Transient hemiblock: An abnormal type of response to the Master two-step test

Kulbertus, H; Humblet, L

doi:10.1016/0002-8703(72)90053-1

Cited by 18 publications

(3 citation statements)

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“…When studies relating to QRS axis are evaluated, in clinical practice a QRS axis shift may be related to coronary artery disease (CAD). Recent reports have pointed out that an exercise-induced QRS axis shift may be related to CAD [10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Korkmaz

2019

Turkish Journal of Clinics and Laboratory

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Aim: Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, the association between coronary arterial dominance and the QRS axis on 12-lead surface electrocardiography (ECG) was not investigated. The present study aims to evaluate the relationship between coronary arterial dominance and the QRS axis on ECG in patients without significant coronary artery and structural cardiac disease. Material and Methods:Overall, 133 patients, without significant CAD and who met the inclusion criteria, participated in this study. A standard surface 12-lead ECGs were performed in all study patients. QT interval, QTc interval, QRS duration, PR interval, P wave and QRS axis were determined. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance.Results: There were 133 subjects with 56 right dominant (42%), 39 left dominant (29%) and 38 codominant (29%) pattern.QRS axis value was found to be significantly higher in the left dominant group when compared with the codominant and right dominant group (p<0.05). No significant difference was observed between the codominant and right dominant groups regarding QRS axis values. The axis of (+30)-(+90) ratio in the left dominant group was found to be significantly higher when compared with the codominant and right dominant group (p<0.05). No significant difference was observed between the codominant and right dominant groups regarding the axis of (+30)-(+90) ratio. Conclusion:Our findings suggested that the QRS axis may be related to coronary artery dominance.

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Section: Discussionmentioning

confidence: 99%

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Korkmaz

2019

Turkish Journal of Clinics and Laboratory

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“…4 A transient leftward QRS axis shift on the electrocardiogram (ECG) during anginal attacks is a specific predictor of proximal LAD disease. [5][6][7][8] Conduction disturbance caused by ischemia of the anterior fascicle of the left bundle branch, which is supplied by the first major septal perforator branch of the LAD, 9 is thought to be one reason for the axis shift.Here, we describe a patient with a non-Q wave myocardial infarction whose coronary arteriogram documented severe luminal narrowing in the first major septal perforator branch arising anomalously from the first diagonal branch. Exercise ECG showed a transient leftward QRS axis shift.…”

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confidence: 99%

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confidence: 99%

Ischemia in the Territory of the First Major Septal Perforator Branch Anomalously Originating From the First Diagonal Branch Leads to a Transient Leftward Shift of the QRS Axis in the Frontal Plane-A Case Report-

Kodama-Takahashi

Suzuki

Watanabe

et al. 2003

Circ J

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rigination of the first major septal perforator branch from a site other than the left anterior descending coronary artery (LAD) is a relatively rare and benign congenital variation. 1 Coronary angiography reveals anomalous vessels originating directly from the aorta and from the proximal portion of the right coronary artery as collateral circulation to the LAD, particularly in patients with proximal LAD disease. 2,3 Anomalous vessels also arise from the proximal circumflex coronary artery, diagonal branch, or obtuse marginal branch. 4 A transient leftward QRS axis shift on the electrocardiogram (ECG) during anginal attacks is a specific predictor of proximal LAD disease. [5][6][7][8] Conduction disturbance caused by ischemia of the anterior fascicle of the left bundle branch, which is supplied by the first major septal perforator branch of the LAD, 9 is thought to be one reason for the axis shift.Here, we describe a patient with a non-Q wave myocardial infarction whose coronary arteriogram documented severe luminal narrowing in the first major septal perforator branch arising anomalously from the first diagonal branch. Exercise ECG showed a transient leftward QRS axis shift. Case ReportA 61-year-old man was referred because of anterior chest pain that started 4 h before admission. His medical history included stable angina pectoris on exertion, hypertension, and gout. The patient's physical examination on admission was unremarkable, except for a high systemic blood pressure of 162/108 mmHg. A radiograph of the chest taken in the supine position showed a cardiothoracic ratio of 62% and no pulmonary congestion. The ECG demonstrated ST-segment elevation in leads V1-4 and STsegment depression in leads I, aVL, V5, and V6. Diphasic or negative T waves in leads I and aVL, and in leads V2-6 were also found.The patient was treated with isosorbide dinitrate (40 mg/day), bisoprolol (2.5 mg/day), and aspirin (162 mg/day). Heparin (10,000 U/day) was also administered intravenously. Creatine kinase, myosin light chain I, and troponin T peaked at 472 IU/L, 9.8 ng/ml, and 2.38 ng/ml, respectively. On the 21st hospital day, he underwent cardiac catheterization. The coronary arteriogram documented severe luminal narrowing in the proximal LAD, first diagonal branch, which originated from the site of just LAD lesion, and first septal perforator branch originating from the first diagonal branch. The left ventriculogram disclosed hypokinesis in the anterolateral, septal, and apical regions with an ejection fraction of 40%.On the 36th hospital day, percutaneous coronary angioplasty (PCI) of the proximal LAD and first diagonal branch was performed. An 8F Judkins-type guide catheter was inserted into the left coronary artery, and an intracoronary injection of isosorbide dinitrate was administered before PCI. After baseline angiography, two 0.014-inch guide wires were advanced through the stenotic lesions in the proximal LAD and the first diagonal branch. First, a 3.5×20-mm balloon catheter was placed within the proximal LAD lesion, and...

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The usefulness of exercise‐induced QRS axis shift as a predictor of coronary artery disease

Oginö

Fukugi

Hirai

et al. 1988

Clinical Cardiology

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Summary:The QRS axis of 101 patients with coronary artery disease (CAD) and 57 nonnal subjects without CAD who underwent coronary arteriograms were measured before and after exercise testing. There was no improvement in the sensitivity of positive axis shifts (15 degnxs or greater) for CAD (1 8 %) when compared to the value of positive ST depression (61%). However, the specificity of positive axis shifts for CAD was significantly increased (98%) when compared to the value of positive ST depression (77 96). In addition, 39 96 of those patients with CAD (39 of 101) showed false negative ST depression, but 18% of these patients (7 of 39) showed a positive axis shift. In nonnal subjects 21 % (12 of 57) showed false positive ST depression, but all of the 21 % (12 of 12) showed negative axis shift. There was no significant difference in the increments of heart rate between positive ST depression, positive axis shift, and negative ST depression, negative axis shift. No statistical differences in the sensitivity of ST depression and an axis shift for one-, two-and threevessel diseases were noted. The specificity of left-axis shift for the left anterior descending attery lesion was 98 % and the specificity of right-axis shift for the right coronary artery and/or left circumflex artery lesion was 91 % . Therefore, the axis shift response is no more sensitive for the detection of CAD than ST depression. However, when a positive axis shift is observed, one can predict two things: the CAD and the localization of the coronary stenosis .

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Transient hemiblock: An abnormal type of response to the Master two-step test

Cited by 18 publications

References 5 publications

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Ischemia in the Territory of the First Major Septal Perforator Branch Anomalously Originating From the First Diagonal Branch Leads to a Transient Leftward Shift of the QRS Axis in the Frontal Plane-A Case Report-

The usefulness of exercise‐induced QRS axis shift as a predictor of coronary artery disease

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