Assessment of acute myocardial infarction: current status and recommendations from the North American society for cardiovascular imaging and the European society of cardiac radiology

There are a number of imaging tests that are used in the setting of acute myocardial infarction and acute coronary syndrome. Each has their strengths and limitations. Experts from the European Society of Cardiac Radiology and the North American Society for Cardiovascular Imaging together with other prominent imagers reviewed the literature. It is clear that there is a definite role for imaging in these patients. While comparative accuracy, convenience and cost have largely guided test decisions in the past, the introduction of newer tests is being held to a higher standard which compares patient outcomes. Multicenter randomized comparative effectiveness trials with outcome measures are required

Twelve-lead electrocardiogram: The advantages of an orderly frontal lead display including lead -aVR

Background: It is possible that efforts in ECG review by both young experienced clinicians are currently discouraged-and risk to be completely dismissed-by the conventional (ie, disorderly) display of the frontal plane leads, with lead aVR at -150degrees. Methods: We reviewed studies on the usefulness of leads aVR and -aVR as well as on the history of the frontal leads in electrocardiography. Results: Lead aVR and particularly, lead -aVR, provide useful information when systematically analyzed. in addition, if lead -aVR is examined in its anatomically logical sequence, ie, aVL, 1, -aVR, 11, aVF, and 111, the frontal plane of the 12-lead ECG is more easily understood. This "panoramic" or "orderly" display is in common use in countries such as Sweden, but it is rarely seen in the United States. Conclusions: ECG interpretation would be enhanced by displaying the limb leads in an orderly arrangement that starts with lead aVL and ends with lead 111, and many ECG changes would be ideally displayed by a lead -aVR at 30degrees

Detailed definition and interobserver agreement for the electrocardiographic Sclarovsky-Birnbaum ischemia grading system

A generally implementable method for predicting salvageability on the presenting electrocardiogram (ECG) in patients with acute myocardial infarction (AMI) would be of great clinical importance. ECG-derived Grades of Ischemia (1) have been proven useful in predicting the extent and severity of left ventricular dysfunction after anterior MI, estimating short and long-term prognosis, final infarct size, and salvageability by reperfusion therapy (2)