development of new therapeutic agents, as well as a clearer definition of the role of established medications. To date there are no published treatment guidelines for NeP in the Middle East. A multidisciplinary panel of Middle East and international experts met to review critically and reach a consensus on how best to apply evidence-based guidelines for the treatment of NeP (mainly peripheral NeP) in the Middle East. The expert panel recommended pregabalin, gabapentin and secondary amine tricyclic antidepressants (nortriptyline and desipramine) as first-line treatments for peripheral NeP. Serotonin-norepinephrine reuptake inhibitor antidepressants, tramadol and controlled-release opioid analgesics were recommended as second-line treatments. There is a need to increase diagnostic awareness of NeP, use validated screening questionnaires and undertake more treatment research in the Middle East region.

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“…Currently, patients who do not have ST-segment elevation in a standard ECG are not recommended for thrombolytic therapy [17]. Moreover, there are reports of ST elevation in posterior leads in the absence of changes in anterior leads [18]. It is important to diagnose posterior MI because it often is associated with complications such as mitral valve regurgitation [19] and poor patient prognosis [20,21].…”

Section: Posterior Leadsmentioning

confidence: 99%

How many ECG leads do we need?

2006

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Improved detection of posterior myocardial wall ischemia with the 15-lead electrocardiogram

Cited by 33 publications

References 18 publications

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

Guidelines for the Pharmacological Treatment of Peripheral Neuropathic Pain: Expert Panel Recommendations for the Middle East Region

How many ECG leads do we need?

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