Conclusion
Anyone involved in decision making in the patient with acute cardiac ischemia should be familiar with the electrocardiographic signs that indicate the severity and size of the area at risk. This includes knowledge and understanding of the importance of the ST segment deviation score; ischemia grading based upon the behaviour of the terminal portion of the QRS and the beginning of ST elevation; and the ECG signs that indicate which coronary artery is occluded and where the occlusion is located.
Such knowledge is essential for optimal decision making in relation to the use and the type of reperfusion therapy.
Keywords
- Right Ventricular
- Left Anterior Descend
- Right Coronary Artery
- Left Anterior Descend Occlusion
- Wall Infarction
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Bar FW, Vermeer F, de Zwaan C, et al. Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1987:59:6–13.
Aldrich HR, Wagner NB, Boswick J, et al. Use of the ST segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts. Am J Cardiol 1988,61:749–753.
Hathaway WR, Peterson ED, Wagner GS, et al. Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. JAMA 1998;279:387–391.
Crimm A, Severance HW Jr, Coffey K. Prognostic significance of isolated sinustachycardia during first three days of acute myocardial infarction. Am J Med 1984;76:983–988.
Zuanetti G, Mantini C, Hernandez-Bernal F, et al. Relevance of heart rate as a prognostic factor in patients with acute myocardial infarction: Insights from the G1551-2 study. Eur Heart J 1998;19(supplement F):19–26.
Sclarovsky S: Electrocardiography of acute myocardial ischaemic syndromes. London: Martin Duntz Ltd, 1999.
Birnbaum Y, Sclarovsky S. The grades of ischemia on the presenting electrocardiogram of patients with ST elevation acute myocardial infarction. J Electrocardiography 2001;34 (suppl): 17–26.
Hurst JW. Methods used to interpret the 12-lead electrocardiogram: Pattern memorization versus the use of vector concepts. Clin. Cardiol. 2000;24:4–13.
Foerster JM, Vera Z, Janzen DA, Foerster SJ, Mason DT. Evaluation of precordial orthogonal vectrorcardiographic lead ST-segment magnitude in the assessment of myocardial ischemia injury. Circulation 1977;55:728–735.
Vermeer F, Simoons ML, Bar FW, et al. Which patients benefit most from early thrombolytic therapy with intra coronary streptokinase? Circulation 1986; 74:1379–1389.
Mauri F, Gasparini M, Barbonaglia L, et al. Prognostic significance of the extent of myocardial injury in acute myocardial infarction treated by streptokinase (the GISSI trial). Am J Cardiol 1989;63:1291–1295.
Berland J, Caribier A, Behar P, Letal B. Anterior ST depression in inferior myocardial infarction: correlation with results of intracoronary thrombolysis. Am Heart J 1986;111:481–488.
Peterson ED, Hathaway WR, Zabel KM, et al. Prognostic significance of precordial ST depression during inferior myocardial infarction in the thrombolytic era: results in 16.251 patients. J Am Coll Cardiol. 1996; 28:305–312.
Birnbaum Y, Sclarovsky S, Blum A, et al. Prognostic significance of the initial electrocardiographic pattern in a first acute anterior wall myocardial infarction. Chest 1993;103:1681–1687.
Birnbaum Y, Kloner R, Sclarovsky S, et al. Distortion of the terminal portion of the QRS on the admission electrocardiogram in acute myocardial infarction and correlation with infarct size and long term prognosis (Thrombolysis in Myocardial Infarction 4 Trial). Am J Cardiol 1996;78:396–403.
Birnbaum Y, Maynard C, Wolfe S, et al. Terminal QRS distortion on admission is better than ST segment measurements in predicting final infarct size and assessing the potential effect of thrombolytic therapy in anterior wall acute myocardial infarction. Am J Cardiol 1999;84:530–539.
Birnbaum Y, Criger DA, Wagner GS, et al. Prediction of the extent and severity of left ventricular dysfunction in anterior acute myocardial infarction by the admission electrocardiogram. Am Heart J 2001;141:915–920.
Birnbaum Y, Herz I, Sclarovsky S, et al. Prognostic significance of the admission electrocardiogram in acute myocardial infarction. J Am Coll Cardiol 1996;27:1128–1133.
Birnbaum Y, Sclarovsky S, Herz I, et al. Admission clinical and electrocardiographic characteristics predicting in-hospital development of high degree atrio ventricular block in inferior wall acute myocardial infaction Am J Cardiol 1997;80:1134–1139.
Ben-Gal T, Sclarovsky S, Herz I, et al. Importance of the conal branch of the right coronary artery in patients with acute anterior wall myocardial infarction: electrocardiographic and angiographic correlation. J Am Coll Cardiol 1997;29:506–511.
Herz I, Assali AR, Adler Y, Solodky A, Sclarovsky S. New electrocardiographic criteria for predicting either the right or left circumflex artery as the culprit coronary artery in inferior wall acute myocardial infarction. Am J Cardiol 1997;80:1343–1345.
Kontos M, Desai PV, Jesse RL, Ornato JP. Usefulness of the admission electrocardiogram for identifying the infarct related artery in inferior wall acute myocardial infarction. Am J Cardiol 1997;79:182–184.
Birnbaum Y, Herz I, Sclarovsky S, et al. Prognostic significance of precordial ST segment depression on admission electrocardiogram in patients with inferior wall myocardial infarction. J Am Coll Cardiol 1996;28:313–318.
Borgia MC, Gori F, Pellicelli A, Curcio D, Lionetti M, Buccarella PA, Lucidi M. Influence of thrombolytic therapy on inferior acute myocardial infarction with concomitant anterior ST segment depression. Angiology 1999;50:619–628.
Birnbaum Y, Wagner GS, Barbash GI et al. Correlation of angiographic findings and right versus left (V1−V3) versus left (V4−V6) precordial ST-segment depression in inferior wall acute myocardial infarction. Am J Cardiol 1999;83:143–148.
Shah A, Wagner GS, Green CL, et al. Electrocardiographic differentation of the ST-segment depression of acute myocardial injury due to left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies. Am J Cardiol 1997;80:512–513.
Casas R, Marriott HJL, Glancy L. Value of leads V7−V9 in diagnosing posterior wall acute myocardial infarction and other causes of tall R waves in V1−V1 Am J Cardiol 1997;80:8–9.
Matetzky S, Freimark D, Chouraqui P, et al. Significance of ST segment elevations in posterior chest leads (V7 to V9) in patients with acute inferior myocardial infarction: application for thrombolytic therapy. J Am Coll Cardiol 1998;31:506–511.
Assali A, Sclarovsky S, Herz I, et al. Comparison of patients with inferior wall acute myocardial infarction with versus without ST-segment elevation in leads V5 and V6. Am J Cardiol 1998;81:81–83.
Braat SH, Brugada P, de Zwaan C, Wellens HJJ. Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Br Heart J 1983;49:368–372.
Widdershoven J, Gorgels A, Vermeer F, et al. Changing characteristics and in-hospital outcome of patients admitted with acute myocardial infarction. Eur Heart J 1997;18:1073–1080.
Berger PB, Ruocco N, Ryan T, Frederick M, Jacobs A, Faxon D. Incidence and prognostic implications of heart block complicating acute inferiotr myocardial infarction treated with thrombolytic therapy: results from TIMI II. J Am Coll Cardiol 1992;20:533–540.
Kimura K, Kosuge M, Ishikawa T, et al. Comparison of the results of early reperfusion in patients with inferior wall acute myocardial infarction with and without complete atrioventricular block. Am J Cardiol 1999;83:731–733.
Klein HO, Trjordman T, Ninio R, et al. The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation 1983;67:558–565.
Simons GR, Sgarbossa E, Wagner G, Califf RM, Topol EJ, Natale A. Atrioventricular and intraventricular conduction disorders in acute myocardial infarction: a reappraisal in the thrombolytic era. PACE 1992;21:2651–2663.
Berger PB, Ryan TJ. Inferior myocardial infarction: high-risk sub-groups. Circulation 1990;81:401–411.
Berger PB, Ruocco NA, Ryan TJ, et al. Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the Thrombolysis in Myocardial Infarction (TIMI) II trial. Am J Cardiol 1993;71:1148–52.
Zehender M, Kapere W, Kauder E, et al. Right ventricular infarction as independent predictor of prognosis after acute myocardial infarction. N Engl J Med 1993;328:981–988.
Zeymer U, Neuhaus KL, Wegscheider K, Tebbe U, Molhoek P, Schroder R, for HIT-4 Trial Group. Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement. J Am Coll Cardiol 1998;32:876–881.
Buono H, Lopez-Palop R, Bermejo J, Lopez-Sendon JL, Delcan JL. In-hospital outcome of elderly patients with acute myocardial infarction and right ventricular involvement. Circulation 1997;96:436–441.
Buono H, Lopez-Palop R, Perez-David E, Garcia-Garcia J, Lopez-Sendon JL, Delcan JL. Combined effect of age and right ventricular involvement on acute inferior myocardial infarction. Circulation 1998;98:1714–1720.
Mehta SR, Eikelboom JW, Natarajan MK, et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 2001;37:37–43.
Braat SH, Gorgels APM, Bar FWHM, Wellens HJJ. Value of the ST-T segment in lead V4R in inferior wall acute myocardial infarction to predict the site of coronary artery occlusion. Am J Cardiol 1998;62:140–142.
Mittal SR. Isolated right ventricular infarction. Int J Cardiol. 1994;46:53–60.
Van der Bolt CLB, Vermeersch PHMJ and Plokker HWM. Isolated acute occlusion of a large right ventricular branch of the right coronary artery following coronary balloon angioplasty. Eur Heart J 1996;17:247–250.
Lie KI, Wellens HJ, Schuilenburg RM, Becker AE, Durrer D. Factors influencing prognosis of bundle branch block complicating acute anteroseptal infarction: the value of His bundle recordings. Circulation 1974;50:935–941.
Lie KI, Wellens HJ, Schuilenburg RM, David GK, Durrer D. Early identification of patients developing late in-hospital fibrillation after discharge from the CCU. Am J Cardiol 1978;41:674–677.
Melgarejo-Moreno A, Galcera-Tomas J, Garcia-Alberola A, et al. Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era. Circulation 1997;96:1139–1146.
Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol. 1999;34:389–395
Birnbaum Y, Solodky A, Herz I et al. Implications of inferior ST-segment depression in acute anterior myocardial infarction: electrocardiographic and angiographic correlation. Am Heart J 1994;127:1467–73.
Tamura A, Kataoka H, Mikuriya Y, Nasu M. Inferior ST-segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior wall myocardial infarction. Eur Heart J 1995;16:1795–9.
Porter A, Sclarovsky S, Ben-Gal T, Herz I, Solodky A, Sagie A. Value of T wave inversion with lead III ST-segment depression in acute anterior myocardial infarction: electrocardiographic prediction of a wrapped left anterior descending coronary artery. Clin Cardiol 1998;21:562–6.
Sapin PM, Musselman DR, Dehmer GJ, Cascio WE. Implications of inferior ST-segment elevation accompanying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and site of occlusion. Am J Cardiol 1992;69:860–865.
Tamura A, Kataoka H, Nagase K, Mikuriya Y, Nasu M. Clinical significance of inferior ST elevation during acute myocardial infarction. Br Heart J 1995;74:611–614.
Kataoka H, Tamura A, Yano S, Kanzaki K, Mikuriya Y. ST elevation in the right chest leads in anterior wall ventricular acute myocardial infarction. J Am Cardiol 1990;66:1146–1147.
Rights and permissions
Copyright information
© 2002 Kluwer Academic Publishers
About this chapter
Cite this chapter
(2002). Determining the size of the area at risk, the severity of ischemia, and identifying the site of occlusion in the culprit coronary artery. In: The ECG in Acute Myocardial Infarction and Unstable Angina. Developments in Cardiovascular Medicine, vol 245. Springer, Boston, MA. https://doi.org/10.1007/0-306-48202-9_2
Download citation
DOI: https://doi.org/10.1007/0-306-48202-9_2
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4020-7214-7
Online ISBN: 978-0-306-48202-1
eBook Packages: Springer Book Archive