Natural course of electrocardiographic components and stages in the first twelve hours of acute myocardial infarction

Klainman, Eliezer; Sclarovsky, Samuel; Lewin, Ruben F.; Topaz, On; Farbstein, Hanan; Pinchas, A; Fohoriles, Lion; Agmon, Jacob

doi:10.1016/s0022-0736(87)80098-5

Cited by 19 publications

(9 citation statements)

References 34 publications

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“…8–15 In our study, we were able to demonstrate that sum STE (V1-V6) plus ST depression (II, III, and aVF) is significantly different between proximal and nonproximal LAD occlusions for ECGs performed within 60 minutes of symptom onset.…”

Section: Discussionmentioning

confidence: 49%

“…This is similar to what has been demonstrated in other studies charting sum STE during the course of an acute myocardial infarction. 8,13,14 Our data showed that nonproximal LAD occlusions have an initially smaller sum STE plus ST depression (mean = 11.7 ± 4.8 mm) within the first hour of symptom onset. The mean sum STE plus ST depression does not decrease over the first 3 hours as seen in the proximal LAD occlusions.…”

Section: Discussionmentioning

confidence: 56%

“…8,9 Extensive anterior myocardial infarctions have a steady decrease in sum ST elevation (STE) over the first 3 hours, whereas antero-septal myocardial infarctions have a fairly constant sum STE over the first 3 hours. 8 A study using dogs as a model for myocardial infarctions found that maximum STE occurred within 5 to 10 minutes of complete occlusion of the left circumflex artery. 10 …”

Section: Introductionmentioning

confidence: 99%

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Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Aertker¹,

Barker²,

Anderson³

et al. 2011

WestJEM

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IntroductionAcute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions.MethodsIn a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset.ResultsIn this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n = 35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P = 0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n = 37), there was no significant difference in ST-segment deviation between the 2 groups.ConclusionThe sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Aertker¹,

Barker²,

Anderson³

et al. 2011

WestJEM

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“…Serial 12-lead ECGs, recorded at admission, on the first day after PCI, at discharge, and after 3 months, were analyzed, and ECG stages of AMI were assessed by the following criteria (19):…”

Section: Methodsmentioning

confidence: 99%

Changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct-related artery with and without stent implantation

Kalinauskienė¹,

Naudžiūnas²,

Navickas³

et al. 2007

Medicina

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“…The diagnosis of anterior AMI was established on the basis of a history of chest pain, appearance of new pathological Q waves in the precordial chest leads V2-V6, and typical elevation of serum cardiac enzymes. The ECG evolution of anterior AMI was divided into four stages [6]: (1) distinct positive T waves, with elevation of the ST segment and absent Q waves; (2) beginning with emergence of pathologic Q waves and continuing ST segment elevation and Echocardiography Technically satisfactory two-dimensional ECG studies were ob tained during the first 24 h of infarction in 42 patients. The wall motion of the various left ventricular regions was semiquantitively assessed independently by two experienced observers without knowledge of the clinical or ECG findings.…”

Section: Ecg Recording Protocol and Definitionmentioning

confidence: 99%

Significance of Rightward Axis Shift in Anterior Acute Myocardial Infarction

Sagie¹,

Sclarovsky²,

Strasberg³

et al. 1991

Am J Noninvas Cardiol

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The purpose of this study was to assess the significance of two types of rightward axis shift appearing during anterior acute myocardial infarction. Of 731 consecutive patients admitted with evidence of anterior acute myocardial infarction, 72 (10%) developed acute rightward axis shift and were divided into two groups according to electrocardiographic criteria: group A consisted of 27 patients with rightward axis shift and an electrocardiographic pattern characteristic of left posterior hemiblock, and group B consisted of 45 patients with rightward axis shift without the electrocardiographic pattern of left posterior hemiblock. A comparison between their electrocardiographic patterns, clinical course, prognosis, and échocardiographie findings was made. There was no significant difference in the average shift of the axis to the right between the groups (60 vs. 62°). The average mean axes of the first (<0.04 ms) and second (>0.04 ms) vector in group A were 2 and 107°, respectively, as compared with 68 and 52° in group B (p < 0.001). The Killip class on admission was worse in group A (26 vs. 2% for Killip III and IV). The patients in group A had a significantly higher incidence of in-hospital morbidity such as congestive heart failure (63 vs. 24%) and cardiogenic shock (74 vs. 7%). The in-hospital mortality rate in group A was very high (70%) as compared with group B (9%; p < 0.001). The echocardiogram of group A patients showed severe general hypokinesia as compared with group B patients in whom there was a better left ventricular function with normal inferior wall motion and lateral base wall compensatory hyperkinesia. The right axis deviation in group A is attributed to different degrees of left posterior hemiblock, while in group B the rightward axis shift is attributed to the cancellation of electrical forces from the anterolateral wall as a result of the infarction and the upsurge of the right electrical forces from the posterior wall. In conclusion, it is very important to differentiate between patients with these two electrocardiographic patterns of rightward axis shift during anterior acute myocardial infarction because they are completely different in their electrocardiographic characteristics, clinical course, and prognosis.

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Natural course of electrocardiographic components and stages in the first twelve hours of acute myocardial infarction

Cited by 19 publications

References 34 publications

Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

Changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct-related artery with and without stent implantation

Significance of Rightward Axis Shift in Anterior Acute Myocardial Infarction

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