Precordial ST-Segment Mapping

Precordial ST-segment mapping was applied serially in the coronary care unit for the study of 46 patients with myocardial infarction (MI), using a 49-lead system. Data from the maps were compared with clinical status of patients, conventional ECGs obtained simultaneously, and serum enzyme levels. Stability of the maps over a one hour period was noted in the early phase of admission. However, a drop of 32% of the sum of ST-segment elevations (+ 2 ST) was detected in eight patients with uncomplicated anterior MI over the first 24 hours after admission. Extension of infarction was associated with abrupt rise of + 1 ST, and was diagnosed in two cases from maps in the presence of unchanged standard ECGs. The course of ST elevations was followed more accurately by the map than the standard ECG in eight patients. Pericarditis invalidated the technique completely, due to persistent + 1 ST. The standard ECG was superior to the map in following patients with inferior MI. A case of true posterior MI was more accurately delineated by maps of the posterior thorax than by the standard ECG. Intraventricular conduction defects and pacemaking interfered with the maps. Early repolarization produced stable maps; however, mapping showed no advantages over the standard ECG. Preinfarction angina can probably be followed by serial mapping of ST-segment depres-