Journal of electrocardiology
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For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). ⋯ Leads placed on a horizontal strip, in line with leads V(1) and V(2), provided the optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and replication of lead placement but also may lead to increased recruitment of patients eligible for revascularization with none or borderline ST-segment elevation on the initial 12-lead ECG.
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Seven cases are reported of acute right coronary artery occlusion and predominantly right ventricular myocardial infarction with typical ST-segment elevation in the precordial leads resembling acute anterior wall myocardial infarction. These electrocardiograms were compared with those of 5 unselected patients who had combined inferior and anterior ST-segment elevation due to a distal occlusion of the left anterior descending artery. In this manuscript, the electrocardiographic features of both conditions are briefly discussed.
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The report is on a 49-year-old patient who experienced life-threatening ventricular tachyarrhythmias caused by a pacemaker lead that was abandoned 26 years ago, migrated with its proximal ending to the main pulmonary artery and remained there asymptomatically for at least 3 years.
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Case Reports
Transient peaked T waves during exercise stress testing: an unusual manifestation of reversible cardiac ischemia.
A 57-year-old man presented with atypical upper body pain, initially attributed to musculoskeletal etiology. After analgesic failure, an exercise myocardial perfusion imaging was performed. During stress testing, patient's pain was reproduced, accompanied by prominent T-wave peaking with minor J-point elevation. ⋯ Subsequent coronary arteriography demonstrated a 99% stenosis of the left anterior descending artery that was stented. Patient has remained asymptomatic since. We conclude that transient peaked T waves with minor J-point elevation during exercise may be an unusual electrocardiographic manifestation of reversible cardiac ischemia.