Dilemma in predicting the infarct-related artery in acute inferior myocardial infarction: A case report and review of the literature

The electrocardiogram (ECG) has being used for decades as a reliable and inexpensive tool to diagnose acute myocardial infarction (AMI). ECG diagnosis of an occluded coronary artery is of the utmost importance. We present the case of a 46 year-old man admitted to our hospital for inferior AMI. The ECG findings suggested right coronary artery occlusion. Coronary angiography showed left circumflex artery occlusion. We also briefly review the literature. (Cardiol J 2011; 18, 2: 204-206

Aikuisurheilijan EKG-muutokset

Vertaisarvioitu. Näin tutkin.Urheilijan EKG-muutokset heijastavat sydämen rakenteellista ja sähköistä uudelleen muovautumista. Monet muutokset ovat tavanomaisten tulkintakriteerien mukaan poikkeavia ja viittaavat sydänvikaan. Siksi on tärkeää erottaa urheilijansydämeen liittyvät EKG-muutokset poikkeavuuksista, jotka viittaavat sydänsairauteen, kuten kardiomyopatiaan, sydänlihastulehdukseen tai sydämen sähköisen järjestelmän vikaan. Erotusdiagnostiikan kansainvälisiä kriteerejä muokataan tutkimustulosten perusteella. Niiden mukaan osa EKG-muutoksista, kuten harva sinusrytmin syketiheys ja pidentynyt PQ-aika, ovat selvästi hyväksyttäviä, kun taas toiset, kuten vasen haarakatkos, vaativat jatkoselvittelyjä. Urheilutausta selittää osan muutoksista, esimerkiksi vasemman kammion hypertrofian EKG-muutoksen, joka esiintyy yksin. T-aallon inversiot aiheuttavat eniten tulkintaongelmia. Sivuseinämäkytkentöihin (I, aVL, V5 ja V6) paikallistuvat T-inversiot edellyttävät tarkkoja kuvantamistutkimuksia

Aikuisurheilijan EKG-muutokset

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Comparison of the prognostic role of Q waves and inverted T waves in the presenting ECG of STEMI patients

Background Both Q waves and T-wave inversion (TWI) in the presenting ECG are associated with a progressed stage of myocardial infarction, possibly with less potential for myocardial salvage with reperfusion therapy. Combining the diagnostic information from the Q- and T-wave analyses could improve the prognostic work-up in ST-elevation myocardial infarction (STEMI) patients. Methods We sought to determine the prognostic impact of Q waves and TWI in the admission ECG on patient outcome in STEMI. We formed four groups according to the presence of Q waves and/or TWI (Q+TWI+; Q-TWI+; Q+TWI-; Q-TWI-). We studied 627 all-comers with STEMI derived from two patient cohorts. Results The patients with Q+TWI+ had the highest and those with Q-TWI- the lowest 30-day and one-year mortality. One-year mortality was similar between Q-TWI+ and Q+TWI-. The survival analysis showed higher early mortality in Q+TWI- but the higher late mortality in Q-TWI+ compensated for the difference at 1 year. The highest peak troponin level was found in the patients with Q+TWI-. Conclusion Q waves and TWI predict adverse outcome, especially if both ECG features are present. Q waves and TWI predict similar one-year mortality. Extending the ECG analysis in STEMI patients to include both Q waves and TWI improves risk stratification.Peer reviewe

Outcome of all-comers with STEMI based on the grade of ischemia in the presenting ECG

Background: Grade 3 ischemia (G3I) in the 12 lead electrocardiogram (ECG) predicts poor outcome in patients with ST-elevation myocardial infarction (STEMI). The outcome of G3I in "real-life" patient cohorts is unclear. Methods: The aim of the study was to establish the prognostic significance of grade 2 ischemia (G2I), G3I and the STEMI patients excluded from ischemia grading (No grade of ischemia, NG) in a real-life patient population. We assessed in-hospital, 30-day and 1-year mortality as well as other endpoints. Results: The NG patients had more comorbidities and longer treatment delays than the two other groups. Shortterm and 1-year mortality were highest in patients with NG and lowest in patients with G2I. Maximum troponin level was highest in G3I, followed by NG and G2I. In logistic regression multivariable analysis, NG was independently associated with 1-year mortality. Conclusions: NG predicted poor outcome in STEMI patients. G2I predicted relatively favorable outcome. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Coronary revascularisation in stable patients after an acute coronary syndrome: a propensity analysis of early invasive versus conservative management in a register-based cohort study

OBJECTIVES: To compare the effectiveness of in-hospital medical therapy versus coronary revascularisation added to medical therapy in patients who stabilised after an acute coronary syndrome (ACS). DESIGN: Propensity score-matched cohort study from the database of the Tampere ACS registry. SETTING: A single academic hospital in Finland. PARTICIPANTS: 1149 patients with a recent ACS, but no serious coexisting conditions: recurrent ischaemic episodes despite adequate medical therapy, haemodynamic instability, overt congestive heart failure and serious ventricular arrhythmias. PRIMARY AND SECONDARY OUTCOME MEASURES: The composite endpoint of major acute cardiovascular events (MACEs): unstable angina requiring rehospitalisation, stroke, myocardial infarction and all-cause mortality, at 6-month follow-up. RESULTS: Compared with standard medical treatment, revascularisation was associated with a lower rate of MACEs at 6 months in patients of the first quintile (HR 0.81; 95% CI 0.66 to 0.99), but a higher rate of MACEs in the fifth quintile (HR 4.74, CI 1.36 to 16.49; p=0.014). There were no significant differences in the rates of MACEs in the remaining three quintiles. Patients of the first quintile were the oldest (79.7\ub18.3 years) and had a more significant (p<0.001) history of prior myocardial infarction (37%) and poor renal function (creatine, \ub5mol/l: 114.9\ub170.7). They also showed the highest C reactive protein (7.3\ub19.5 mg/l) levels. CONCLUSIONS: Our findings suggest that in-hospital coronary revascularisation did not lead to any advantage with signal of possible harm in the great majority of patients who stabilised after an ACS. An early invasive management strategy may be best reserved for elderly patients having high-risk clinical features and biochemical evidence of a strong inflammatory activity

Solunsalpaajahoidon aiheuttama sepelvaltimotautikohtaus

Kapesitabiini on mm. paksusuoli- ja rintasyövän hoidossa laajasti käytetty 5-fluorourasiiliksi metaboloituva suun kautta otettava solunsalpaaja. Sen sydämeen kohdistuvien haittavaikutuksien on ajateltu olevan harvinaisia. Kuvaamme neljä potilasta, joille ilmaantui sepelvaltimotautikohtaus kapesitabiinihoidon aikana sepelvaltimospasmin pohjalta. Tämä haittavaikutus kannattaa muistaa kapesitabiinia käyttävän potilaan rintakipuoireiden yhtenä syynä, ja lääkkeen käyttö tulee tätä epäiltäessä lopettaa. English summary: Coronary artery disease attack caused by cytotoxic chemotherapy Capesitabine is a orally administered cytotoxic drug metabolized to 5-fluorouracil and is widely used in large intestine cancer and breast cancer therapy. Its adverse effects against the heart have been considered to be rare. We describe four patients, who were diagnosed with an attack of coronary artery disease during capesitabine therapy on the basis of coronary spasm. This adverse effect should be kept in mind as a cause of chest pain symptoms and the medication discontinued in a suspected case

Acute chest pain in a patient with left bundle branch pacing

We present a patient with left bundle branch (LBB) electronic ventricular pacing with chest pain. ECG showed ventricular pacing and ST elevation in the inferolateral leads. At first it was felt that the Sgarbossa criteria for STEMI in electronic ventricular pacing are not met. However, as symptoms persisted, emergency coronary angiography was performed showing complete occlusion of the left circumflex artery. As LBB pacing results in narrow QRS complexes with incomplete right bundle branch block, ST-segment deviation should not be ignored and the Sgarbossa criteria for patients with LBB block or right ventricular electronic pacing should not be applied.Non peer reviewe