Journal of electrocardiology
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Classifying the location of an occlusion in the culprit artery during ST-elevation myocardial infarction (STEMI) is important for risk stratification to optimize treatment. We developed a new logistic regression (LR) algorithm for 3-group classification of occlusion location as proximal right coronary artery (RCA), middle-to-distal RCA or left circumflex (LCx) coronary artery with inferior myocardial infarction. We compared the performance of the new LR algorithm with the recently introduced decision tree classifier of Fiol et al (Ann Noninvasive Electrocardiol. 2004;4:383-388) in the classification of the same 3 categories. ⋯ Discrimination of proximal RCA lesion location from LCx or middle-to-distal RCA using the new LR classifier shows improvement over decision tree–type classification criteria. Automated identification of proximal RCA occlusion could speed up the risk stratification of patients with STEMI. The addition of leads V4R and V8 should further improve the automated classification of the occlusion site in RCA and LCx.
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Typical electrocardiographic (ECG) signs of acute Takotsubo syndrome (TTS) consist of ST-segment elevation and/or T wave inversion. We report an unusual case of a 62-year-old woman with TTS who acutely exhibited on 12-lead ECG transient J waves preceding ST-T abnormalities. ⋯ Because of the similar ECG time course observed in TTS and myocardial ischemia, we speculate that common electrophysiologic mechanisms may account for J waves appearance in these 2 clinical conditions. Our case report shows that recording of ECG J waves in postmenopausal women presenting for acute chest pain may be a sign of an ongoing TTS and suggests a similarity to myocardial ischemia as the pathologic basis.
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We studied 620 patients who activated "911" for chest pain symptoms to determine the sensitivity and specificity of 12-lead electrocardiogram (ECG) ST-segment monitoring in the prehospital period (PH ECG) for diagnosing acute coronary syndrome (ACS) and to assess whether the addition of PH ECG signs of ischemia/injury to the initial hospital 12-lead ECG obtained in the emergency department would improve the diagnosis of ACS. ⋯ Prehospital ECG data obtained with 12-lead ST-segment monitoring provides diagnostic information about ACS above and beyond the initial hospital ECG.
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There are few reports of acute myocardial infarction (AMI) relating to the occlusion of the conus branch, most of which are iatrogenic in nature. So far as we are concerned, this is the first case of spontaneous AMI with isolated conus branch occlusion. Electrocardiogram (ECG) showed mild elevation of ST segment in leads V(1) through V(3). ⋯ Right coronary angiography revealed an isolated occlusion of the conus branch. Penetration of the guidewire in the occluded lesion was attempted, and recanalization was successfully achieved. The patient was discharged without any adverse events.
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Four patients with long QT type 2, aged 11 to 18 years from unrelated families, with recurrent syncope and polymorhic ventricular tachycardia were studied. Long QT syndrome was diagnosed in these children at ages 4 to 7 years. Syncope, QT prolongation on electrocardiogram (corrected QT interval ≥ 490 milliseconds), notched T-wave morphology, bradycardia, and polymorphic ventricular arrhythmia were found in all of the patients. ⋯ Adding a sodium-channel blocker (IC class) led to a reduction in the polymorphic ventricular arrhythmia. No syncope episodes were registered during the patients' 8 to 60 months of follow-up on the combined antiarrhythmic therapy. Further studies are needed to better define the possible role of sodium-channel blockers in patients with long QT type 2.