Improving the ECG classification of inferior and lateral myocardial infarction by inversion of lead aVR.
نویسندگان
چکیده
OBJECTIVE To assess whether the use of inverted lead aVR (-aVR) would improve the classification of acute inferior or lateral myocardial infarction presenting with ST elevation. DESIGN Observational study. The presence of >/= 1 mm ST elevation in lead -aVR (derived by manual assessment of ST depression in conventional lead aVR) was determined by a single investigator, blinded to patient outcome. PATIENTS 173 consecutive patients with chest pain for /= 1 mm in inferior leads (II, III, aVF) or lateral leads (I, aVL, V5, V6), excluding those with anterolateral ST elevation. MAIN OUTCOME MEASURE Incidence of ST elevation in lead -aVR in patients with inferior or lateral ST elevation, or both. RESULTS ST elevation in lead -aVR was present in 25 of 136 patients (18%) with inferior but no lateral ST elevation (indicating greater superior involvement) and in three of 11 patients (27%) with lateral but no inferior ST elevation (indicating greater inferior involvement). ST elevation in lead -aVR bridged the gap between inferior and lateral ST elevation in 15 of 25 (60%) patients with inferior and lateral chest lead (V5/V6) ST elevation, and in all patients with inferior and lateral limb lead (I/aVL) ST elevation. The presence of ST elevation in lead -aVR was associated with a larger infarct size as defined by median peak creatine kinase on serial sampling: 1780 v 987 mmol/l; p = 0.021. CONCLUSIONS Use of lead -aVR improves the ECG classification of acute inferior or lateral acute myocardial infarction and thus may be useful as part of the routine 12 lead ECG assessment of such patients.
منابع مشابه
The relation of ST segment deviations in 12-lead conventional Electrocardiogram, right and posterior leadswith the site of oc-clusion in acute inferior myocardial infarction
Background :In addition to diagnosing the acute myocardial infarction (MI), stratifying high-risk patients and proper treatment strategies are important issues in managing patients complaining of chest pain and suspecting MI. Many studies have been conducted to predict the occlusion site by interpreting the ST segment deviations in Electrocardiogram (ECG).Additional posterior and right precor...
متن کاملClinical manifestations of right ventricle involvement in inferior myocardial infarction
Abstract Background: Early diagnosis of right ventricle (RV) involvement in inferior myocardial infarction (Inf MI) is very critical. This study was performed to evaluate the clinical findings of Inf MI with or without RV infarction. Methods: From September 2010 to September 2012, 195 patients with definite diagnosis of Inf MI were evaluated in the Department of Cardiology, in Babol, north of...
متن کاملECG discrimination between right and left circumflex coronary arterial occlusion in patients with acute inferior myocardial infarction: value of old criteria and use of lead aVR.
STUDY OBJECTIVES Prior studies have proposed several ECG criteria for identifying the culprit artery in patients with acute inferior myocardial infarction (MI). We applied each criterion to our patients to assess its utility. In doing so, we discovered a previously unreported, but highly useful, criterion utilizing lead aVR. STUDY DESIGN Retrospective review. PATIENTS Thirty consecutive pat...
متن کاملLeft arm-left leg lead reversal in a case of inferior wall myocardial infarction mimics as high lateral wall infarction.
A 56-year-old male patient was admitted with an evolved inferior wall myocardial infarction (IWMI). Electrocardiogram (ECG) showed presence of ST elevation and T wave inversion in the inferior leads. ECG taken on the next day surprisingly showed features suggestive of acute high lateral wall myocardial infarction (LWMI), without features suggestive of re-infarction which was finally diagnosed t...
متن کاملECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction
BACKGROUND ECG criteria differentiating Takotsubo cardiomyopathy (TTC) from mainly anterior myocardial infarction (MI) have been suggested; however, this was in small patient populations. METHODS AND RESULTS Twelve-lead admission ECGs of consecutive 200 TTC and 200 MI patients were compared in dichotomized groups based on the presence or absence of ST-elevation MI (STEMI versus STE-TTC and no...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Heart
دوره 83 6 شماره
صفحات -
تاریخ انتشار 2000