Significance of Poor R Wave Progression

Berger, Marvin; Schack, Jerome A.

doi:10.1159/000399668

Cited by 4 publications

(2 citation statements)

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“…Also Yunis et aZ(198 1) have demonstrated that unless one uses sophisticated cell synchronization techniques to detect subtle chromosomal rearrangements, many patients with d-ANL will have normal karyotypes. In t-ANL, however, the frequency of chromosome abnormalities is very high even when one uses standard banding procedures yielding an average of 250-350 bands per haploid set (Rowley et al, 1981;Kapadia et al, 1980;Berger et al, 198 1). The reason for this high frequency of chromosome abnormalities in t-ANL has not been firmly established.…”

Section: Discussionmentioning

confidence: 99%

Therapy‐induced preleukaemia in patients treated for Hodgkin's lymphoma: clinical and therapeutic relevance of sequential chromosome banding studies

et al. 1984

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Between January 1978 and December 1982 successful sequential chromosome analyses were carried out on bone marrow cells of five patients previously treated for Hodgkin's lymphoma (HL) presenting unexplained cytopenia or pancytopenia during follow-up. All patients had concurrent morphological examination of bone marrow specimens showing signs of dysplasia and/or hypoplasia, without leukaemic infiltrate. Six other patients treated for HL who had normal haematological parameters served as controls. All the patients with unexplained cytopenias had clonal chromosome abnormalities; monosomy for chromosome No. 5 was the most frequent. No abnormalities were detected in the control group. Two patients have evolved to resistant leukaemia, one died of sepsis before leukaemic conversion while severely neutropenic, and two are in full marrow and cytogenetic recovery after aggressive anti-leukaemic treatment in the pre-leukaemic phase. Our data suggest that cytogenetic studies may be of crucial value in detecting therapy-induced preleukaemia (t-PL) at an early stage of its evolution and in planning appropriate therapy before the establishment of overt leukaemia.

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Section: Discussionmentioning

confidence: 99%

Therapy‐induced preleukaemia in patients treated for Hodgkin's lymphoma: clinical and therapeutic relevance of sequential chromosome banding studies

et al. 1984

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“…[1][2][3] In such patients there is difficulty in deciding whether these electrocardiographic appearances are the result of emphysema or previous anterior myocardial infarction, or whether in fact both conditions are present. Such electrocardiographic appearances in emphysema have been ascribed to hyperinflation with descent of the diaphragm.4-6 This results in a relatively low position of the heart so that the anterior chest leads now have a superior orientation, and so reflect the dominantly negative QRS complexes normally associated with such an orientation.…”

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Diagnosis of old anterior myocardial infarction in emphysema with poor R wave progression in anterior chest leads.

Hart¹,

Barrett²,

Barnaby³

et al. 1981

Heart

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SUMMARYThe electrocardiograms of patients with emphysema may suggest associated old anterior myocardial infarction. Sixteen patients with the physiological characteristics ofemphysema were studied, who also showed poor R wave progression in the anterior chest leads, so that RV3 was < 4 mm. A thallium-201 cardiac scan consistent with previous anterior (septal) myocardial infarction was present in seven patients. In these patients there was no significant increase in RV3 amplitude when recorded one interspace below the conventional site. In the nine patients with a thallium-201 cardiac scan negative for old anterior myocardial infarction, RV3 amplitude increased from 2-2±+04 mm to 6-4±1 2 mm.Patients with or without associated old anterior myocardial infarction could be better diagnosed by consideration of RV3 amplitude as recorded from one interspace lower, as compared with conventional electrode placement. All five patients with RV3 (lower interspace) <2 mm had associated anterior infarction, and all seven patients with RV3 (lower interspace) >3 mm did not. This simple manoeuvre is recommended in patients with emphysema and an electrocardiogram suggestive of old anterior myocardial infarction.The electrocardiogram of some patients with emphysema may suggest previous anterior myocardial infarction, with small or absent initial R waves in the anterior chest leads, resulting in QS complexes or "poor R wave progression" in these leads.1-3In such patients there is difficulty in deciding whether these electrocardiographic appearances are the result of emphysema or previous anterior myocardial infarction, or whether in fact both conditions are present. Such electrocardiographic appearances in emphysema have been ascribed to hyperinflation with descent of the diaphragm.4-6 This results in a relatively low position of the heart so that the anterior chest leads now have a superior orientation, and so reflect the dominantly negative QRS complexes normally associated with such an orientation.The value of recording the anterior chest leads in a lower intercostal space and noting the presence or absence of increase in R wave amplitude, to Received for publication 28 November 1980 exclude or confirm associated anterior myocardial infarction, has been suggested in the past.4 Such studies, however, have involved patients with a wide variety of cardiopulmonary diseases, or have not adequately documented the respiratory pathophysiology. In addition, the criteria for the presence or absence of anterior myocardial infarction have usually been clinical, and therefore subject to the error inherent in this difficult clinical differentiation. Moreover, the actual changes in R wave amplitude in such patients with emphysema with and without associated anterior myocardial infarction have not been quantified.In this study, 16 patients with the physiological characteristics of emphysema, who also showed small or absent initial R waves in the electrocardiographic chest leads Vi to V3 were considered, and these leads were also recorded one ...

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