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myocardial infarction location


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myocardial infarction location

Home> Journal of Clinical Cardiology> inferior wall acute myocardial infarction coronary artery blockage location of the new standard ECG inferior wall acute myocardial infarction coronary artery blockage location of the new standard ECG download full Add to Favorites
Objective: To evaluate the inferior wall acute myocardial infarction (AIMI) infarct-related vessel the new standard ECG. METHODS: November 1999 ~ August 2001 76 patients admitted to our department AIMI patients, according to ST segment depression in leads V3 and â…¢ leads the ratio of ST-segment elevation (ST V3 / â…¢) divided into 3 groups: V3 / â…¢ 1.2. by coronary angiography (CAG) observed three groups of patients with infarct-related artery is right coronary artery (RCA) proximal, RCA distal or left circumflex artery (LCX). Results: V3 / â…¢ 1.2 infarct related artery is the LCX. Conclusion: ST V3 / â…¢ is a good position to judge the standard AIMI coronary blockage, and it can also help determine the RCA plug is located in the proximal or distal. of Wang Xiaofei (Department of Cardiology, Tianjin First Central Hospital, Tianjin, 300192); between the party (First Central Hospital of Tianjin, Tianjin, 300192); Title Clinical Cardiology 2003 19 05 English Journal Name JOURNAL OF CLINICAL CARDIOLOGY Key words Myocardial Infarction Electrocardiography CLC R542.2 coronary angiography clinical study section name 6 citations similar to the literature references cited literature similar degree in foreign language similar to similar meetings
Acute inferior myocardial infarction myocardial infarction electrocardiogram to determine the location of the role of arteries and occlusion
Chinese Circulation Journal 1999, Volume 14, Issue 1 column Myocardial Infarction
Of: Jilin Chen Yun-lin Wu Yao high Herbalife Yuejin Yang Qin Xuewen Shubin Qiao Jia Yao Min Chen
Unit: Beijing, China Academy of Medical Sciences and Peking Union Medical Institute of Cardiovascular Disease big Fu Wai Hospital, Coronary Heart Disease Research Center, 100037
Key words: myocardial infarction, heart Electrocardiography
Abstract Objective: Acute inferior wall myocardial infarction (AMI) of the electrocardiogram in myocardial infarction-r
elated artery and to determine the location of the role of occlusion. Methods: 90 patients with ECG in patients with inferior wall AMI and coronary angiography were analyzed. Results: â‘  The right coronary artery occlusion occurred in 87.8%, LCX 12.2%, with right ventricular infarction (RVI) accounted for 41.4%. â‘¡ right coronary artery in inferior wall AMI-related artery for myocardial infarction, vascular occlusion occurred in a position right ventricular branch openings beyond (73.8%), combined RVI occlusion occurred when the right ventricular branch in a front opening (64.9 %); under the posterior wall AMI with circumflex artery for myocardial infarction related artery, its occlusion of obtuse marginal branch location were issued before. â‘¢ inferior wall AMI, â… , aVL lead ST segment depression was correspondence, suggesting that the right coronary artery to the sensitivity of myocardial infarction was 97.5%, specificity 93.9%, ST segment was isoelectric line or slightly elevated , suggesting that the sensitivity of circumflex artery occlusion was 54.5%, specificity 75.0%. RVI compared with the traditional diagnosis of ST-segment elevation range â…¢> â…¡ lead, suggesting that RVI 100.0% sensitivity and specificity of 49.3%. Conclusions ECG inferior wall AMI, in judging the location of the infarct-related artery and the occlusion has important predictive value.
Value of Electrocardiogram in Predicting the Myocardial Infarct-related Artery and the Location of Occlusion in Inferior Wall Acute Myocardial Infarction
Chen Jilin, Gao Runlin, Wu Yuan, et al.
Division of Coronary Heart Disease, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Abstract Objective: To investigate the value of the electrocardiogram in predicting the myocardial infarct-related artery (IRA) and the location of occlusion in inferior wall acute myocardial infarction (IAMI). Methods: Ninety patients with IAMI were studied.Results: â‘  IAMI was caused by right coronary artery (RCA) occlusion in 79 (87.8%) cases, by left circumflex artery (LCX) occlusion in 11 (12.2%) cases.Concomitant right ventricular infarction (RVI) was found in 37 (41.4%) patients with IAMI . â‘¡ The location of RCA occlusion often occured at distal to the origin of the first right ventricular branch in patients with IAMI.In patients with concomitant RVI, the location of occlusion often occured at proximal to the origin of the first right ventricular branch.With LCX as infarct vessel, the location of occlusion occured at proximal in obtuse marginal branch in all patients with concomitant inferoposterior and lateral (V5, 6) wall AMI. â‘¢ ST reciprocal depression in â… , aVL identified RCA occlusion with a sensitivity of 97.5%, specificity of 93.9% in patients with IAMI, but isoelectric or elevated ST segment in lead â… , aVL identified LCX occlusion with sensitivity of 54.5%, specificity of 75.0%. ST elevation ratio â…¢ / â…¡> 1 as diagnostic index of RVI have the highest sensitivity ( 100.0%) and lower specificity (49.3%). Conclusion: Electrocardiogram have significant valve in predicting the infarct-related artery and the location of occlusion in inferior wall acute myocardial infarction.
Key words Electrocardiography; Myocardial infarction
Acute myocardial infarction (AMI) early identification of myocardial infarction when the artery and its position on the assessment of the prognosis of occlusion and the need for revascularization therapy as soon as possible to take important clinical significance. However, the most simple ECG to determine whether the accuracy of the above has been made to explore the issue in recent years [1 ~ 4]. In this paper, 90 cases of patients with inferior wall AMI ECG and coronary angiography results were analyzed, designed to improve the electrocardiogram in myocardial infarction-related artery and to determine the location of the accuracy of the occlusion to provide clinical experience.
1 Materials and methods
Case Selection: From January 1990 ~ August 1997 in our hospital and have the results of coronary angiography 90 patients with inferior wall AMI, 76 males and 14 females, aged 33 to 71 years, mean age 56.9 years . All cases are in line with the World Health Organization (WHO) diagnostic criteria for AMI required. 90 cases, 56 cases were under the surveillance of coronary thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) patients, coronary angiography, the average time from onset of AMI <6 hours, another 34 cases of coronary angiography is 3 to 5 weeks after AMI completed.
Clinical data analysis: ECG Ⅱ, Ⅲ, aVF lead ST-segment elevation ≥ 1 mm patient inclusion criteria. Myocardial infarct-related artery and occlusion to determine the location of the principle are: coronary angiography showed complete occlusion of the artery of myocardial infarction related artery, if the myocardial infarct-related artery recanalization, the most narrow part of the occlusion location. In addition, the angiography showed a filling the narrow part, sign, or narrow defect contrast agent retention local characteristics such as myocardial infarction can be used to determine the location of an important artery and occlusion of reference. 1 right coronary artery to right ventricular branch of industry, issued the first one before right ventricular branch Ⅰ, para 1, after the issue of right ventricular branch to the descending branch and left ventricular after the issue before the Ⅱ of collateral. Circumflex obtuse marginal branch with a large issue for the sector.
2 Results
With myocardial infarction and its related artery occlusion position (Schedule)
Schedule with myocardial infarction-related artery and occlusion with the position (cases)
Number of patients with myocardial infarction myocardial infarction location of the right coronary artery circumflex artery occlusion RA Ⅰ RA Ⅱ OM OM issued prior to the issue under the wall 121114 * 7 ** 01 *** 22 inferoposterior 28,244,519 13,762,560 under the inferior wall after the wall with the right ventricle 37370241300 Total 907 911 354 483 Note: *: 2 cases of collateral circulation distal right coronary artery, 1 case of left dominant coronary distribution * *: 1 patient after complete occlusion of LAD * * *: 3 cases of left ventricular collateral complete occlusion. Right ventricular acute myocardial infarction criteria V3R, V4R, and V5R ST-segment elevation ≥ 1 mV, and V4R V5R ST-segment elevation or larger than V3R. RA Ⅰ: right coronary artery segments Ⅰ RA Ⅱ: the right coronary artery Ⅱ of OM: obtuse marginal branch
ECG and myocardial infarction-related artery occlusion and the relationship between the location: in the right coronary artery to myocardial infarction in 79 cases, ECG â… , aVL lead ST segment depression was correspondence were 77 cases (97.5%), no corresponding sex change in 2 cases (2.5%). By the circumflex artery in 11 cases due to total occlusion in patients with inferior wall AMI, 5 patients had â… , aVL lead ST segment depression (4 cases for the next posterior wall AMI, 1 case was simply inferior wall AMI), 6 patients without correspondence changer are inferior, posterior, lateral wall AMI, including 3 cases with â… , aVL lead ST-segment elevation with mild, and its location are in the circumflex artery occlusion of obtuse marginal branch before the issue. 90 patients with ST-segment elevation in ECG amplitude â…¢> â…¡ lead in 75 cases (83.3%), 70 cases of complete occlusion of right coronary artery, 5 cases of circumflex artery occlusion, which are all balanced type of coronary artery distribution . With a right ventricular infarction in 37 patients showed an ST segment elevation â…¢> â…¡ lead. ST-segment elevation ECG amplitude â…¢ = â…¡, 10 cases (11.1%), of which 9 cases of right coronary artery occlusion and 1 case of circumflex artery occlusion. ST-segment elevation â…¢ <â…¡ lead in 5 cases (5.6%), the occlusion occurred in the circumflex artery before the issue of the proximal obtuse marginal branch.
3 Discussion
Rely on inferior wall AMI, myocardial infarction ECG to determine arterial and vascular occlusion is often more difficult position. Our results show that AMI patients with inferior wall myocardial infarction right coronary artery was 87.8%, LCX 12.2%. The posterior wall AMI patients under the circumflex artery for myocardial infarction related artery was significantly increased 46.2%. To ECG â… , aVL lead ST segment corresponds to a change of depression prompted the sensitivity of the right coronary artery occlusion was 97.5%, specificity 93.9%, specificity was significantly higher than Hasdai et al [5] reported that it could be used as right coronary artery for myocardial infarction related to the important electrocardiographic pattern. The â… , aVL lead ST-segment depression or no elevation was mild, suggesting circumflex artery occlusion with sensitivity and specificity were 54.5% and 75.0%, sensitivity was significantly lower than the Hasdai and other results, consider the specificity is higher, so the circumflex artery occlusion could be used as an important reference.
Vascular occlusion in determining the location of the wall under the terms of Our results show that RVI in patients with AMI do not merge when the right coronary artery to myocardial infarction related artery, the occlusion occurred at the 1st position of the right ventricular branch Kaikou beyond (73.8%), who combined their RVI occlusion occurred in position 1 before the issue of right ventricular branch (64.9%), circumflex artery for myocardial infarction related artery, the mere location of inferior wall AMI vascular occlusion beyond the obtuse marginal branch issued; inferoposterior AMI, particularly after the next lateral wall AMI, its blocking position in the obtuse marginal branch more than before the issue of the above results suggest that occlusion of obtuse marginal branch is caused by posterior wall, lateral wall AMI, the main reason.
1989, Andersen et al [6] when the inferior wall ST-segment elevation AMI rate â…¢> â…¡ lead with a right ventricular infarction as an important diagnostic indicators. Our results show that the traditional diagnostic criteria for right ventricular infarction [7, 9] as a reference, according to the index diagnosis of right ventricular infarction, although the sensitivity was 100.0%, but specificity was only 49.3%, significantly lower than other reports of Andersen , suggesting that only under the ST-segment elevation range â…¢> â…¡ lead specific diagnosis of right ventricular infarction is not high. This study also found that 5 patients with ST-segment elevation range â…¡> â…¢ lead, are all non-proximal edge of the circumflex artery occlusion caused by a specificity of 100.0%, sensitivity was 45.4%, the circumflex artery could be used as occlusion of the major electrocardiographic pattern.
About the author: 50-year-old director of Jilin Chen, MD, MA, Ph.D., research director with coronary heart disease tutor
References
1 Bairey CN, Shah PK, Lew AS, et al.Electrocardiographic differentiation of occlusion of the left circumflex versus the right coronary artery as a cause of inferior acute myocardial infarction.Am J Cardiol ,1987,60:456-459.
2 Huey BL, Beller GA, Kaiser FDL, et al.A comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion.J Am Coll Cardiol, 1988,12: 1156-1166.
3 Birnbaum Y, Sclarovsky S, Mager A, et al.ST segment depression in aVL: a sensitive marker for acute inferior myocardial infarction.Eur Heart J ,1993,14:4-7.
4 Kontos MC, Desai PV, Jesse RL, et al.Usefulness of the admission electrocardiogram for identifying the infarct-related artery in inferior wall acute myocardial infarction.Am J Cardiol ,1997,79:182-184.
5 Hasdai D, Birnbaum Y, Herz I, et al.ST segment depression in lateral limb leads in inferior wall acute myocardial infarction.Eur Heart J ,1995,16:15
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6 Andersen HR, Nielsen D, Falk E. Right ventricular infarction: diagnostic value of ST elevation in lead â…¢ exceeding that of lead â…¡ during inferior / posterior infarction and comparison with right-chest leads V3R to V7R.Am Heart J, 1989,117 :82-85.
7 Andersen HR, Falk E, Nielsen D. Right ventricular infarction: diagnostic accuracy of electrocardiographic right chest leads V3R to V7R investigated prospectively in 43 consecutive fatal cases from a coronary care unit.Br Heart J ,1989,61:514-520.
8 Lopez-Senden J, Coma-Canella I, Alcasena S, et al.Electrocardiographic findings in acute right ventricular infarction: sensitivity and specificity of electrocardiographic alterations of right precordial leads V4R, V3R, V1, V2, and V3.J Am Coll Cardiol ,1985,6:1273 -1279.
9 Robalino BD, Whitlow PL, Underwood DA, et al.Electrocardiographic manifestations of right ventricular infarction.Am Heart J ,1989,118:138-144.
(Received :1998-06-08 Revised :1998 -09-03)
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