Segment Depression In Leads Research Articles

The prediction of right atrial pressure using electrocardiogram: a novel approach.

AimsPulmonary hypertension (PH) is a serious disorder that can complicate pulmonary and cardiovascular diseases. Right atrial (RA) pressure is a robust predictor of the pulmonary hypertension severity, which is measured via right heart catheterization. Limited studies have been carried out to assess the association between electrocardiogram data and the RA pressure as a prognostic factor of PH. In this study, the relation between P wave and PR segment changes with RA pressure was evaluated.Methods and resultsIn this study, 94 patients in PH groups of 1, 3, and 4, based on the World Health Organization classification, were entered. RA pressure was measured using the right heart catheterization. PR segment and P wave morphology in leads II and V1 were evaluated in patient's electrocardiogram. The median age of the patients was 35.5 years old in which 64.9% of them were female. The distribution of patients in groups 1, 3, and 4 PH were 77.7%, 5.3%, and 17%, respectively. Among the studied P wave and PR segment changes, PR segment depression in lead II and pulmonary P wave in lead V1 had significant relation with the RA pressure (P‐value <0.001). The sensitivity, specificity, and negative predictive values of PR segment depression for detection of patients with high RA pressure (RA pressure > 14 mmHg) were 80%, 84%, and 94%. The specificity and negative predictive values of pulmonary P wave in lead V1 were determined 89% and 88%.ConclusionsIt was found that the PR segment depression in lead II and pulmonary P wave in lead V1 associate with the RA pressure in patients with precapillary PH. PR segment depression had useful sensitivity, specificity, and negative predictive values, and the pulmonary P wave in lead V1 had acceptable specificity and negative predictive values for detection of patients with high RA pressure. Therefore, the electrocardiogram can be used as a screening tool for determination of pulmonary hypertension severity.

Acute Occulusion of Diagonal Branch:Triad of Severe Pain,Small Infarct &amp; Specific Ekg Pattern

A 59 years female, known case of Non-Insulin Dependent Diabetes Mellitus (NIDDM) for 10 years with a strong family history of coronary artery disease (both parents &amp; siblings have CAD), presente with severe agonizing precordial chest discomfort, radiating to left shoulder associated with profuse sweating for last 3 hours.In emergency room,patient was restless,pulse=100/min.,BP=170/100mm Hg,O2 saturation 98%.There was no sign of cardiac failure.ECG recorded in emergency room revealed ST elevation of 5to 6 mm in lead I,aVL, 4 mm ST elevation in lead II, V2 and shuttle ST segment sagging in lead II, 4 mm ST segment depression in lead III &amp; Avf (South African Flag Sign) (Fig 1).

Value of electrocardiogram (ECG) in identifying acute occlusion sites of right coronary artery

Clinical data of 151 patients with acute occlusion of right coronary artery were retrospectively analyzed. Coronary angiography and electrocardiography (EEG) were performed in all 151 patients, angiography showed proximal-middle segment occlusion in 114 cases and distant segment occlusion in 37 cases. The correlation of ECG findings with coronary artery occlusion sites was analyzed. Results showed that EEG findings related to proximal-middle segment occlusion were: ST segment elevation in lead V4R ≥0.05 mV, Ⅲ degree atrioventricular block, ST segment depression in lead Ⅰ>0.1 mV, ST segment depression in lead AVL≥0.2 mV, ST segment elevation in lead Ⅲ≥0.25 mV, the total ST depression in lead V2,V3 and V4 ≥0.4 mV , the total ST depression in lead I and aVL ≥0.25 mV; among which ST depression of Lead Ⅰ>0.1 mV, ST elevation of Lead V4R≥0.05 mV and Ⅲ degree atrioventricular block were used to predict occlusion of proximal-middle segment of right coronary artery with 100% specificity. ECG findings related to distal segment occlusion were: ST depression in lead Ⅰ≤0.1 mV, ST segment depression in lead AVL<0.2 mV, ST elevation in lead Ⅲ≤0.25 mV, the total ST depression in lead V2,V3 and V4 <0.4 mV, ST segment were not depression in lead V1-V5,the total ST depression in lead I and aVL<0.25 mV. Based on a 4-step flow method, ECG might be adopted to identify the acute occlusion sites in proximal-middle segment and distal segment of right coronary. Key words: Coronary occlusion; Inferior wall myocardial infarction; Electrocardiography

Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer

A 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m2 per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21st course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4–6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications.

Inverted Takotsubo contractile pattern caused by pheochromocytoma with tall upright T-waves, but not typical deep T-wave inversion

We describe a 36-year-old woman with inverted Takotsubo cardiomyopathy caused by pheochromocytoma crisis. In the acute phase, her electrocardiogram showed ST segment depression in lead II, III, aVF and V2 through V5. On day 14, tall upright T-waves were observed in leads V2 through V5 despite heart failure and basal to midventricular ballooning improved on day 4, and all electrocardiographic abnormalities finally normalized after surgical removal of the pheochromocytomas. This is the first report of electrocardiographic course of inverted Takotsubo cardiomyopathy, and these findings seem as if the inverted electrocardiographic findings are contrary to those of apical ballooning.

Relationship between ST segment of lateral leads and culprit arteries in acute inferior myocardial infarction

Background and Objectives:Our purpose was to assess the characteristics of ST segment deviation in the lateral leads (aVL, I, V5, V6) of patients with acute inferior myocardial infarction (AIMI) and elucidate any relationship with the culprit arteries. Materials and Method:The subjects were comprised 51 patients diagnosed as AIMI by standard electrocardiogram, cardiac enzymes and typical chest pain. The subjects were divided into two groups by angiographically proven culprit arteries:a left circumflex artery (LCx) group and a right coronary artery (RCA) group. We compared the frequencies of a ST segment depression more than 1 mm and less than 1 mm in aVL and I, and a ST segment elevation more than 0.5 mm and less than 0.5 mm in V5 and V6 in each culprit artery group. Results:Among the 51 patients with AIMI, 42 were in the RCA group and 9 were in the LCx group. The frequency of a ST segment depression more than 1 mm in aVL was 44% in the LCx group and 71% in the RCA group (p=0.140). 11% of the LCx group and 43% of the RCA group showed more than 1 mm ST segment depression in lead I (p=0.128). 56% of the LCx group showed more than 0.5 mm ST segment elevation in V5 and V6 and 81% of the RCA group showed less than 0.5 mm ST segment elevation in V5 and V6 (p=0.036). Conclusion:Culprit arteries in patients with AIMI and ST segment deviation in V5 and V6 are significantly related. ST segment elevation more than 0.5 mm in V5 and V6 was predominantly found in the LCx group, rather than the RCA group. Observation for ST segment deviation in the lateral precordial lead V5 and V6 would be important in predicting the culprit artery in AIMI. (Korean Circulation J 2001;31(10):982-987)