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Simple anatomical basis for surface electrocardiographic changes during selective coronary arteriography
Authors:PAPOUCHADO, M.   PITCHER, D. W.   JAMES, M. A.   WALKER, P. R.   WILDE, R. P. H.
Affiliation:*Departments of Cardiology, Bristol Royal Infirmary Bristol, Avon BS2 8HW, England
"{dagger}"County Hospital Hereford
"{ddagger}"Southmead Hospital, Bristol.
"§"Departments of Radiodiagnosis, Bristol Royal Infirmary Bristol, Avon BS2 8HW, England
Abstract:The relationship between surface electrocardiographs changesduring selective coronary arteriography and coronary arteryanatomy was examined in 185 consecutive patients. When bothmajor arteries were patent, two distinct patterns of electrocardiographschanges occurred. Electrocardiogram leads reflecting the areassupplied by the injected vessels showed a change we have termedthe ‘perfusion response’, while electrocardiogramleads reflecting regions not supplied by the injected vesselsimultaneously showed a pattern we have termed the ‘reciprocalresponse’. These changes were reproducible on serial injections,and occurred whether or not coronary artery or valvular heartdisease was present. A third type of electrocardiographic change—termed a ‘biphasic response’ and comprising a reciprocalfollowed by a perfusion response — was observed in leadsreflecting a collateral-dependent region of viable myocardium.This response was seen in the inferior surface leads with leftcoronary artery injection when the right coronary artery wasoccluded, but not in leads I andaVL with right coronary arteryinjection when a branch of the left coronary artery was occluded,where chest leads may be needed for its detection. The biphasicresponse was also seen in the inferior leads with left coronaryartery injection in patients in whom this artery was dominant. Thus, the distribution of electrocardiographic changes duringarteriography is dependent on native coronary artery anatomy,collateral vessels and myocardial viability. Changes relateto the site of coronary lesions only where vessels are occluded,but may be of practical value when the viability of (and thussuitability for bypass grafting to) a myocardial region is indoubt.
Keywords:Coronary arteriography    electrocardiographic changes
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