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Zheng X, Wu H, Zhang M, Yao B. Clinical significance of R-wave amplitude in lead V 1 and inferobasal myocardial infarction in patients with inferior wall myocardial infarction. Ann Noninvasive Electrocardiol 2024; 29:e13114. [PMID: 38563240 PMCID: PMC10985631 DOI: 10.1111/anec.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 02/10/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To assess electrocardiogram (ECG) for risk stratification in inferior ST-elevation myocardial infarction (STEMI) patients within 24 h. METHODS Three hundred thirty-four patients were divided into four ECG-based groups: Group A: R V1 <0.3 mV with ST-segment elevation (ST↑) V7-V9, Group B: R V1 <0.3 mV without ST↑ V7-V9, Group C: R V1 ≥0.3 mV with ST↑ V7-V9, and Group D: R V1 ≥0.3 mV without ST↑ V7-V9. RESULTS Group A demonstrated the longest QRS duration, followed by Groups B, C, and D. ECG signs for right ventricle (RV) infarction were more common in Groups A and B (p < .01). ST elevation in V6, indicative of left ventricle (LV) lateral injury, was more higher in Group C than in Group A, while the ∑ST↑ V3R + V4R + V5R, representing RV infarction, showed the opposite trend (p < .05). The estimated LV infarct size from ECG was similar between Groups A and C, yet Group A had higher creatine kinase MB isoform (CK-MB; p < .05). Cardiac troponin I (cTNI) was higher in Groups A and C than in B and D (p < .05 and p = .16, respectively). NT-proBNP decreased across groups (p = .20), with the highest left ventricular ejection fraction (LVEF) observed in Group D (p < .05). Group A notably demonstrated more cardiac dysfunction within 4 h post-onset. CONCLUSIONS For inferior STEMI patients, concurrent R V1 <0.3 mV with ST↑ V7-V9 suggests prolonged ventricular activation and notable myocardial damage. RV infarction's dominance over LV lateral injury might explain these observations.
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Affiliation(s)
- Xiao‐Bin Zheng
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Hai‐Yan Wu
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Ming Zhang
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
| | - Bing‐Qi Yao
- Department of CardiologyShanxi Cardiovascular HospitalTaiyuanChina
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2
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Rahmani R, Gholami Z, Ghanavati K, Ayati A, Shafiee A. Diagnostic value of electrocardiographic indices in discriminating the culprit vessel based on the coronary dominancy in inferior acute myocardial infarction. J Electrocardiol 2024; 83:111-116. [PMID: 38422574 DOI: 10.1016/j.jelectrocard.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Identifying the culprit during inferior myocardial infarction (MI) is still challenging. We determined the diagnostic effect of electrocardiographic (ECG) indices in identifying the culprit vessel of acute MI and the impact of coronary artery dominance on it. METHODS This cross-sectional study included patients with acute inferior MI who presented to Imam Khomeini Hospital and Tehran Heart Center and underwent primary PCI within 12 h of the onset of symptoms. A standard 12‑lead ECG was recorded and interpreted by two cardiologists. Based on the coronary angiography, the patients were divided into two groups of LCX or RCA involvement and were compared for general variables and ECG indices. The diagnostic values of the ECG indices for predicting the culprit vessel were then calculated. RESULTS We evaluated 411 patients with inferior STEMI (321 [77.5%] male, age 58.1 ± 11.1 years). RCA was the culprit vessel in 286 patients (69.1%) and LCX in 128 patients (30.9%). 321 patients (77.5%) were right dominant, 40 (9.7%) patients were left dominant, and 53 patients (12.8%), were codominant. Coronary dominance had minimal impact on the ECG indices regarding culprit identification even after adjustment for confounders. STE in lead III > lead II had the highest sensitivity for detecting RCA as the culprit (sensitivity: 89.2% and specificity: 57.8%). STE ≥0.1 mV in V5 or V6 leads had the highest sensitivity for detecting LCX as the culprit (sensitivity: 51.6, specificity: 93.7%). CONCLUSION In inferior STEMI, ECG indices can predict the culprit vessel with acceptable sensitivity and specificity independent of coronary artery dominance.
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Affiliation(s)
- Reza Rahmani
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Gholami
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimia Ghanavati
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Tretyakov AY, Ermilov OV, Zakharchenko SP, Tretyakova VA, Biryukov GV, Kotova DP. [Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome]. Kardiologiia 2024; 64:60-65. [PMID: 38462805 DOI: 10.18087/cardio.2024.2.n2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 03/12/2024]
Abstract
AIM To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. MATERIAL AND METHODS This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. RESULTS The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. CONCLUSION Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.
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Drissa M, Azaiez F, Jaoued F, Khelifa R, Lagha E, Romdhane RB, Tlili R, Ameur YB. A rare case of concurrent left ventricular aneurysm and ventricular septal rupture complicating an inferior myocardial infarction: a case report. Pan Afr Med J 2023; 45:74. [PMID: 37663629 PMCID: PMC10474810 DOI: 10.11604/pamj.2023.45.74.39612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 09/05/2023] Open
Abstract
Complications following acute myocardial infarction (MI) such as ventricular septal rupture (VSR) and left ventricular (LV) aneurysm are rare and can be dreadful. Their simultaneous presence in the same patient is extremely rare. We aimed to present a rare case of concomitant association of ventricular aneurysm and VSR complicating an inferior myocardial infarction. We report the unusual case of Mr. A. D, a 63-year-old, active smoker, with a history of diabetes mellitus and hypertension, admitted for the management of inferior MI within 6 days. The MI was complicated by an LV aneurysm in the inferoposterior and the inferoseptal walls associated with a VSR in the inferoseptal wall. The patient had only signs of right heart failure on admission. This observation illustrates on the one hand the rarity of the association of VSR and LV aneurysm after an inferior myocardial infarction, and on the other hand the possibility of founding them at an early stage of MI without any signs of cardiogenic shock.
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Affiliation(s)
- Mariem Drissa
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Fares Azaiez
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Fekher Jaoued
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Rouaida Khelifa
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | - Elyes Lagha
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
| | | | - Rami Tlili
- Department of Cardiology, Mongi Slim Hospital, Tunis, Tunisia
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Zhou P, Wu Y, Wang M, Zhao Y, Yu Y, Waresi M, Li H, Jin B, Luo X, Li J. Identifying the culprit artery via 12-lead electrocardiogram in inferior wall ST-segment elevation myocardial infarction: A meta-analysis. Ann Noninvasive Electrocardiol 2023; 28:e13016. [PMID: 36317727 PMCID: PMC9833364 DOI: 10.1111/anec.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized. AIMS The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG. METHODS We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. RESULTS Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods. CONCLUSIONS Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.
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Affiliation(s)
- Peng Zhou
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yingying Wu
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Meng Wang
- Department of Endocrinology and MetabolismHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yikai Zhao
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yangjie Yu
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Maieryemu Waresi
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Huiyang Li
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Bo Jin
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Xinping Luo
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jian Li
- Department of CardiologyHuashan Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
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Chuang YT, Ueng KC, Tsai CF. Grouped Beating After Acute Inferior Myocardial Infarction. Circulation 2021; 144:1518-1520. [PMID: 34723635 DOI: 10.1161/circulationaha.121.056366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yao-Tsung Chuang
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kwo-Chang Ueng
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chin-Feng Tsai
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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7
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Ahmed AS, Rai N, Divani G. Acute Dyspnea After Inferior-Wall Myocardial Infarction. J Invasive Cardiol 2021; 33:E834. [PMID: 34609329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.
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Affiliation(s)
- A Shaheer Ahmed
- Department of Cardiology, 7th floor, Super Speciality Block, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
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Di Filippo C, Caniato F, Cappelli F, Mattesini A, Meucci F, Sori A, Stolcova M, Agostini C, Bernardo P, Di Mario C. Discontinuation of both cangrelor and ticagrelor because of severe dyspnea during primary angioplasty. J Cardiovasc Med (Hagerstown) 2021; 22:317-319. [PMID: 33633048 DOI: 10.2459/jcm.0000000000001042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chiara Di Filippo
- Heart Lung and Vessels Department, Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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9
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Xiong P, Xue Y, Liu M, Du H, Wang H, Liu X. [Detection of inferior myocardial infarction based on densely connected convolutional neural network]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2020; 37:142-149. [PMID: 32096388 DOI: 10.7507/1001-5515.201904028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inferior myocardial infarction is an acute ischemic heart disease with high mortality, which is easy to induce life-threatening complications such as arrhythmia, heart failure and cardiogenic shock. Therefore, it is of great clinical value to carry out accurate and efficient early diagnosis of inferior myocardial infarction. Electrocardiogram is the most sensitive means for early diagnosis of inferior myocardial infarction. This paper proposes a method for detecting inferior myocardial infarction based on densely connected convolutional neural network. The method uses the original electrocardiogram (ECG) signals of serially connected Ⅱ, Ⅲ and aVF leads as the input of the model and extracts the robust features of the ECG signals by using the scale invariance of the convolutional layers. The characteristic transmission of ECG signals is enhanced by the dense connectivity between different layers, so that the network can automatically learn the effective features with strong robustness and high recognition, so as to achieve accurate detection of inferior myocardial infarction. The Physikalisch Technische Bundesanstalt diagnosis public ECG database was used for verification. The accuracy, sensitivity and specificity of the model reached 99.95%, 100% and 99.90%, respectively. The accuracy, sensitivity and specificity of the model are also over 99% even though the noise exists. Based on the results of this study, it is expected that the method can be introduced in the clinical environment to help doctors quickly diagnose inferior myocardial infarction in the future.
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Affiliation(s)
- Peng Xiong
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
| | - Yanping Xue
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
| | - Ming Liu
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
| | - Haiman Du
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
| | - Hongrui Wang
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
| | - Xiuling Liu
- Key Laboratory of Digital Medical Engineering of Hebei Province, College of Electronic and Information Engineering, Hebei University, Baoding, Hebei 071002, P.R.China
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Abstract
RATIONALE Acute Type-A aortic dissection (AD) is a challenging clinical emergency. Despite advances in diagnosis and surgical techniques, the high surgical mortality rate of the condition persists. As a result of similarities in clinical symptoms, AD can mimic acute myocardial infarction (AMI). In this paper, we report 2 cases of patients with acute AD manifesting as inferior AMI. PATIENT CONCERNS Two patients with undetected AD were misdiagnosed with AMI; in such patients, the administration of thrombolytic therapy has disastrous consequences. DIAGNOSES The patients were initially diagnosed with AMI in the emergency room, and then diagnosed with AD during catheterization. INTERVENTIONS The patients were transferred to the cardiac catheterization laboratory for primary coronary angiography. The initial attempt to selectively engage the coronary ostium was unsuccessful. Subsequent computed tomography angiography (CTA) confirmed AD from the aortic root to the abdominal aorta and dissection violations of the coronary ostium. The patients underwent emergency aortic root replacement. OUTCOMES One patient recovered and was discharged 2 weeks later. At a 1-year follow-up examination, CTA indicated that this patient had made a full recovery. The other patient died 6 days after surgery. LESSONS As a result of similarities in clinical symptoms, AD can mimic AMI. Rapid diagnosis and treatment of AD is crucial. Difficulty during catheter engagement should raise the suspicion of acute Type-A AD.
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Affiliation(s)
| | | | - Xin Zhao
- Department of Cardiac Surgery, Qilu Hospital of Shandong University
| | - Beian You
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Chuanbao Li
- Department of Emergency, Chest Pain Center
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Casas G, Soriano-Colomé T, Sambola A, Gil-Sala D, Cuéllar H, García-Dorado D. Acute Myocardial Infarction, Stroke and Bilateral Carotid Vasospasm: A Rare Association. Rev Esp Cardiol (Engl Ed) 2018; 71:980-982. [PMID: 29037613 DOI: 10.1016/j.rec.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Guillem Casas
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Toni Soriano-Colomé
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonia Sambola
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Dani Gil-Sala
- Departamento de Angiología y Cirugía Vascular, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hug Cuéllar
- Departamento de Radiodiagnóstico, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David García-Dorado
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Liang H, Wu L, Li Y, Zeng Y, Hu Z, Li X, Sun X, Zhang Q, Zhou X. Electrocardiogram criteria of limb leads predicting right coronary artery as culprit artery in inferior wall myocardial infarction: A meta-analysis. Medicine (Baltimore) 2018; 97:e10889. [PMID: 29901579 PMCID: PMC6024025 DOI: 10.1097/md.0000000000010889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prior studies have proposed several electrocardiogram (ECG) criteria in limb leads for identifying the culprit coronary artery (CCA) in patients with acute inferior wall myocardial infarction (IWMI). The aim of our study was to conduct an evidence-based evaluation and test accuracy comparison of these criteria. METHODS We searched the PubMed, Embase, and Ovid. Eligible studies to assess the diagnostic performance of ECG criteria predicting CCA in IWMI were reviewed for inclusion. A diagnostic meta-analysis of bivariate approach was performed for pooled estimates of sensitivity and specificity, and meta-regression was implemented to investigate sources of heterogeneity. RESULTS Twenty-four studies with 4431 unique participants met the inclusion criteria. The pooled sensitivity and specificity for ST-segment elevation (STE) in III > II, ST-segment depression (STD) in I, STD in aVL, STD in aVL > I, STE in III > II, and STD in aVL > I were 0.91 (0.88-0.94) and 0.69 (0.53-0.81), 0.80 (0.73-0.87) and 0.69 (0.62-0.76), 0.90 (0.81-0.95) and 0.41 (0.22-0.62), 0.84 (0.75-0.91) and 0.72 (0.48-0.88), and 0.79 (0.62-0.90) and 1.00 (0.37-1.00), respectively. Heterogeneity investigation showed that whether multi-vessel diseased patients were excluded, sample size, publication year, etc., could influence the diagnostic performance. CONCLUSION STE in III > II performed better than other criteria for predicting RCA as CCA in IWMI, and STE in III > II and STD in aVL > I were potential and simple algorithms. ECG could be an effective tool to identify the CCA, but future studies are clearly needed to address the potential of diagnostic and prognostic value.
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Affiliation(s)
- Hao Liang
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Lan Wu
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Yingchen Li
- The Third Xiangya Hospital, Central South University
- The Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine, Hunan Institute of Traditional Chinese Medicine
| | - Yidi Zeng
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Zhixi Hu
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xinchun Li
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xiang Sun
- Cardiology Department, Hospital of Changsha, Changsha, Hunan, China
| | - Qiuyan Zhang
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
| | - Xiaoqing Zhou
- Institute of TCM Diagnostics
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
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Zupančić-Šalek S, Vodanović M, Pulanić D, Skorić B, Matytsina I, Klovaite J. A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion. Medicine (Baltimore) 2017; 96:e9075. [PMID: 29384900 PMCID: PMC6392801 DOI: 10.1097/md.0000000000009075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE The extent of protective effects of hemophilia against thrombotic events such as myocardial infarction (MI) and other acute coronary syndromes remains to be determined, as major risk factors for cardiovascular disease exist despite factor VIII (FVIII) deficiency. We present a case report of a 41-year-old male with severe hemophilia A and several cardiovascular risk factors. PATIENT CONCERNS This morbidly obese patient developed chest pressure, followed by chest pain and difficulty in breathing shortly after receiving on-demand treatment with intravenous recombinant FVIII (rFVIII) (turoctocog alfa) dosed per body weight. DIAGNOSES An electrocardiogram revealed a diagnosis of inferior ST-segment elevation MI. INTERVENTIONS The patient underwent an urgent coronary angiography using a radial artery approach. During the next 12 months, he received dual antiplatelet treatment, acetylsalicylic acid 100 mg, and clopidogrel 75 mg daily. His treatment for severe hemophilia A was changed to plasma-derived FVIII replacement therapy. OUTCOMES During this 12-month period, he experienced several small bleeds in his elbows. CONCLUSIONS The temporal relationship between rFVIII infusion and onset of the MI suggests a possible association; however, apart from obesity, the patient also had other major risk factors for arterial thrombosis, such as hypertension and smoking. Furthermore, atherosclerotic disease and underlying atherosclerotic changes could not be excluded with certainty. This case highlights the importance of studies assessing the impact of excess body weight on rFVIII dosing.
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Affiliation(s)
- Silva Zupančić-Šalek
- Unit for Haemostasis, Thrombosis and Benign Diseases of Haematopoietic System, Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb
- Medical School University of Zagreb, Zagreb
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Osijek
| | - Marijo Vodanović
- Unit for Haemostasis, Thrombosis and Benign Diseases of Haematopoietic System, Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb
| | - Dražen Pulanić
- Unit for Haemostasis, Thrombosis and Benign Diseases of Haematopoietic System, Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb
- Medical School University of Zagreb, Zagreb
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Osijek
| | - Boško Skorić
- Medical School University of Zagreb, Zagreb
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
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14
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Teruzzi G, Calligaris G, Ravagnani P, Trabattoni D, Grancini L, Monizzi G, Lualdi A, Bartorelli AL. [Peripartum spontaneous coronary artery dissection: a case report]. G Ital Cardiol (Rome) 2016; 17:24S-27. [PMID: 27729666 DOI: 10.1714/2372.25478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) accounts approximately for 0.2% of cases of acute coronary syndrome. It is defined "spontaneous" in absence of any coronary wall damage. This disease affects primarily young women in good health, with no risk factors for coronary artery disease, especially during the postpartum period. Since the clinical presentation varies widely from no symptoms to typical angina and sudden cardiac death, SCAD incidence is underestimated.A 40-year-old woman, in the 8th week after delivery, was admitted to our emergency department because of acute chest pain, and a diagnosis of inferior and posterior non-ST-elevation myocardial infarction was made. Emergency coronary angiography showed a small SCAD of the distal segment of a little marginal branch. Because of the small dimension of the dissection, optimal medical therapy was started. However, two days later, symptoms recurred and the ECG showed an anterior ST-elevation myocardial infarction. The patient was therefore transferred to the cath lab and coronary angiography showed extensive dissection of the left anterior descending coronary artery with good angiographic result. Percutaneous coronary intervention was performed and three drug-eluting stents were implanted.No retrospective studies or randomized clinical trials are available to guide the best treatment option in patients with SCAD, because of the wide variety of clinical presentation and the rarity of the pathology. Early and correct diagnosis of SCAD is key for adequate management. First, the site and precise quantification of lesion severity should be assessed with multiple angiographic projections. Intravascular ultrasound and optical coherence tomography can provide additional information about the entry point of the lesion. Hemodynamic status and extension of the myocardium at risk should be also evaluated to determine the best therapeutic strategy. Since the presence of SCAD may be associated with aneurysm formation and dissections of other arteries, screening of the arterial tree may be useful, especially of the supra-aortic trunks and splanchnic circulation.
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Affiliation(s)
- Giovanni Teruzzi
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Giuseppe Calligaris
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Paolo Ravagnani
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Daniela Trabattoni
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Luca Grancini
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Giovanni Monizzi
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Alessandro Lualdi
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
| | - Antonio L Bartorelli
- Dipartimento di Cardiologia, Centro Cardiologico Monzino, IRCCS e Università degli Studi, Milano
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Gómez Menchero AE, Camacho Freire SJ, Díaz Fernández JF, Roa Garrido J, León Jiménez J, Cardenal Piris R. The Absorb Limits. J Invasive Cardiol 2016; 28:E122-E123. [PMID: 27705895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A patient presented with an inferior non-ST segment elevation myocardial infarction and a tight lesion on the distal right coronary artery. After stent implantation, a large scaffold malapposition was observed by optical coherence tomography. This case emphasizes the importance of not expanding a bioresorbable vascular scaffold more than 0.5 mm over its nominal size.
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16
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Anuwatworn A, Milnes C, Kumar V, Raizada A, Nykamp V, Stys A. A Case of Post Myocardial Infarction Papillary Muscle Rupture. S D Med 2016; 69:249-251. [PMID: 27443107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.
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Mishra TK, Das B. ST-Segment Elevated Acute Myocardial Infarction: Changing Profile Over Last 24 Years. J Assoc Physicians India 2016; 64:28-34. [PMID: 27739264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is rising in epidemic proportions with India not being an exception. CAD in Indian scenario has its onset at a younger age with multitude of risk factors. OBJECTIVE This study was carried out to obtain complete information about demographic profile, risk factors, clinical scenario, therapeutic modalities, natural course, outcome and changing profile of acute ST-segment elevated myocardial infarction (STEMI) patients. METHODS This cross-sectional study was conducted in 45,122 acute STEMI patients admitted 1st March 1990 to 1st March 2014. A predefined performa was completed in every patient with detailed clinical history, physical examination, laboratory and investigation parameters, therapeutic interventions and inhospital outcome. RESULTS Our population cohort presented with STEMI at age of 56.34±11.88 years with 82.48% male. Urban residency (64.35%), lower level of education (61.03%), middle and low socioeconomic status (81.01%), unemployment (56.47%), lack of exercise (78.80%) and poor dietary pattern including low intake of fruits and vegetables (58.80%) were pivotal players. Smoking was prevalent in 48.80% cases, with overweight and obesity (51.11%), diabetes mellitus (27.34%), hypertension (38.85%), hyperlipidemia (28.15%), alcoholism (28.80%) and family history (16.66%). Our population had mildly elevated LDL (101.4±33.38 mg/dl), low HDL (36.6±10.7 mg.dl) and high TC/HDL ratio (4.05±1.36). Majority harbored (52.06%) two or more risk factors, while in 16.60% no conventional risk factors were identified. Anterior wall STEMI (56.78%) far exceeded the inferior wall (37.55%). Less than half (47.77%) presented within the window period of 12 hours while only 0.8% of patients availed the golden period of 1 hour. 50.27% presented in Killip Class II or beyond. Angiography revealed single vessel disease (46.76%) with LAD involvement being most common (58.85%). Thrombolytic therapy was provided in 38.95% and primary PCI in 2.1%. Complications in the form of CHF (34.7%), cardiogenic shock (8.65%), reinfarction (6.5%), arrhythmia (59.2%) and mortality (10.57%) were seen. Mortality decreased from 13.9% (from 1990-2000) to 8.8% (2000-2014). CONCLUSIONS With recent increased use of β-blocker, ACEI/ARB, aldosterone antagonist and reperfusion strategy, we have brought down the mortality to lower level.
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Bhagwat N, Sahasrabuddhe S. Two Cases of Pseudo Inferior Myocardial Infarction. J Assoc Physicians India 2016; 64:94-95. [PMID: 27739284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report two cases of pseudo inferior wall myocardial infarction where ST segment elevation in inferior leads was caused by hyperkalemia and atrial tachycardia respectively. Only one case of pseudo inferior Ml caused by hyperkalemia has been reported so far and atrial tachycardia as a cause has hitherto been unreported.
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Pineda AM, Mihos CG, Nascimento FO, Santana O, Lamelas J, Beohar N. Coronary Embolization from a Left Atrial Myxoma Containing Malignant Lymphoma Cells. Tex Heart Inst J 2015; 42:565-8. [PMID: 26664313 DOI: 10.14503/thij-14-4619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic embolization from a primary cardiac tumor is a relatively frequent presentation. However, an acute myocardial infarction due to coronary embolization is rarely seen. We offer an unusual case of a 50-year-old man who presented with severe angina and was diagnosed with an inferolateral ST-segment-elevation myocardial infarction. Aside from otherwise healthy coronary arteries, his coronary angiogram revealed an acute occlusion of the first obtuse marginal branch, which was treated with balloon angioplasty. Because no residual plaque or dissection was found after the angioplasty, an embolic source was suspected. An echocardiogram then revealed a large mobile left atrial myxoma prolapsing into the left ventricle, so the patient underwent minimally invasive resection. Detailed pathologic examination of the myxoma revealed a concomitant high-grade B-cell lymphoma.
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Karabag T, Sayın R, Yavuz N, Aktop Z. Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries. Korean J Intern Med 2015; 30:540-2. [PMID: 26161022 PMCID: PMC4497343 DOI: 10.3904/kjim.2015.30.4.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/18/2014] [Accepted: 11/14/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Turgut Karabag
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Rasit Sayın
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Nesimi Yavuz
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ziyaeddin Aktop
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
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Rovai D, Rossi G, Pederzoli L, Aquaro GD, Di Bella G, Pingitore A. Prominent T wave in V2 with respect to V6 as a sign of lateral myocardial infarction. Int J Cardiol 2015; 189:148-52. [PMID: 25897894 DOI: 10.1016/j.ijcard.2015.04.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/13/2015] [Accepted: 04/07/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the absence of confounding electrocardiographic features, a prominent R wave in leads V1-V2 reflects a lateral myocardial infarction (MI). We hypothesized that repolarization abnormalities in V1-V2 could also reflect a lateral MI. METHODS We retrospectively selected a group of 57 patients with a recent or previous first Q-wave MI involving left ventricular (LV) inferior and/or lateral wall at contrast-enhanced cardiac magnetic resonance (CMR). The location and extent of the MI at CMR were compared with electrocardiographic features. RESULTS The infarction was located in the inferior wall in 12 patients (21%), in the lateral wall in 8 (14%), and in both walls in 37 patients (65%). Infarct size corresponded to 16.8 (SD 9.0%) of LV myocardium. Infarct extent in the inferior and lateral wall (8.3%, SD 7.2% vs. 8.4%, SD 7.5% of LV myocardium) did not differ significantly. Using multiple linear regression analysis, inferior Q-waves and inferior negative T waves were directly associated with infarct extent in the inferior wall (p = 0.014 and p = 0.010, respectively). A prominent R wave in V1 and a prominent anterior T wave (expressed by the T wave amplitude in V2 minus its amplitude in V6) were directly associated with MI extent in the lateral wall (p = 0.008 and p = 0.018), while inferior negative T waves were negatively associated (p = 0.006). CONCLUSIONS In patients with MI of the inferior and/or lateral wall, a prominent T wave in V2 with respect to V6 reflects greater infarct extent in the lateral wall.
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Affiliation(s)
- Daniele Rovai
- CNR, Clinical Physiology Institute, Via Moruzzi 1, 56124 Pisa, Italy.
| | - Giuseppe Rossi
- CNR, Clinical Physiology Institute, Via Moruzzi 1, 56124 Pisa, Italy.
| | - Laura Pederzoli
- Pederzoli Hospital, Via Monte Baldo 24, 37019 Peschiera del Garda, Italy.
| | | | - Gianluca Di Bella
- Department Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Via C. Valeria, 98125 Messina, Italy.
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23
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Kelly ME, Dodd J, Barry M. Triad of emboli in acute flare of ulcerative colitis. Ir Med J 2014; 107:152-153. [PMID: 24908863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Arterial thrombosis is rare in ulcerative colitis (UC). Our case report described a triad of arterial emboli in a UC patient who presented with bilateral lower limb claudication associated acute chest pain, confusion, ataxia and diplopia. Investigations confirmed bilateral femoral and popliteal artery occlusion, occipital infarct and a sub-endocardial infarct secondary to embolic disease.
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24
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Dwivedi SK, Kharwar RB, Mehrotra A, Saran M, Chandra S, Saran RK. Dilated cardiomyopathy with inferior wall myocardial infarction: a rare presentation of Takayasu arteritis. J Am Coll Cardiol 2014; 63:e35. [PMID: 24583310 DOI: 10.1016/j.jacc.2013.10.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/17/2013] [Indexed: 11/20/2022]
Affiliation(s)
| | - Rajiv Bharat Kharwar
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anupam Mehrotra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mahim Saran
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ram Kirti Saran
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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25
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Slatnik M. Country cardiograms case 51. Can J Rural Med 2014; 19:107-115. [PMID: 24991862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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26
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Glancy DL, Ali MJ. Epigastric pain in a 63-year-old woman. Atrial flutter with 2:1 atrioventricular block; acute inferoposterior myocardial infarction. J La State Med Soc 2013; 165:286-287. [PMID: 24350531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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27
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Sclarovsky S. Physiological and pathological remodeling in acute inferior wall myocardial infarction. Isr Med Assoc J 2013; 15:143-146. [PMID: 23781745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In acute myocardial ischemic syndrome the electrocardiogram is capable of providing sophisticated information on coronary artery anatomy (the culprit artery, the level of obstruction, the arterial dimension), along with the hemodynamics, molecular biological characteristics and ionic changes that occur in the involved and uninvolved ischemic musculature. In acute myocardial ischemia, during a sudden obstruction of a distal co-dominant right coronary artery the ECG may be able to discriminate between physiological and pathological remodeling, providing predictive information to differentiate low from high risk cases during acute inferior wall infarction.
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Evstratova SG, Gazarian GA, Zakharov IV, Chepkiĭ DA, Nefedova GA, Golikov AP. [Efficacy of reperfusion therapy in syndrome of predominant right ventricular dysfunction associated with inferior myocardial infarction]. Kardiologiia 2013; 53:4-11. [PMID: 23952945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aim of the study was choice of optimal tactics of treatment of patients with syndrome of predominant right ventricular (RV) dysfunction, associated with inferior myocardial infarction. We compared immediate and remote results of 3 strategies of treatment of 100 patients admitted to N.V. Sklifosovsky Research Institute for Critical Care in 2003-2007: various methods of percutaneous coronary intervention (PCI), including delayed PCI in the acute period (n=48), thrombolytic therapy without subsequent PCI (n=20), conservative therapy without reperfusion therapy (n=32). Indications to delayed interventions were based on high risk of death due to RV infarction. It follows from the data obtained that optimal tactics of treatment of RV infarction is provision of availability of reperfusion therapy in the form of various types of PCI. Preferable are primary PCIs in the absence of which delayed PCIs acquire practical value. Thrombolytic therapy can be used as a component of combined reperfusion. Absence of signs of its efficacy on electrocardiogram during first 90 minutes serves as absolute indication for rescue PCI. Inaccessibility of the latter is a reason for provision of delayed interventions. Electrocardiographic signs of achieved pharmacological reperfusion do not exclude high probability of early recurrences of ischemia, expediency of application of PCI during the time preceding these recurrences. In the absence of PCI hospital and remote mortality have been very high. Optimization of accessibility of mechanical reperfusion including delayed allows to achieve efficacy of treatment of RV infarction, prevent development of complications and lethal outcomes.
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Jim MH, Tsui KL, Yiu KH, Cheung GSH, Siu CW, Ho HH, Chow WH, Li SK. Jeopardised Inferior Myocardium (JIM) score: an arithmetic electrocardiographic score to predict the infarct-related artery in inferior myocardial infarction. Ann Acad Med Singap 2012; 41:300-304. [PMID: 22892607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION A few electrocardiographic criteria have been described to identify the infarct-related artery in inferior myocardial infarction. The aim of this study was to devise an arithmetic score to further improve the diagnostic accuracy. MATERIALS AND METHODS From 2004 to 2006, 78 patients who underwent primary angioplasty for inferior myocardial infarction within 6 hours from symptom onset were recruited for electrocardiographic and angiographic analysis. RESULTS The mean age of patients was 65 ± 12 years with male predominance (74%). Less ST depression in lead I and aVL, and more prominent ST depression in lead V1-3 were observed in left circumflex artery (LCX) than right coronary artery (RCA) occlusions. In addition, more prominent ST depression in lead I and ST elevation in V1 were found in proximal RCA than distal RCA occlusions. Based on the findings, the Jeopardised Inferior Myocardium (JIM) score was constructed and defi ned as [II-V3/III+V1- I]. The sensitivity and specificity of JIM score ≤0.5 to predict proximal RCA occlusions; 0.5 <JIM score ≤1.5 to predict distal RCA occlusions; and JIM score >1.5 to predict LCX occlusions were 58% and 85%, 69% and 68%, and 79% and 94%, respectively. The accuracy of prediction is slightly better than the 2 previously reported criteria. CONCLUSION By taking into account more leads, the JIM score is capable of identifying the infarct-related artery with an improved diagnostic accuracy.
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Affiliation(s)
- Man Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, ROC.
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30
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Pracoń R, Kruk M, Jakubczak B, Demkow M, Bilińska ZT. Superior early diagnostic performance of a sensitive cardiac troponin assay as compared to a standard troponin test in the diagnosis of acute myocardial infarction. Kardiol Pol 2012; 70:131-138. [PMID: 22427076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND New generation cardiac troponin assays have sufficient precision to detect and quantify plasma troponin concentrations below the lower threshold of detection of the currently employed troponin tests. However, diagnostic performance of the newer generation assays in daily clinical practice is not well established. AIM To evaluate the diagnostic performance of a sensitive assay as compared to a standard assay in a single reading at admission in the diagnosis of acute myocardial infarction (AMI) in patients presenting to the Emergency Department with chest pain. METHODS The study comprised 187 consecutive patients admitted to the Institute of Cardiology in Warsaw in June and July 2010 with chest pain in whom the attending physician ordered troponin assay to rule AMI in or out. In all of these patients, in addition to the standard Dimension Flex Troponin I (Siemens Healthcare Diagnostics, Inc.) the sensitive Architect Stat Troponin I (Abbott Diagnostics) test was assayed. The triage of patients as well as all diagnostic and treatment decisions were left to the discretion of the attending physician who was blinded to the sensitive troponin test readings. The final diagnosis was adjudicated by a team of two cardiologists on the basis of all the available medical records except for sensitive troponin test results. RESULTS Mean age of the study cohort (n = 187) was 64.3 ± 13.9 years and 119 (63.6%) were males. The final diagnosis of AMI was adjudicated in 84 (44.9%) patients (mean age 67.5 ± 12.9 years; 119 [63.6%] males). Receiver operating characteristic (ROC) analysis showed greater area under the curve (AUC) for the sensitive cardiac troponin assay compared to the standard assay (AUC = 0.916, 95% CI = 0.866-0.951 vs AUC = 0.863, 95% CI = 0.806-0.909, respectively; p = 0.02) in a single reading at admission. Sensitive assay was characterised by higher sensitivity (87%), specificity (88%), positive (86%) and negative (89%) predictive values in the detection of AMI compared to the standard troponin test (82%, 81%, 78%, and 85% respectively). CONCLUSIONS The newer generation sensitive cardiac troponin assay presented superior diagnostic accuracy in the diagnosis of AMI compared to the standard troponin test in a single reading at admission with improved sensitivity and specificity. The sensitive troponin assay has the potential to improve early detection and/or exclusion of AMI.
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Affiliation(s)
- Radosław Pracoń
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland.
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Hajsadeghi S, Jafarian Kerman SR, Pouraliakbar H, Mohammadi R. A huge coronary artery aneurysm in osteogenesis imperfecta: a case report. Acta Med Iran 2012; 50:785-788. [PMID: 23292633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Osteogenesis imperfecta (OI) as an inherited connective tissue disorder can affect all tissues that contains type I collagen. Well-known cardiac complications of this disease such as aortic root dilatation, aortic regurgitation and mitral valve prolapse have been rarely reported in the literature. Coronary artery aneurysm is a rare cardiac complication in OI, as reported in a 19 year old female presenting with myocardial infarction and hypotension.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Korkmaz H, Gürger M. [An inferior myocardial infarction due to single dose paracetamol use]. Anadolu Kardiyol Derg 2011; 11:562-563. [PMID: 21827994 DOI: 10.5152/akd.2011.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Hasan Korkmaz
- Elazığ Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, Elazığ, Türkiye.
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Girish MP, Gupta MD, Mittal A. Percutaneous retrieval of entrapped partially inflated broken coronary angioplasty balloon by modified Fogarty technique. J Invasive Cardiol 2011; 23:E173-E176. [PMID: 21725135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The optimal approach in managing cases complicated due to retained components in the coronary arteries during angioplasty is still not clear. In most cases, management is individualized. We report the retrieval of a partially inflated balloon with a broken shaft from the coronary system using a simple technique based on Fogarty. This did not involve the use of a snare or any other retrieval tool.
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Affiliation(s)
- M P Girish
- Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, New Delhi, India
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Yarlioglues M, Akpek M, Ardic I, Elcik D, Sahin O, Kaya MG. Mad-honey sexual activity and acute inferior myocardial infarctions in a married couple. Tex Heart Inst J 2011; 38:577-580. [PMID: 22163140 PMCID: PMC3231547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mad-honey poisoning can occur after the eating of honey that contains grayanotoxin. Mad honey is intentionally produced from the nectar of Rhododendron ponticum, which grows in Japan, Nepal, Brazil, parts of North America and Europe, and the eastern Black Sea region of Turkey. Low doses of grayanotoxin can cause dizziness, hypotension, and bradycardia, and high doses can cause impaired consciousness, syncope, atrioventricular block, and asystole due to vagal stimulation. Reports of acute coronary syndrome are very rare. Herein, we present the case of a 50-year-old husband and 42-year-old wife who, to improve sexual performance, intentionally ate honey from the Black Sea area of Turkey for 1 week. Within 3 hours of consuming increased amounts of the honey, they presented at our emergency department with acute inferior myocardial infarctions. Coronary angiography revealed normal coronary arteries in both patients. Supportive treatment with atropine rapidly resolved the clinical symptoms and electrocardiographic irregularities. Grayanotoxin-containing rhododendron pollen was detected in the honey.In patients from geographic regions where mad honey can be obtained, mad-honey poisoning should be considered in the differential diagnosis of chest pain, particularly in the presence of unexplained bradyarrhythmia and hypotension. Sexual performance is a chief reason for the purchase of mad honey and self-treatment with it by persons of our patients' ages.
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Affiliation(s)
- Mikail Yarlioglues
- Department of Cardiology, School of Medicine, Erciyes University, 38039 Kayseri, Turkey.
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Gul EE, Nikus KC, Sonmez O, Kayrak M. Dilemma in predicting the infarct-related artery in acute inferior myocardial infarction: a case report and review of the literature. Cardiol J 2011; 18:204-206. [PMID: 21432832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The electrocardiogram (ECG) has being used for decades as a reliable and inexpensive tool to diagnose acute myocardial infarction (AMI). ECG diagnosis of an occluded coronary artery is of the utmost importance. We present the case of a 46 year-old man admitted to our hospital for inferior AMI. The ECG findings suggested right coronary artery occlusion. Coronary angiography showed left circumflex artery occlusion. We also briefly review the literature.
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Affiliation(s)
- Enes E Gul
- Department of Cardiology, Meram School of Medicine, Selcuk University, Konya, Turkey.
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Doğan I, Sönmez B, Karaman K, Celik S, Türker O. Optimal positioning in the detection of inferior wall infarct size with myocardial perfusion scintigraphy: prone vs. supine. Anadolu Kardiyol Derg 2010; 10:539-543. [PMID: 20952355 DOI: 10.5152/akd.2010.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The prone position is commonly utilized to reduce false positive perfusion defects because this position overcomes the diaphragmatic inferior wall attenuation in single-photon emission computerized tomography (SPECT) studies. We investigated whether the prone position had an important advantage over the supine position in determining the severity and extent of infarct in patients with acute inferior myocardial infarction (MI). METHODS Twenty-nine male patients (mean age 61 ± 10 years) with acute inferior MI were enrolled in the cross-sectional study. After injection of thallium-201 (201Tl) under resting conditions, redistribution SPECT imaging was twicely performed in each subject, in both the supine and prone positions, consecutively. The extent and severity scores of the perfusion defects were calculated from the sum of individual segment scores. Myocardial infarction size was also evaluated using peak cardiac troponin T (cTnT) levels. Wilcoxon rank and Spearman's rank correlation tests were used for statistical analyses of data. RESULTS For the supine vs. prone positions, the median defect severity scores were 8 (4-13) vs. 5 (0.5-8.5) and the defect extent scores were 4 (3-5.5) vs. 3 (0.5-4.5), respectively. Both perfusion defect scores in the prone position were significantly lower than those in the supine position (p=0.001). The mean peak cTnT level during hospitalization was 7.2 ± 3.9 µg/l. Peak cTnT levels were correlated with all SPECT parameters. However, the correlation was greater in the prone position (defect severity: r=0.712, p=0.001) (defect extent: r=0.790, p=0.001) than in the supine position (defect severity: r=0.495, p=0.01) (defect extent: r=0.481, p=0.01). CONCLUSION In patients with inferior MI, the SPECT results revealed a significant difference between the supine and prone images. The perfusion extent and severity scores of SPECT in the inferior wall with prone imaging correlates better with the peak troponin compared to the supine position. Comparative studies that use advanced imaging tools are needed to verify our present findings.
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Affiliation(s)
- Ismail Doğan
- Department of Nuclear Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Andreou AY, Ioannides MA, Georgiou GM, Avraamides PC. Diffuse precordial ST-segment elevation in inferior-right myocardial infarction. Cardiol J 2010; 17:628-631. [PMID: 21154269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A right ventricular (RV) myocardial infarction (MI) may yield precordial ST-segment elevation (STE). Accordingly, combined inferior and precordial STE may be produced during an inferior-RV MI. Such an electrocardiographic picture may be mistakenly regarded as showing wrapped left anterior descending artery (LADA) occlusion or double vessel occlusion. We present a patient with inferior-RV MI and STE in the inferior, all precordial and right chest leads, in whom the diffuse precordial STE was probably mistakenly regarded as showing anterior MI. However, the STE resolution in V1-V2 and late R' wave in V1, which were combined with a recanalized RV branch, favored the RV origin of this STE. Furthermore, the LADA was patent when V3-V6 showed severe ischemia, while its lesion was angiographically stable. Thus its simultaneous occlusion was unlikely. The late R' wave in V1 indicates RV transmural conduction delay;as highlighted herein, it is diagnostic of a RV myocardial infarction.
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De Cicco G, Vizzardi E, Gelsomino S, Lorusso R. Unknown ankylosing spondylitis with only cardiac involvement in patient with surgical indication: Call for patient and family members immunological screening. Int J Cardiol 2009; 137:e61-2. [PMID: 19439376 DOI: 10.1016/j.ijcard.2009.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 04/11/2009] [Indexed: 11/16/2022]
Abstract
Aortic regurgitation (AR) and first-degree atrioventricular heart block (FDAVB) are encountered in ankylosing spondylitis (AS). This rheumatological disease also presents in 90% of the cases an immunogenetic marker that is Human Leucocyte Antigen-B27 (HLA-B27). In this report we describe a case of a patient presenting with AR, FDAVB, aneurysm and thinning of the ascending aortic wall, aneurysm of the sinuses of Valsalva and inferior myocardial infarction-like electrocardiographic pattern with unknown cardiac AS and absence of other AS-related systemic manifestations.
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Jim MH, Chan AO, Tse HF, Lau CP. Predictors of inhospital outcome after acute inferior wall myocardial infarction. Singapore Med J 2009; 50:956-961. [PMID: 19907884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Compared with anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as being low risk. The aim of this study was to elucidate the clinical factors affecting its inhospital outcome. METHODS From January 1997 to March 2006, 546 consecutive patients who suffered from their first inferior wall myocardial infarction were recruited for the study. The demographic, clinical, electrocardiographical and angiographical characteristics, treatment and medications, complications and inhospital deaths were subjected to univariate analysis. The factors that had a p-value of less than 0.1 were included for multivariate logistic regression analysis. A p-value of less than 0.05 was considered significant. The impact of thrombolysis on clinical outcome in various high-risk patient subsets was also examined. RESULTS An advanced age of more than 74 years, female gender, lateral wall extension, complete atrioventricular block, bundle branch block, and cardiac free-wall rupture were found to be independent predictors of inhospital mortality, whereas the use of thrombolysis was associated with a favourable outcome. On the other hand, right ventricular infarction and precordial ST-segment depression are not predictive of poor outcome. In addition, thrombolysis reduced inhospital mortality in patients with an age above 64 years, male gender, lateral wall extension, haemodynamically-significant right ventricular infarction and complete atrioventricular block. CONCLUSION In inferior wall myocardial infarction, independent predictors of poor inhospital outcome are advanced age, female gender, lateral wall extension, complete atrioventricular block, bundle branch block and cardiac free-wall rupture. The use of thrombolysis is generally beneficial, especially in those of the high-risk subsets.
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Affiliation(s)
- M H Jim
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong.
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Naqvi MA, Ali M, Hakeem F, Masood A, Akram Z. Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease. J Ayub Med Coll Abbottabad 2008; 20:82-85. [PMID: 19999212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute interior wall myocardial infarction (MI) cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermole, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery (RCA) in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross sectional study carried out at the department of cardiology and cardiac catheterization at Jiinnah Hospital, Lahore from April 2008 to September 2008. METHODS A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. RESULTS Out of 60 patients, 29 (48.4%) had the culprit lesion in proximal, 23 (38.5%) in mid and 8 (13.4%) in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. CONCLUSION This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion.
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