Natural history and evaluation of ST segment changes and MB CK release in acute myocardial infarction.

Selwyn, Andrew P.; Ogunro, Edward A.; Shillingford, John

doi:10.1136/hrt.39.9.988

Cited by 35 publications

(6 citation statements)

References 14 publications

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“…Blomqvist et al (1975) showed that there was a significant correlation between EST and the area of an infarct as determined by pyrophosphate scan. By contrast, Norris et al (1976), Thompson and Katavatis (1976), and Selwyn et al (1977a) showed no correlation or at best weak correlation between ST segment elevation and peak or total plasma enzyme.…”

Section: St Segment Elevationmentioning

confidence: 72%

“…Secondly, variations in chest shape and size and localisation of infarction may lead to differences between patients. Thirdly, ST segment elevation is known to increase or decrease rapidly in some patients (Selwyn et al, 1977a) and variable intervals between onset of pain and time of electrocardiographic recording will introduce further error. To minimise this source of error we have taken recordings at regular intervals in all our patients.…”

Section: St Segment Elevationmentioning

confidence: 99%

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Value of electrocardiogram in predicting and estimating infarct size in man.

Yusuf¹,

Lopez²,

Maddison³

et al. 1979

Heart

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The value of the electrocardiogram in assessing infarct size was studied using serial estimates of the MB isomer of creatine kinase (CK MB) in plasma, serial 35 lead praecordial maps in 28 patients with anterior myocardial infarction, and serial 12 lead electrocardiograms in 17 patients with inferior myocardial infarction. In patients with anterior infarcts, sigma ST, sigma R, sigma Q, sigma R/(Q+S), and the number of sites with ST elevation more than 2 mm or with QS waves, were obtained from each map. Correlation between both maximum sigma Q and maximum sigma ST with cumulative CK MB was highly significant. There was also a significant correlation between sigma R and sigma R/(Q+S) with cumulative CK MB. There was no significant correlation between maximum number of sites with ST elevation or with Q or QS waves and cumulative CK MB. Maximum sigma ST and number of sites with ST elevation predicted maximum sigma Q and number of sites with QS or Q waves at a time when infarction was not complete. In patients with inferior infarcts, there was a significant correlation between maximum sigma Q and maximum sigma ST in leads II, III, and a VF, and cumulative CK MB. This study shows that all the waves in the electrocardiogram are useful in assessing infarct size. The fact that maximum sigma ST predicts final sigma Q may be used to assess the efficacy of interventions designed to salvage ischaemic myocardium.

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Section: St Segment Elevationmentioning

confidence: 72%

Section: St Segment Elevationmentioning

confidence: 99%

Value of electrocardiogram in predicting and estimating infarct size in man.

Yusuf¹,

Lopez²,

Maddison³

et al. 1979

Heart

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“…when using the same lead. It has recently been shown, using the praecordial mapping technique in patients with anterior AMI, that the maximal ST elevation occurs one hour after the onset of chest pains (13). However, animal experiments have demonstrated that the maximal ST elevation, when using epicardial electrodes, occurs already 5-15 min after the occlusion (6,10).…”

Section: Discussionmentioning

confidence: 99%

“…Recent investigations suggest that the most pronounced development in the infarction process in man takes place within the first 24 hours after the onset of symptoms ( I , 13,14). This makes it essential to know the exact time sequence of the electrocardiographic (ECG) changes in the early phase of acute myocardial infarction (AMI).…”

mentioning

confidence: 99%

Evolution of ST Segment and Q and R Waves during Early Phase of Inferior Myocardial Infarction

Thygesen

Hørder

Nielsen

et al. 1979

Journal of Internal Medicine

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ABSTRACT. Using the aVF lead, the ST segment deviation and the amplitudes of Q and R waves were measured hourly for 48 hours after the onset of symptoms in 14 patients with inferior AMI. The average ST deviation reaches a maximum elevation at about 3 hours and then falls to a uniform level within 12 hours. The average depth of the Q waves began to increase within the first 2 hours, and the increase was linear until around the 12th hour, whereafter the depth was somewhat uneven. The average height of the R waves declined almost linearly from the 3rd to 15th hour, after which the height became fairly uniform. Within a 48‐hour period after the onset of symptoms, there was a significant positive correlation not only between the average amplitudes of the Q and R waves (r = 0.951, p > 0.001), but also between the courses of the individual Q and R waves in 13 of the 14 patients. A significant positive correlation was found between ST elevation at 3 hours and the reduction in the R wave within 24 hours (r = 0.634, p > 0.05), but no correlation existed between ST elevation and the Q wave at these times. It is concluded that within 48 hours of the onset of symptoms, the magnitude of electrically inert myocardial tissue can be determined by the course of the Q or R waves, but that during the first 24 hours the R wave is superior to the Q wave for evaluating the evolution of the infarction process.

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“…The ST segment was considered to be depressed if there was 1 00 mm or more of shift for at least 0-08 s (Mason and Likar, 1966). ST segment elevation was measured 0-06 s from the end of the QRS complex (Selwyn et al, 1977b), and was ignored if less than 1 mm. None of the patients had ST segments which at rest lay above or below the isoelectric line.…”

Section: Interpretation Of Recordsmentioning

confidence: 99%

Projection of electrocardiographic signs in praecordial maps after exercise in patients with ischaemic heart disease.

Fox¹,

Selwyn²,

Shillingford³

1979

Heart

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suMMARY Praecordial surface maps of the electrocardiogram were recorded before and after exercise using 16 electrodes covering the left hemithorax. The ST segment and R and S wave changes were measured in the praecordial maps from 20 individuals with no detectable cardiovascular disease. These showed no significant alteration in ST segments or R/S. In contrast in 40 patients with angiocardiographically proven coronary artery disease it was possible clearly to outline the distribution, severity, and time course of praecordial areas of ST segment depression (36 patients) and ST segment elevation (10 patients). In addition these praecordial areas of ST segment changes were accompanied by a regional and significant fall in the R/S.The praecordial electrocardiogram with exercise complements the anatomical information obtained from the coronary arteriogram by clearly outlining electrocardiographic projections of regional myo--cardial ischaemia or cell death.The exercise electrocardiogram has long been used in the diagnosis and evaluation of patients with coronary artery disease (Bruce and McDonough, 1969;Sheffield and Roitman, 1975;Blackburn, 1977). Interest has centred on ST segment changes on exercise (Roitman et al., 1970;Redwood et al., 1977) though in recent years changes in the QRS vector have been described (Kilpatrick, 1976). Though the praecordial electrocardiogram using 36 to 72 leads is being used to study the natural history of acute myocardial infarction and the effect of interventions (Maroko et al., 1972;Selwyn et al., 1977a;Selwyn and Shillingford, 1977), this technique has not been widely applied to the exercise electrocardiogram. This is the result of difficulties in recording the surface electrocardiogram before transient changes have regressed and in designing an adequate electrode system which is stable during severe exertion. In a recent study, a technique for recording the praecordial electrocardiogram, using conventional equipment available in most hospitals, has been described (Fox et al., 1978). The purpose of the present study is to describe the variety of praecordial electrocardiographic abnormalities that occur on exercise.'This work was supported by a grant from the British Heart Foundation and Welcome Trust.Received for publication 13 February 1979 Methods Twenty normal male volunteers (aged 28 to 74, mean 52 years) and 40 consecutive male patients (aged 32 to 72, mean 54 years) with a typical history of angina pectoris, ST segment changes after exercise, and anatomical evidence of coronary artery disease shown by coronary arteriography were studied. Routine 12 lead electrocardiograms were recorded in all patients. All patients were in sinus rhythm at rest. Patients whose electrocardiograms showed abnormalities in the mean frontal axis (that is beyond -30°and + 120°) or QRS duration more than 110 ms before exercise were excluded from the study.Praecordial exercise electrocardiograms were recorded using a direct writing ink jet Mingograf (Elema-Schonander) recording on four channels si...

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Natural history and evaluation of ST segment changes and MB CK release in acute myocardial infarction.

Cited by 35 publications

References 14 publications

Value of electrocardiogram in predicting and estimating infarct size in man.

Value of electrocardiogram in predicting and estimating infarct size in man.

Evolution of ST Segment and Q and R Waves during Early Phase of Inferior Myocardial Infarction

Projection of electrocardiographic signs in praecordial maps after exercise in patients with ischaemic heart disease.

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