Significance Of ST-segment Elevation Research Articles

Significance of ST-Segment Elevation Following Transseptal Catheterization

Objectives: The aim of this study was to evaluate the prevalence and course of ST-segment elevation following transseptal catheterization in patients referred for left-sided accessory pathway ablation. Background: Transient ST-segment elevation during transseptal catheterization has been reported previously. Methods: Patients undergoing transseptal catheterization for left-sided accessory pathwayablation were enrolled in this cohort study. During and following a transseptalpuncture, ST-segments of all 12 leads were constantly monitored. Results: A total of 140 patients were included in the study. Eleven patients (7.8%) experienced ST-segment elevation following transseptal catheterization. Mean time (from a transseptal puncture to ST elevation) was 38 seconds. The mean duration of ST-elevation was 109 seconds. All patients with ST-elevation had an elevation in lead III, 2 patients had ST elevation only inlead III, and one had ST elevation in III and aVF. Anterior lead ST elevation was not detected. Lead III seems to be the most sensitive lead for ST-elevation monitoring. Conclusion: Early and transient ST-segment elevation can occur in the inferior leads following transseptal catheterization. They are almost always self-limiting with conservative managements and typically resolve rapidly; however, close and continuous observation should be made during this situation and the procedure may be detained until ST-segment elevation fades away. Lead III seems to be the most sensitive lead for ST elevation monitoring. ST elevation in anterior leads, persistent ST elevation lasting for more than 3 minutes, and ST elevation at the end of the cardiac ablation procedure warrants immediate evaluation by diagnostic coronary angiography.

Significance of ST Segment Elevation in Lead aVR in Patients with Non-ST Elevation Acute Coronary Syndrome

Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years.
 Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables.
 Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%.
 Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy.
 University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76

Significance of ST-segment elevation in lead aVR

Significance of ST-segment elevation in lead aVR

Loss of biventricular pacing due to T wave oversensing: Case report and review of the literature

themanagement of patients with ST-elevationmyocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update), a report of the American College of Cardiology Foundation/AmericanHeart AssociationTask Force on Practice Guidelines. J Am Coll Cardiol 2009;54:2205–41. [7] From AM, Best PJM, Lennon RJ, Rihal CS, Prasad A. Acutemyocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation. Am J Cardiol 2010;106:1081–5. [8] Rasoul S, Ottervanger JP, Dambrink JHE, et al. External validity of ST elevationmyocardial infarction trials: the Zwolle studies. Catheter Cardiovasc Interv 2007;69:632–6. [9] Terkelsen CJ, Lassen JF, Norgaard BL, et al. Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J 2005;26:18–26.

Clinical Significance of ST Segment Elevation in Posterior Leads V7, V8 and V9 in Patients with Acute Inferior Wall Myocardial Infarction

Objectives: The aim of the study was to assess the role of ST segment elevation in the Posterior leads V7, V8, and V9 for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI. Background: The posterior wall infarction is difficult to diagnose through standard 12 lead ECG alone, especially in the acute setting. Methods: In our retrospective study, 121 patients (101 male, 20 female) with an inferior acute MI, were included. They were divided into two groups according to the presence (Group A: mean age 60.00±10.05 years) or absence (Group B: mean age 57.65 ± 12.86 years) of ST segment elevation in leads V7, V8, V9. Complete demographic data were recorded in all subjects, the infarct size was estimated by CPK MB, left ventricular function was assessed by echocardiographically and infarct related artery patency was evaluated by coronary angiography. Results: Group A patients had a higher frequency of Left cirucumflex occlusion than group B patients (n=33, 27.3% vs. n=4, 3.3%, p=0.0001). Group A had a more extensive infarction, as is shown by CPK MB values (90.12 ± 33.42 vs 45 ± 38.28, P= 0.0001) but with no difference in left ventricular ejection fraction. Conclusion: ST segment elevation in posterior leads helps to diagnose left circumflex artery as a culprit IRA in an acute inferior wall MI with extensive infarct area involving posterolateral walls.

ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome

A 59-year-old-male patient with no previous medical history presented with oppressive chest pain; initial electrocardiogram showed ST segment elevation in aVR and V1, with intermittent right bundle branch block. Emergent coronary angiogram showed a proximal sub-occlusive stenosis of the left anterior descending artery, and the patient was hemodynamically unstable during the first 72 hours. Insights into the significance of ST segment elevation in aVR are presented and discussed in light of the current medical data.

Significance of ST-Segment Elevation in Lead aVR—Diagnosis

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Significance of ST-Segment Elevation in Lead aVR—Quiz Case

A 69-YEAR-OLD MAN WITH A HISTORY OF HYpertension, hyperlipidemia, active tobacco smoking (35 pack-years), and atrial flutter status post successful electrical cardioversion self-presented to the emergency department for 1 month of progressively worsening dyspnea on exertion and 2 days of frequent episodes of exertional and nonpleuritic mid-sternal chest pressure. He did not have a known history of coronary artery disease or diabetes mellitus, although there was a paternal history of fatal myocardial infarction at age 54 years. The patient was asymptomatic at the time of presentation and an electrocardiogram (ECG) was obtained (Figure 1). The ECG was remarkable for 1-mm ST-segment elevation in lead aVR, submillimeter STsegment elevation in lead V1, and ST-segment depressions in leads II, III, aVF, and V4 through V6. Questions: Are the noted ECG findings concerning for a critical coronary artery lesion? What is the most appropriate next step in evaluation and management?

Augmented ST-Segment Elevation during Recovery from Exercise Predicts Cardiac Events in Patients with Brugada Syndrome

Objectives: The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing.Background: During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS).Methods: Treadmill exercise testing was conducted for 93 patients (91 men), 46±14 years of age, with BrS (22 documented ventricular fibrillation, 35 syncope alone, and 36 asymptomatic); and for 102 healthy control subjects (97 men), 46±17 years of age. Patients were routinely followed up. The clinical end point was defined as the occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia.Results: Augmentation of ST-segment elevation ?0.05 mV in V(1) to V(3) leads compared with baseline was observed at early recovery (1 to 4 min at recovery) in 34 BrS patients (37% [group 1]), but was not observed in the remaining 59 BrS patients (63% [group 2]) or in the 102 control subjects. During 76±38 months of follow-up, ventricular fibrillation occurred more frequently in group 1 (15 of 34, 44%) than in group 2 (10 of 59, 17%; p=0.004). Multivariate Cox regression analysis showed that in addition to previous episodes of ventricular fibrillation (p=0.005), augmentation of ST-segment elevation at early recovery was a significant and independent predictor for cardiac events (p=0.007), especially among patients with history of syncope alone (6 of 12 [50%] in group 1 vs. 3 of 23 [13%] in group 2) and among asymptomatic patients (3 of 15 [20%] in group 1 vs. 0 of 21 [0%] in group 2).Conclusions: Augmentation of ST-segment elevation during recovery from exercise testing was specific in patients with BrS, and can be a predictor of poor prognosis, especially for patients with syncope alone and for asymptomatic patients.

Acute Myocardial Infarction Due to Left Circumflex Artery Occlusion and Significance of ST-Segment Elevation

Acute occlusion of the left circumflex (LC) artery can be difficult to diagnose. The aim of the present study was to assess the incidence of LC occlusion in patients with acute myocardial infarction (AMI) requiring percutaneous coronary intervention (PCI), the frequency of ST-segment versus non-ST-segment elevation presentation among them, and to correlate the electrocardiographic findings with the outcomes. The clinical characteristics and outcomes of consecutive patients from November 2001 through December 2007 with AMI within 7 days before PCI of a single acutely occluded culprit vessel were included in the present analysis. Of the 1,500 patients, the culprit lesion was located in the right coronary artery, left anterior descending artery, or LC artery in 44.7%, 35.8%, and 19.5% of patients, respectively. Of the 1,500 patients, 72% presented with ST-segment elevation AMI, but only 43% were patients with a LC lesion (n = 127). PCI was significantly less likely (80%, 83%, and 70% for right coronary, left anterior descending, and LC artery, respectively; p < 0.001) to be performed within 24 hours for LC occlusions than for occlusions in the other territories. Among those with a non-ST-segment elevation AMI, the highest post-PCI troponin levels were in patients with a LC artery occlusion (median 1.4, 1.3, and 2.5 ng/ml; p < 0.001). No significant difference was found in the in-hospital mortality (4.4%, 7.4%, and 6.5%; p = 0.66) or major adverse cardiovascular event (9.2%, 13.9%, and 11.6%; p = 0.53) rates for right, left anterior descending, and LC occlusions, respectively. In conclusion, our results have demonstrated that in clinical practice, the LC artery is the least frequent culprit vessel among patients treated invasively for AMI. Patients with LC occlusion are less likely to present with ST-segment elevation AMI and have emergency PCI. The study results suggest that detection of these patients has been suboptimal, highlighting the need to improve the diagnostic approach toward the detection of an acutely occluded LC artery.

P-310 Clinical Significance of ST Segment Elevation in Lead aVR as Predictor of Left Main Coronary Artery Occlusion in Acute Coronary Syndrome

P-310 Clinical Significance of ST Segment Elevation in Lead aVR as Predictor of Left Main Coronary Artery Occlusion in Acute Coronary Syndrome

Significance of ST-segment elevation and chest pain during exercise stress testing for the assessment of myocardial viability

Significance of ST-segment elevation and chest pain during exercise stress testing for the assessment of myocardial viability

Transient ST elevation after transthoracic cardioversion in patients with hemodynamically unstable ventricular tachyarrhythmia

The significance of ST-segment elevation after resuscitation from arrhythmias not associated with ischemia was examined in a group of patients who received transthoracic shocks for hemodynamically unstable ventricular tachyarrhythmias during electrophysiologic studies. ST-segment elevation was seen in 15.4%, was transient, and was not associated with clinical evidence of myocardial infarction.

Factors predicting mortality in patients after myocardial infarction caused by left main coronary artery occlusion: significance of ST segment elevation in both aVR and aVL leads.

Acute left main coronary artery obstruction is rare and most patients in this clinical setting die of sudden death or cardiogenic shock. During the past 8 years, we encountered 13 patients with acute myocardial infarction caused by total occlusion of the left main coronary artery (LMCA-AMI). Thus, we surveyed these patients, and attempted to elucidate helpful predictors related to the prognosis. Six of 13 patients with LMCA-AMI survived. Successful left coronary artery dilatation was achieved in all survivors (group S), and in 5 (71%) non-survivors (group non-S). The age was not different between the two groups. A past history of angina was confirmed in 83% of group S. while only in 29% of group non-S. Clinical findings such as time of onset of AMI, interval from the AMI onset to admission, elapsed period from the AMI onset to recanalization of LMCA and the value of CK on admission were not different between the two groups. However, cardiogenic shock occurred in only 1 patient (17%) in group S compared with 5 patients (71%) in group non-S. As emphasized in the literature, good collateral circulation to the left anterior descending artery was observed in 5 patients (83%) in group S, while not observed in group non-S. Electro cardiographically, ST elevation in the aVR lead was very characteristic. This finding was confirmed in 69% of the total patients. Noticeably, 5 out of 6 non-survivors (83%) showed ST elevation not only in leads aVR but also in the aVL lead. In addition to the absence of collateral circulation, this electrocardiographic finding, which obviously indicates the presence of extensive myocardial ischemia in the diseased heart, is a simple and important predictor suggesting a poor prognosis in LMCA-AMI patients.

316 Clinical significance of ST segment elevation during dobutamine stress echocardiography in patients with previous myocardial infarction

316 Clinical significance of ST segment elevation during dobutamine stress echocardiography in patients with previous myocardial infarction

316 Clinical significance of ST segment elevation during dobutamine stress echocardiography in patients with previous myocardial infarction

316 Clinical significance of ST segment elevation during dobutamine stress echocardiography in patients with previous myocardial infarction

Clinical Significance of ST-Segment Elevation in the Lateral Precordial Lead in Acute Inferior Myocardial Infarction

Clinical Significance of ST-Segment Elevation in the Lateral Precordial Lead in Acute Inferior Myocardial Infarction

Importance of the Conal Branch of the Right Coronary Artery in Patients With Acute Anterior Wall Myocardial Infarction: Electrocardiographic and Angiographic Correlation

Objectives. This study assessed prospectively the correlation between the conal branch of the right coronary artery and the pattern of ST segment elevation in leads V1and V3R during anterior wall acute myocardial infarction (AMI).Background. The traditional electrocardiographic (ECG) definition of anteroseptal AMI—ST segment elevation in leads V1to V3—has recently been challenged. The significance of ST segment elevation in lead V1during anterior wall AMI is unclear.Methods. The admission 12-lead ECG with additional lead V3R and the coronary angiograms performed within 10 days of hospital admission were evaluated in 28 consecutive patients (mean age ± SD 62 ± 9 years) admitted to the coronary care unit with anterior wall AMI. Patients were classified into two groups according to the magnitude of ST segment elevation in lead V1: group A (elevation ≥1.5 mm, n = 12) and group B (elevation <1.5 mm, n = 16). Two types of conal branch were identified: small (not reaching the interventricular septum [IVS]) and large (reaching the IVS).Results. ST segment elevation in lead V3R was found in 11 (92%) and 6 (37%) patients from group A and group B, respectively (p < 0.001); a small conal branch was seen in 10 (83%) and 3 (19%) patients, respectively (p < 0.001). Ten patients (all from group B) had a large conal branch.Conclusions. ST segment elevation in lead V1in the admission ECG of patients with anterior wall AMI is strongly related to ST segment elevation in lead V3R and is associated with a small conal branch. Our findings suggest that lead V1reflects the right paraseptal area supplied by the septal branches of the left anterior descending coronary artery (LAD), alone or together with the conal branch. The absence of ST segment elevation in lead V1during anterior AMI suggests that the IVS is protected by a large conal branch in addition to the septal branches of the LAD (double circulation).(J Am Coll Cardiol 1997;29:506–11)

Significance of ST-segment elevation during dobutamine-stress echocardiography in patients with acute myocardial infarction treated with thrombolysis.

Stress-induced ST-segment elevation in patients with recent myocardial infarction treated with thrombolysis has not been extensively investigated. According to the results of previous studies it may represent residual myocardial ischaemia or dyskinesia in the infarcted region. The aim of the study was to analyse the significance of dobutamine-induced ST-segment elevation in the infarcted area in a consecutive group of patients (n = 42, 41 men, mean age 53 +/- 7 years) with a first acute myocardial infarction treated with thrombolysis within 6 h from symptoms onset. All patients underwent dobutamine-stress echocardiography (up to 40 micrograms.kg-1.min-1 + atropine) 7 +/- 3 days from the acute event and coronary arteriography within 1 month from the test. Significant ST-segment elevation was defined as a shift > or = 1 mm during dobutamine compared to baseline in at least two contiguous infarct-related leads; a correlation was made between the site of ST-segment elevation and wall motion changes during dobutamine. Dobutamine-induced ST-segment elevation in 23/42 (55%) patients (group 1) while no changes were observed in 19/23 (45%) patients (group 2). Compared to group 2, group 1 patients showed a higher asynergy score index (1.72 +/- 0.24 vs 1.50 +/- 0.32, P < 0.02) and a higher number of asynergic segments (5.04 +/- 1.9 vs 4.11 +/- 1.8), at baseline, a higher incidence of baseline and/or stress-induced dyskinesia (39 vs 10%, P < 0.05) in the infarct-related region and a higher percentage of occluded infarct-related arteries (48 vs 0%, P < 0.001). In the 42 patients studied, a significant correlation was found between baseline ST-segment elevation and baseline asynergy score index (RS = 0.56, P < 0.001) and between ST-segment elevation and asynergy score index at peak stress (RS = 0.55, P < 0.001). The incidence of reversible wall motion abnormalities indicative of myocardial viability and residual myocardial ischaemia was similar in the two groups (87 vs 84% and 74 vs 68%, respectively), while the number of segments with irreversible akinesia indicative of myocardial necrosis was higher in group 1 compared to group 2 (1.5 +/- 1.4 vs 0.9 +/- 1.4). Among the 23 patients of group 1 with dobutamine-induced ST-segment elevation, six had no reversible wall motion abnormalities indicative of myocardial ischaemia; of the 17 patients with myocardial ischaemia, 11 had > or = 50% and six had < or = 50% of basally asynergic segments showing reversible wall motion abnormalities. In patients with recent thrombolyzed myocardial infarction dobutamine-induced ST-segment elevation is associated with a larger akinetic area in basal conditions and either with reversible wall motion abnormalities indicative of myocardial ischaemia or with irreversible or minimally reversible wall motion abnormalities in the infarct area during the test. Thus, dobutamine echocardiography provides useful information for the interpretation of stress-induced ST-segment elevation and clinical management of these patients.

Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms.

Twenty-three patients with aneurysmal subarachnoid haemorrhage (SAH), who showed an ST segment elevation in their electrocardiograms (ECG), were examined. There were 12 males and 11 females, with a mean age of 61 years. The clinical condition on admission was Hunt and Kosnik grade II in four, III in seven, IV in one, and V in 11 patients. Computerized tomography (CT) also revealed many cases of diffuse, thick SAH or intracerebral or intraventricular haematoma. Laboratory examinations including serum electrolyte, pH, and PaO2 revealed no abnormalities that might have influenced the ECG. Elevation in the levels of myocardial enzymes in serum was observed in two of the nine patients examined, although the elevation was only slight in one of them. Echocardiography, which was performed on several occasions on all patients, and cardiac catheterization, which was performed on eight patients, revealed a reduction in the motion of the left ventricular apex that was synchronous with ST segment elevation. This is the first report about these phenomena. No abnormalities were observed in the coronary artery. The elevated ST segment was normalized within one week in all patients, accompanied by normalization of the apical wall motion recorded on echocardiograms. In four patients, however, T wave inversion accompanied the improvement of the ST segment and was normalized within three months after the onset. These results suggest that ST segment elevation in the acute stage of SAH reflects transient cardiac dysfunction rather than myocardial injury. In some patients, however, the elevated serum levels of myocardial enzymes or T wave inversion suggested the presence of myocardial injury. Close follow-up seems to be necessary in such cases.