Right and left ventricular ejection fraction in acute inferior wall infarction with or without ST segment elevation in lead V4R

To detect right ventricular involvement, lead V4R was recorded within 10 hours of the onset of chest pain in 42 consecutive patients admitted with acute inferior wall myocardial infarction. One week after the acute infarction, multigated equilibrium radionuclide ventriculography was performed to assess right and left ventricular ejection fraction. Two weeks after the acute infarction, coronary angiography was performed to determine the site and location of the obstruction leading to the infarction. Seventeen patients had an obstruction in the right coronary artery proximal to the first branch to the right ventricular free wall (group 1); all of these had ST segment elevation in lead V4R. Fourteen patients had an obstruction in the right coronary artery distal to the first branch to the right ventricular free wall (group 2); only two of these patients had ST segment elevation in lead V4R. In 11 patients, the obstruction was located in the circumflex coronary artery (group 3); none of these had ST segment elevation in lead V4R. Nineteen patients had ST segment elevation of 1 mm or greater in lead V4R (group 4). Left ventricular ejection fraction was not different among the four groups of patients, although the right ventricular ejection fraction was significantly lower in group 1 and group 4 patients. It is concluded that ST segment elevation in lead V4R reliably identifies the group of patients with inferior wall myocardial infarction with depressed right ventricular function. This phenomenon persists for at least 1 week after infarction.     

Electrocardiographic differentiation between right coronary and left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction

The presence of atrioventricular block and ST segment elevation in lead V4R accurately predicts right coronary artery occlusion in patients with inferior wall myocardial infarction. However, these electrocardiographic signs are absent in the majority of patients with inferior myocardial infarction. We studied ST segment elevation in leads II and III, ST segment in lead I and T wave polarity in lead V4R in order to differentiate between right coronary artery and left circumflex coronary artery occlusions in 104 patients with inferior myocardial infarction who subsequently underwent coronary angiography. The ST segment elevation was greater in lead III than in lead II when the right coronary artery was the culprit vessel and vice versa when the left circumflex was the culprit vessel (p < 0.001). An upright T wave in lead V4R and ST segment depression in lead I was common when the right coronary artery was the culprit vessel and not seen with left circumflex occlusion (p < 0.001). ST segment elevation in lead III was higher than in lead II with a sensitivity of 99 percent and a specificity of 100 percent for diagnosing right coronary artery as the culprit vessel. ST segment elevation in lead II was higher than in lead III with a sensitivity of 93 percent and a specificity of 100 percent in identifying the left circumflex as the culprit vessel. Thus, these signs are very useful in identifying the culprit vessel in inferior myocardial infarction.     

平板运动试验诱发ST段抬高对冠状动脉病变部位定位诊断的意义

目的探讨平板运动试验诱发ST段抬高对冠心病的诊断价值及对冠状动脉病变部位定位诊断的意义。方法分析8例无心肌梗死而运动诱发ST段抬高的运动心电图及冠状动脉造影检查结果。结果8例患者冠脉造影均显示有程度不等的血管狭窄(50%￣100%);ST段抬高导联与缺血相关血管有良好对应关系。结论无心梗患者运动诱发心电图ST段抬高是冠脉痉挛或冠脉严重狭窄所致心肌局部缺血的标志,且对预测冠状动脉病变部位有一定意义。     

急性下壁心肌梗死患者心电图胸前导联ST段改变的临床意义

目的探讨急性下壁心肌梗死患者心电图胸前导联ST段改变与冠状动脉造影(CAG)所见冠状动脉病变部位的关系及其临床意义。方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为3组,ST段无变化组(47例),ST段抬高组(16例),ST段压低组(124例);所有患者均行CAG。结果急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉(RCA)近段闭塞(14例,82.3%),尤其是伴圆锥支动脉闭塞,与RCA中远端闭塞(2例,5.9%)比较差异有统计学意义(P0.01),且14例(73.7%)伴有右心功能不全和血流动力学障碍。下壁心肌梗死胸前导联ST段压低者可见于RCA、回旋支(LCX)闭塞及RCA、LCX闭塞与前降支(LAD)、对角支(D)病变的不同组合,其中LCX闭塞伴RCA病变者多表现为朐前ST V_4～V_6的压低,RCA闭塞伴LAD近端病变多有胸前ST V_1～V_6的压低,RCA伴D病变胸前ST V_1～V_3压低,与对照组比较差异有统计学意义(P0.05)。结论急性下壁心肌梗死合并胸前导联ST段抬高表明为RCA近段或丌口闭塞且多伴右心室心肌梗死和心功能不全;下壁心肌梗死伴胸前导联ST段压低提示为多支病变,ST V_1～V_3压低多伴有对角支严重狭窄,STV_1～V_6压低多伴有前降支的严重狭窄。     

活动平板运动试验诱发ST段抬高的临床意义

为探讨活动平板运动试验诱发ST段抬高的临床意义 ,分析了 9例无心肌梗死 (简称心梗 )而运动诱发ST段抬高的静息心电图、运动试验及冠状动脉 (简称冠脉 )造影检查结果。结果 :5 0 5 5例行平板运动试验者中 ,有 11例未患心肌梗死而运动诱发心绞痛伴ST段抬高 ,发生率 0 .2 2 %。其中 ,8例患者作了进一步检查 ,冠脉造影显示均有程度不等的血管病变 ,缺血相关血管的狭窄达到 5 0 %～ 10 0 %。ST段抬高导联与缺血相关血管有良好对应关系。另有 1例患者于运动试验 1周后死于心脏性猝死。结论 :无心梗患者运动诱发心电图ST段抬高是冠脉痉挛或冠脉严重狭窄所致心肌局部缺血的标志。     

Value of the bipolar lead CM5 in electrocardiography

Only bipolar lead recording are available during ambulatory monitoring. Their sensitivity in detecting ST segment changes in relation to standard electrocardiographic leads is not known. The magnitude and direction of ST segment changes in the bipolar lead CM5 were compared with those in standard electrocardiographic leads in patients during exercise testing and percutaneous transluminal coronary angioplasty. Thirty patients with coronary artery disease were studied during exercise tests in which ST segment depression (greater than 0.5 mm) occurred in one or more standard electrocardiographic leads and 13 patients were studied during angioplasty that resulted in ST segment change in one or more leads (I, II, III, V2, V5, and CM5). Lead CM5 was the most sensitive lead (93%) during exercise testing and also showed the greatest magnitude of ST segment change below the isoelectric line in 93% of the patients. Only two patients, one with ST segment elevation in inferior leads and one with changes restricted to septal leads, had no ST segment depression in lead CM5. When ST segment shift from the baseline electrocardiogram was measured the magnitude of depression was greatest in lead CM5 in only 63% of the patients. During angioplasty of the left anterior descending coronary artery, lead CM5 showed ST segment depression in seven patients, ST segment elevation in two, and a biphasic response in one. Two of the three patients with balloon inflation in right coronary artery developed ST segment elevation in lead CM5. Thus lead CM5 is a reliable lead for detecting subendocardial ischaemia experienced during everyday activities in anginal patients. During total occlusion of coronary arteries (as in variant angina or myocardial infarction) lead CM5 commonly shows ST segment depression and changes due to right coronary artery occlusion may not be detected.     

Value of the bipolar lead CM5 in electrocardiography.

Only bipolar lead recording are available during ambulatory monitoring. Their sensitivity in detecting ST segment changes in relation to standard electrocardiographic leads is not known. The magnitude and direction of ST segment changes in the bipolar lead CM5 were compared with those in standard electrocardiographic leads in patients during exercise testing and percutaneous transluminal coronary angioplasty. Thirty patients with coronary artery disease were studied during exercise tests in which ST segment depression (greater than 0.5 mm) occurred in one or more standard electrocardiographic leads and 13 patients were studied during angioplasty that resulted in ST segment change in one or more leads (I, II, III, V2, V5, and CM5). Lead CM5 was the most sensitive lead (93%) during exercise testing and also showed the greatest magnitude of ST segment change below the isoelectric line in 93% of the patients. Only two patients, one with ST segment elevation in inferior leads and one with changes restricted to septal leads, had no ST segment depression in lead CM5. When ST segment shift from the baseline electrocardiogram was measured the magnitude of depression was greatest in lead CM5 in only 63% of the patients. During angioplasty of the left anterior descending coronary artery, lead CM5 showed ST segment depression in seven patients, ST segment elevation in two, and a biphasic response in one. Two of the three patients with balloon inflation in right coronary artery developed ST segment elevation in lead CM5. Thus lead CM5 is a reliable lead for detecting subendocardial ischaemia experienced during everyday activities in anginal patients. During total occlusion of coronary arteries (as in variant angina or myocardial infarction) lead CM5 commonly shows ST segment depression and changes due to right coronary artery occlusion may not be detected.     

Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction

In 84 patients with an acute inferior wall myocardial infarction (MI) admitted within 10 hours after the onset of chest pain, a right precordial lead V4R electrocardiogram was recorded in addition to the standard 12-lead electrocardiogram. The presence or absence of ST-segment elevation in lead V4R was correlated with results of coronary angiography performed 2 to 26 weeks (mean 10) after MI. Patients were classified into 3 groups: (1) those with a critical stenosis or occlusion proximal to the first right ventricular (RV) branch (27 patients); (2) those with stenosis distal to the right ventricular branch of the right coronary artery (36 patients); and (3) those with stenosis in the left circumflex coronary artery (21 patients). The presence of ST-segment elevation greater than or equal to 1 mm in lead V4R has a sensitivity of 100% and a specificity of 87% for occlusion of the right coronary artery above the first RV branch; the predictive accuracy is 92%. Seven of 36 patients with a distal occlusion of the right coronary artery showed ST-segment elevation of 1 mm or more in lead V4R . The absence of ST-segment elevation greater than or equal to 1 mm in lead V4R excluded proximal occlusion of the right coronary artery. ST-segment elevation in lead V4R was not seen either in 29 of 36 patients with a distal occlusion of the right coronary artery or in all patients with an occlusion of the left circumflex artery. Recording of lead V4R within 10 hours after onset of acute inferior wall MI can give information rapidly about the vessel responsible for MI.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Value of Exercise Electrocardiography and Exercise Thallium-201 Myocardial Perfusion Scanning in Determining the Presence of Single Vessel Coronary Artery Obstruction

Summary: In 39 patients with single vessel coronary artery disease and no previous myocardial infarction, exercise thallium-207 myocardial perfusion scanning and 12 lead exercise electrocardiography (ECG) were compared to see how reliably each method identified the site of coronary artery obstruction. Significant (≥ 70% diameter) stenosis was present in the left anterior descending (LAD) coronary artery in 21 patients, in the right coronary artery (RCA) in 14 patients and in the left circumflex (LCX) in four patients. Thallium defects on the scan in the septa1 (SEPT), anteroseptal (ANT SEPT) and anterior (ANT) segments correlated (P < 0.0005) with LAD disease and defects in the inferior (INF), posteroinferior (POST INF), and posterior (POST) segments correlated (P < 0.0005) with RCA or LCX disease. Exercise induced ST segment elevation in VI and/or AVL correlated with LAD disease. The site of ischaemic ST depression did not correlate with disease in any vessel. ST segment depression in leads L2, 3, AVF (67%) and in leads V4–6 (67%) was most sensitive for detecting patients with LAD disease and ST depression in leads V4–6 was most sensitive (56%) for detecting patients with RCA or LCX disease but neither differentiated LAD from RCAILCX disease.
During exercise induced ischaemia, the site of ST segment depression on the 12 lead exercise ECG will not identify the area of ischaemia in patients with single vessel disease but thallium defects will. In contrast to ST depression, ST elevation in V1 and/or AVL may identify LAD stenosis.     

Wellens' syndrome and other electrocardiographic changes in a patient with a left anterior descending artery subocclusion associated with a left main coronary artery subocclusion

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Patients with unstable angina have a higher incidence of left main coronary artery (LMCA) and proximal left anterior descending (LAD) coronary artery disease compared to patients with stable angina pectoris. In 1982, Wellens and colleagues described two electrocardiographic patterns that were predictive of critical narrowing of the proximal LAD artery, and were subsequently termed Wellens' syndrome. The criteria were: a) prior history of chest pain, b) little or no cardiac enzyme elevation, c) no pathologic precordial ST segment elevation, d) no loss of precordial R waves, and e) biphasic T waves in leads V2 and V3, or asymmetric, often deeply inverted T waves in leads V2 and V3. The ECG changes are best recognized outside the episode of anginal pain. Lead aVR and lead v1 ST segment elevation, during chest pain, has been reported in patients with LMCA disease with ST segment depression in leads V3, V4 and V5 (with maximal depression in V4).We present a case of changing axis deviation in a 37-year-old Italian man with a LAD coronary artery subocclusion associated with a LMCA subocclusion. This case focuses attention on the importance of the recognition of the patterns suspected for LAD coronary artery disease or for LMCA disease.     

Stress-induced ST segment shift in leads V3R and V4R after acute myocardial infarction.

A total of 107 patients with acute myocardial infarction underwent a dobutamine stress test and received increasing doses of the drug (5, 10, 15, 20, and up to 40 micrograms/kg/min). Coronary angiography was performed within the first month. The 12 conventional ECG leads plus the right chest leads V3R and V4R were recorded under basal conditions and after each dose of dobutamine. In 51 patients (group A) there was an ST shift greater than or equal to 0.5 mm in the right chest leads, with two different patterns: rightward (V2 less than V1 less than V3R V less than V4R) (n = 26) and leftward (V2 less than V1 less than V3R greater than V4R) (n = 25). In 56 patients (group B) no ST shift in the right chest leads was induced. An ST segment elevation greater than or equal to 0.5 mm in V4R was 43% sensitive and 86% specific for the detection of proximal right coronary artery disease. Four subgroups were established in group A: A1R, rightward ST elevation (n = 23); A1L, leftward ST elevation (n = 12); A2R, rightward ST depression (n = 3); and A2L, leftward ST depression (n = 13). Group A1R had predominantly inferior infarcts and right coronary artery stenoses, group A1L had predominantly anterior infarcts and left anterior descending coronary stenoses, and group A2L had posteroinferior infarcts and right or left circumflex stenoses, all of them with low sensitivity (less than 50%) and high specificity (greater than 87%) for a such diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.     

运动诱发ST段抬高的意义

目的观察运动诱发心电图ST段抬高的无心肌梗死（MI）者6例,探讨其冠状动脉（冠脉）病变特点。方法对无MI而运动诱发心电图ST段抬高的患者进行静息心电图、运动试验及冠脉造影检查,运动试验采用Bruce方案。结果在3002例行运动试验检查者中,有6例未患MI而运动诱发心绞痛伴心电图ST段抬高,发生率为0．2％。相应导联ST段抬高0．1～0．6mV,停止运动后心绞痛症状消失,ST段恢复正常。6例中,1例冠状动脉正常;余5例冠脉均有严重狭窄（70％～95％）,ST段抬高导联与缺血相关血管有良好的对应关系,近期内行冠脉介入治疗效果良好,术后症状消失。多次复查运动试验,结果均阴性。结论无MI者运动诱发心电图ST段抬高多提示心肌透壁缺血,冠脉病变重,应采取积极的治疗措施。     

11例急性单纯后壁心肌梗死心电图及梗死相关动脉特点分析

目的 分析急性单纯后壁心肌梗死（不包括同时合并下壁及右室心肌梗死）的心电图及冠状动脉造影特点。方法 总结自2001年至2006年门、急诊收治的急性单纯后壁心肌梗死患者11例,随访心电图特点,并行冠状动脉造影确定梗死相关动脉。结果 11例患者除了V7-V9导联ST段有典型的弓背向上抬高1．0—2．0mm外,9例（81．8％）V1-V2导联R／S≥1,5例（45．5％）V1-V4导联ST段压低1．0—2．0mm,4例（36．4％）Ⅰ、aVL导联ST段抬高0．5-1．5mm,5例（45．5％）V5-V6导联ST段抬高0．5—1．5mm。冠状动脉造影显示梗死相关动脉均为左回旋支（LCX）。梗死部位1例在第一钝缘支（OM1）发出前,为95％管状狭窄;6例（54．5％）在OM1发出后,其中4例为100％闭塞,1例为99％次全闭塞,1例为90％长段狭窄;4例（36．4％）在OM1,其中2例为100％闭塞,1例为99％次全闭塞,1例为95％局限性狭窄。单支病变3例（27．3％）,合并左前降支（LAD）病变4例（36．4％）,合并右冠状动脉（RCA）病变2例（18．2％）,同时合并LAD及RCA病变2例（18．2％）。结论12导联心电图,如有V1-V2导联R／S≥1,V1-V4导联ST段压低等特点时,结合临床与心肌酶学改变,高度怀疑急性后壁心肌梗死,需做后壁导联和冠状动脉造影加以证实,而梗死相关动脉多为左回旋支。     

A case of coronary artery fistula with angina pectoris

A case of coronary artery fistula with myocardial ischemia is reported. A 57-year-old-man was admitted to our hospital complaining of anterior chest pain on exertion. Submaximal Treadmill exercise showed the depression of ST segment in leads II, III, aVF, V5 and V6. 75% stenosis of right coronary artery (segment 2) and congenital coronary artery fistula originating from both the right and left coronary arteries were demonstrated by the coronary arteriography. One abnormal artery was originated from proximal portion of the right coronary artery (segment 1) and entered the pulmonary artery trunk. Another one was originated from proximal portion of the left coronary artery and terminated in angiomatous plexus which then communicated with the pulmonary artery trunk. We speculate that myocardial ischemia resulted from decreased right coronary blood flow due to coronary steal and proximal organic stenosis of right coronary artery. Recently, the reviews of coronary artery fistula are increasing, but coronary artery fistula with myocardial ischemia is relatively rare. This case was followed with medical therapy, because antianginal agents were effective. Operative coronary ligation may be necessary, if he has angina or high output heart failure during follow-up.     

Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction

To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pin-point the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R, and V6R) was routinely recorded on admission and every eight hours thereafter for three consecutive days. Thirty-six to 72 hours after the onset of chest pain a 99mtechnetium pyrophosphate scintigraphy and a dynamic flow study were performed to detect right ventricular involvement, which was found in 29 of the 67 patients (43%). ST segment elevation greater than or equal to 1 mm in leads V3R, V4R, V5R, and V6R is a reliable sign of right ventricular involvement. ST segment elevation greater than or equal to 1 mm in lead V4R was found to have the greatest sensitivity (93%) and predictive accuracy (93%). The diagnostic value of a QS pattern in lead V3R and V4R or ST elevation greater than or equal to 1 mm in lead V1 was much lower. ST segment elevation in the right precordial leads was short lived, having disappeared within 10 hours after the onset of chest pain in half of our patients with right ventricular involvement. When electrocardiograms are recorded in patients with an acute inferior wall infarction within 10 hours after the onset of chest pain, additional right ventricular infarction can easily be diagnosed by recording lead V4R.     

Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction.

To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pin-point the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R, and V6R) was routinely recorded on admission and every eight hours thereafter for three consecutive days. Thirty-six to 72 hours after the onset of chest pain a 99mtechnetium pyrophosphate scintigraphy and a dynamic flow study were performed to detect right ventricular involvement, which was found in 29 of the 67 patients (43%). ST segment elevation greater than or equal to 1 mm in leads V3R, V4R, V5R, and V6R is a reliable sign of right ventricular involvement. ST segment elevation greater than or equal to 1 mm in lead V4R was found to have the greatest sensitivity (93%) and predictive accuracy (93%). The diagnostic value of a QS pattern in lead V3R and V4R or ST elevation greater than or equal to 1 mm in lead V1 was much lower. ST segment elevation in the right precordial leads was short lived, having disappeared within 10 hours after the onset of chest pain in half of our patients with right ventricular involvement. When electrocardiograms are recorded in patients with an acute inferior wall infarction within 10 hours after the onset of chest pain, additional right ventricular infarction can easily be diagnosed by recording lead V4R.     

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

Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups. When patients with a circumflex artery-related infarct were stratified according to the presence or absence of abnormal R waves in lead V1 or V2, the abnormal R wave group had more admission ST elevation (p = 0.025), a larger infarct (p less than 0.05) and more extensive coronary artery disease (p = 0.027). In fact, all patients with a circumflex artery-related infarct and an abnormal R wave in lead V1 had multivessel disease. An abnormal R wave in lead V1 had a 96% specificity for circumflex versus right coronary artery-related infarction but a sensitivity of only 21%. Discriminate function analysis of all admission historical and ECG variables identified inferior and lateral ST elevation as independent predictors of circumflex artery-related infarction...     

严重冠脉病变的心电图分析

目的分析左主干、前降支近端或三支病变冠心病心绞痛患者的心电图改变。方法13例冠脉造影诊断为左主干、前降支近端或三支病变的患者,对其静息时、心绞痛发作时心电图有无aVR、V1导联的ST段抬高及临床资料进行分析。结果胸痛发作时11例出现了aVR、V1导联典型改变,静息时2例aVR、V1导联改变。结论心电图aVR、V1导联ST段抬高,尤其STaVR〉STV1,V4～V6导联ST段下移,合并Ⅱ、Ⅲ、aVF导联或Ⅰ、Ⅱ导联ST段下移与冠脉左主干、前降支近端严重狭窄及三支病变有良好的相关性。     

Recurrence of Prinzmetal angina seven years following aortocoronary bypass surgery: a clinical and angiographic follow-up.

A patient with Prinzmetal angina and ST segment elevation in the anterior ECG leads became asymptomatic after a 50% left anterior descending coronary artery stenosis was bypassed. However, seven years later Prinzmetal angina recurred but with ST segment elevation in the inferior ECG leads. Although the coronary bypass graft had remained patent, the proximal and distal left anterior descending coronary artery was occluded. No significant stenosis was present in the right coronary artery. Perhexiline maleate controlled his symptoms but when the drug was stopped because of side effects an acute inferior myocardial infarction occurred.