Reciprocal ST-Segment Changes in Myocardial Infarction: Ischemia at Distance Versus Mirror Reflection of ST-Elevation

Vaidya, Gaurang; Antoine, Steve; Imam, Syed Haider; Kozman, Hani; Smulyan, Harold; Villarreal, Daniel

doi:10.1016/j.amjms.2017.09.004

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…2A bottom). This mimicked the "reciprocal" ST segment changes frequently observed in human acute myocardial infarction [17], indicating the presence of myocardial injury on the side opposite to the ventricle where the ECG electrode was placed.…”

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confidence: 62%

Reciprocal ST segment changes reproduced in burn-induced subepicardial injury model in bullfrog heart

Kazama

Takamura

Yamada

et al. 2020

The Journal of Veterinary Medical Science

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In our previous studies, by simply inducing burn injuries on bullfrog hearts or partially exposing their surface to high-potassium (K +) solution, we could reproduce a ST segment elevation in the electrocardiogram (ECG), which is a characteristic finding in human ischemic heart disease. In the present study, using our burn-induced subepicardial injury model, we could additionally reproduce "reciprocal" ST segment changes for the first time in frog hearts, mimicking those observed in human acute myocardial infarction. Immunohistochemistry demonstrated markedly decreased Na + /K +-ATPase protein expression in the ventricular surface after the burn injury. The loss of this pump expression in injured cardiomyocytes was thought to be responsible for the creation of "currents of injury" and the subsequent ST segment changes observed in acute myocardial infarction. KEY WORDS: acute myocardial infarction, bullfrog heart, Na + /K +-ATPase expression, reciprocal ST segment change Acute coronary syndrome (ACS, formerly called "ischemic heart disease"), including acute myocardial infarction and unstable angina pectoris, is one of the leading causes of death worldwide [1, 12, 14]. To rapidly diagnose acute myocardial infarction and improve the outcome, the electrocardiogram (ECG) is the most useful test in patients with possible myocardial ischemia [16]. However, not all patients with acute myocardial infarction present typical ECG findings represented by an elevation of the ST segment, which is the interval between the ventricular depolarization and repolarization [13]. Additionally, an elevation of this segment is also observed in other normal or abnormal cardiac conditions, such as early repolarization, right bundle-branch block, left ventricular hypertrophy or pericarditis [9]. "Reciprocal" ST segment change, which is frequently observed in acute anterior or inferior myocardial infarction, is defined as an ST segment depression in leads opposite to those that reflect an ST segment elevation [17]. Since reciprocal ST segment change is specifically noted in acute myocardial infarction, the presence of this change strongly supports its diagnosis [2, 18] and also reflects the extent of myocardial ischemia [6]. In our previous studies, by simply inducing burn injuries on the bullfrog heart or partially exposing the heart surface to high-potassium (K +) solution, we were able to reproduce an ST segment elevation in the ECG, which is a characteristic finding in human ischemic heart disease [7, 11]. Here, using our burn-induced subepicardial injury model, we could reproduce reciprocal ST segment changes in frog hearts for the first time that mimicked those observed in human acute myocardial infarction. By immunohistochemistry, we additionally examined the Na + /K +-ATPase protein expression in burned heart ventricle and revealed the physiological mechanisms underlying the ST segment changes in ECG. Adult male bullfrogs, weighing 450 to 550 g (n=12), were purchased from Ohuchi Shōten (Saitama, Japan). After initial inhalation with...

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supporting

confidence: 62%

Reciprocal ST segment changes reproduced in burn-induced subepicardial injury model in bullfrog heart

Kazama

Takamura

Yamada

et al. 2020

The Journal of Veterinary Medical Science

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“…Active chest pain may suggest NSTEACS, whereas dyspnea usually imply ApHCM. In NSTEACS, you can find reciprocal ST changes or "mirror changes" on ECG, which is not usual in ApHCM [28]. Besides, ECG changes in ApHCM are generally stable against the rapid changes in ST-segment and T wave seen in serial ECGs of NSTEACS patients.…”

Section: Discussionmentioning

confidence: 96%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

BMC Cardiovasc Disord

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Background: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS), triggering a series of studies and treatments that may be unnecessary. This study aimed to clarify the electrocardiogram (ECG) differences between the two diseases. Methods: Initial ECG recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) and R wave, the change of ST-segment as well as the number of leads with neg T wave in the 12-lead ECGs. Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13 ± 1.08 vs. 1.38 ± 0.73 mV, P < 0.001). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85 ± 0.69 vs. 0.35 ± 0.23 mV, P < 0.001). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P < 0.001). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of STsegment depression in lead V5 (0.19 ± 0.07 vs. 0.03 ± 0.06 mV, P < 0.001). The number of leads with neg T wave also differed between ApHCM and NSTEACS (6.75 ± 1.42 vs. 6.08 ± 1.51, P = 0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4 > 2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy. Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECG. The ECG characteristics can help to differentiate ApHCM from NSTEACS in clinical setting.

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“…Active chest pain may suggest NSTEACS, whereas dyspnea usually suggest ApHCM. In NSTEACS, you can find reciprocal ST changes or "mirror changes" on ECG, which is not usual in ApHCM [28] . Besides, ECG changes in ApHCM are generally stable against the rapid changes in ST-segment and T waves seen in serial ECGs of NSTEACS patients.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

Preprint

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Objective: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS) which triggers a series of studies and treatments that may be unnecessary. This study aimed to clarify the ECG differences between the two diseases.Methods: Initial electrocardiogram (ECG) recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) wave, R wave and the change of ST-segment in the 12-lead ECGs as well as the number of leads with neg T waves.Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13±1.08 vs. 1.38±0.73, P=0.000). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85±0.69 vs. 0.35±0.23, P=0.000). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P=0.000). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of ST-segment depression in lead V5 (0.19±0.07 vs. 0.03±0.06, P=0.000). The number of leads with neg T waves also differed between ApHCM and NSTEACS (6.75±1.42 vs. 6.08±1.51, P=0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4>2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy.Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R waves and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECGs.

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Reciprocal ST-Segment Changes in Myocardial Infarction: Ischemia at Distance Versus Mirror Reflection of ST-Elevation

Cited by 15 publications

References 17 publications

Reciprocal ST segment changes reproduced in burn-induced subepicardial injury model in bullfrog heart

Reciprocal ST segment changes reproduced in burn-induced subepicardial injury model in bullfrog heart

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

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