Electrocardiographic prediction of lateral involvement in acute non-anterior wall myocardial infarction

AbstractPurposeRecent research has established that a tall R-wave in V1 indicates lateral wall involvement in non-anterior wall myocardial infarction (MI). The objective of this study was to assess the value of the admission electrocardiogram (ECG) to predict R-waves and consequently lateral wall damage in the late phase of non-anterior MI.MethodsECGs of 69 patients were analyzed. ST-segment changes in representative leads for lateral wall infarction such as V1, V2, V6 and I were correlated with the extent of QRS-wave changes in V1 and V6.ResultsST-segment elevation in V6 showed correlations with R/S ratio in V1 (r=0.802, B=0.440, P=<0.001) and with the depth of Q-waves in V6 (r=0.671, B=0.441, P=0.007). This correlation was higher in a small subgroup where the left circumflex branch (Cx) was the culprit vessel (r=0.888, B=1.469 and P=0.018). ST-segment depression in lead I correlated with the height of R and the surface of R in V1 (height times width of R) (r=0.542, B=−0.150, P=0.005 and r=0.538, B=−0.153, P=0.005 respectively), especially in the subgroup without proximal occlusions of RCA (r=0.711 and r=0.699). ST-segment depression in lead I also predicted Q-waves in V6 (r=0.538, B=0.114, P=0.006). ST-segment changes in V2 showed no significant correlation with either R- or Q-wave measurements.ConclusionsST-segment elevation in V6 in the acute phase of non-anterior MI predicts lateral involvement as expressed by the R/S ratio in V1 in the post reperfusion phase. A subgroup with Cx occlusion showed especially strong correlations, although the size of the group was small. In lead I ST-segment depression is correlated to height and surface of R in V1 and Q-waves in V6

Out-of-Hospital Cardiac Arrest in the 1990s: A Population-Based Study in the Maastricht Area on Incidence, Characteristics and Survival

AbstractObjectives. We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands.Background. Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based study in the Maastricht area allows information on all victims of witnessed and unwitnessed SCA occurring outside the hospital.Methods. Incidence, patient characteristics and survival rates were determined by prospectively collecting information on all cases of SCA occurring in the age group 20 to 75 years between January 1, 1991 and December 31, 1994. Survival rates were related to the site of the event (at home vs. outside the home) and the presence or absence of a witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA.Results. Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and 53% of women, SCA was most likely the first manifestation of heart disease. In patients known to have had a previous myocardial infarction (MI), the mean interval between the MI and SCA was 6.5 years, with >50% having a left ventricular ejection fraction >30%. The mean yearly incidence of SCA was 1 in 1,000 inhabitants. Of all deaths in the age groups studied, 18.5% were sudden. Nearly 80% of SCAs occurred at home. In 60% of all cases of SCA a witness was present. Cardiac resuscitation, which was attempted in 51% of all subjects, resulted overall in 32 (6%) of 515 patients being discharged alive from the hospital. Survival rates for witnessed SCA were 8% (16 of 208 subjects) at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to 18.8%).Conclusions. The majority of victims of SCA cannot be identified before the event. Sudden cardiac arrest usually occurs at home, and the survival of those with a witnessed SCA at home was low compared with that outside the home, indicating the necessity of optimizing out-of-hospital resuscitation, especially in the at-home situation

A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival

AbstractAimsThe survival rate of sudden out-of-hospital cardiac arrests (OHCAs) increases by early notification of Emergency Medical Systems (EMS) and early application of basic life support (BLS) techniques and defibrillation. A Text Message (TM) alert system for trained volunteers in the community was implemented in the Netherlands to reduce response times. The aim of this study was to assess if this system improves survival after OHCA.Methods and ResultsFrom April 2012 to April 2014 data on all 1546 emergency calls for OHCA in the Dutch province of Limburg were collected according to the Utstein template. On site resuscitation attempts for presumed cardiac arrest were made in 833 cases, of which the TM-alert system was activated in 422 cases. Two cardiopulmonary resuscitation (CPR) scenarios were compared: 1. TM-alert system was activated but no responders attended (n=131), and 2. TM-alert system was activated with attendance of ≥1 responder(s) (n=291). Survival to hospital discharge was 16.0% in scenario 1 and 27.1% in scenario 2 corresponding with OR=1.95 (95% CI 1.15–3.33; P=.014). After adjustment for potential confounders the odds ratio increased (OR=2.82; 95% CI 1.52–5.24; P=.001). Of the 100 survivors, 92% were discharged from the hospital to their home with no or limited neurological sequelae.ConclusionThe TM-alert system is effective in increasing survival to hospital discharge in OHCA victims and the degree of disability or dependence after survival is low