Vectorcardiography in the diagnosis of myocardial infarction

Milnor, William R.

doi:10.1016/s0033-0620(59)80057-8

Cited by 7 publications

(2 citation statements)

References 74 publications

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“…In all three, the sagittal rexversal xvas produiced by a markedly superior positionl of the afferen-t (returninig) limb. Figutre12) illuistrates this point well. Apparently reversal in the sagittal plaine, in these cases, was pf()-dutced 1)v the mid-loop effects of concomitant iniferior infarction.…”

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Vectorcardiographic Residua of Inferior Infarction

1964

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THE vectorcardiographic picture of inferior infarction has become increasingly clear during the past decade. Superior forces of abnormal magnitude and duration that exhibit clockwise rotation in the frontal plane have been described by all authors.1-->t This paper describes the long-term vectorcardiographic findings in 78 instances of welldocumented inferior infarction studied an average of 37 months after the acute episode. A study of this material has cast additional light on a number of vectorcardiographic findings in cases of inferior infarction. These include (1) the significance of reversal of rotation in the sagittal projection, (2) the value of quantitative measurements of the duration, direction, and voltage of the early forces, and (3) the meaning of upward deformities of the mid-loop area. Materials and MethodsThe files of the electrocardiographic department for the years 1953-1961 were screened for appropriate cases. Requirements for inclusion were progressive electrocardiographic changes of acute inferior infarction, including the appearance of Q w,aves in leads III and aVF which met the usual criteria.'-" An additionial requirement was a clinical illness diagnosed as acute myocardial infarction. No case was included unless pre-infarction tracings were available indicating the absence of Q waves in III and aVF.Seventy-eight patients were studied by the Frank electrode system.-1-Vectorcardiograms were displayed oni a Sanborn vector system and photographed with a Polaroid camera. Most of From the Electrocardiographic Department of the Long Island Jevish Hospital, New Hyde Park, New York.the loops were photographed at a standardizationi of 1 mv. _ 5 cm. Time interval between "blips" was 0.0025 second.In each case, measurements were made of the duration (milliseconds) and voltage (millivolts) of the superior and anterior forces. Additional voltages measured were the posterior forces and the leftward displacement of the superior forces. Figure 1 inidicates, in diagrammatic fashioni, the measurements made and the abbreviations used for identification. The rotational characteristics of the loops were also recorded.A standard 12-lead electrocardiogram was obtained on each patient immediately after the vectorcardiogram. These tracings were reviewed with special attention to QRS changes of infarction, left ventricuilar hypertrophy, and conduction defects. Table 1 presents a summary of the dcata ob-tCained and is referred to frequentlv in the text. Results and DiscussionThe rotational characteristics of the frontal plane loops provided a convenient and fruitful approach to classification ( fig. 2). Of the 78 cases, all but two displayed clockwise rotation of the efferent (outgoing) limb in the frontal plane, confirming previous observations.' " These 76 examples could be divided into two subgroups, depending on the remainder of the frontal plane loop. In 52 of the 76, clockwise rotation continued throughout the loop, producing a rather smooth, ovoid appearance.

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“…This resulted in some degree of narrowing in the frontal plane, producing a "'scimitar" appearance. The term "minoor axis compression" was used by MJilnor 12 Simnplified diagrammatic schema of frontal, right sagittal, and horizontal loops. M1easured magnitudes (solid arrows) and durations (dotted lines) are indicated.…”

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confidence: 99%