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Abstract Background In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established. Methods We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses. Results We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients. Conclusions Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.

Background: In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established. Methods: We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses. Results: We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients. Conclusions: Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation. [ABSTRACT FROM AUTHOR]

We report a case of ST segment elevation in left precordial leads with a convex shape caused by a rare etiology. By carefully analyzing the electrocardiogram (leads I, II, V3 to V9) of a patient with convex ST segment elevation in the left-sided chest leads, relevant etiological clues were derived. The findings were further supported by cardiac ultrasound and cardiac magnetic resonance imaging, ruling out other common causes. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) was postulated as the underlying cause, and potential mechanisms were discussed. The diagnosis was further confirmed through a follow-up period of over three years. [ABSTRACT FROM AUTHOR]

The STEMI-DTU pilot study tested the early safety and practical feasibility of left ventricular (LV) unloading with a trans-valvular pump before reperfusion. In the intent-to-treat cohort, no difference was observed for microvascular obstruction (MVO) or infarct size (IS) normalized to either the area at risk (AAR) at 3–5 days or total LV mass (TLVM) at 3–5 days We now report a per protocol analysis of the STEMI-DTU pilot study. In STEMI-DTU STUDY 50 adult patients (25 in each arm) with anterior STEMI [sum of precordial ST-segment elevation (ΣSTE) ≥4 mm] requiring primary percutaneous coronary intervention (PCI) were enrolled. Only patients who met all inclusion and exclusion criteria were included in this analysis. Cardiac magnetic resonance (CMR) imaging 3–5 days after PCI quantified IS/AAR and IS/TLVM and MVO. Group differences were assessed using Student's t -tests and linear regression (SAS Version-9.4). Of the 50 patients enrolled, 2 died before CMR imaging. Of the remaining 48 patients those without CMR at 3–5 days (n = 8), without PCI of a culprit left anterior descending artery lesion (n = 2), with OHCA (n = 1) and with ΣSTE < 4 mm (n = 5) were removed from this analysis leaving 32/50 (64 %) patients meeting all inclusion and exclusion criteria (U-IR, n = 15; U-DR, n = 17) as per protocol. Despite longer symptom-to-balloon times in the U-DR arm (228 ± 80 vs 174 ± 59 min, p < 0.01), IS/AAR was significantly lower with 30 min of delay to reperfusion in the presence of active LV unloading (47 ± 16 % vs 60 ± 15 %, p = 0.02) and remained lower irrespective of the magnitude of precordial ΣSTE. MVO was not significantly different between groups (1.5 ± 2.8 % vs 3.5 ± 4.8 %, p = 0.15). Among patients who received LV unloading within 180 min of symptom onset, IS/AAR was significantly lower in the U-DR group. In this per-protocol analysis of the STEMI-DTU pilot study we observed that LV unloading for 30 min before reperfusion significantly reduced IS/AAR compared to LV unloading and immediate reperfusion, whereas in the ITT cohort no difference was observed between groups. This observation supports the design of the STEMI-DTU pivotal trial and suggests that strict adherence to the study protocol can significantly influence the outcome. • LV unloading plus delayed reperfusion may reduce infarct size. • LV unloading plus delayed reperfusion may reduce microvascular obstruction. • This per protocol analysis supports the design of the ongoing STEMI-DTU pivotal trial. [ABSTRACT FROM AUTHOR]

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Background & Objectives: In order to diagnose and treat acute myocardial infarction, the electrocardiogram continues to be a vital tool. A thorough examination of STsegment elevation patterns may have an impact on the perfusion therapy's decision-making process. This study was done to connect coronary angiography and 2D ECHO results with ECG results in individuals with acute ST elevation myocardial infarction to determine the culprit vessel. Materials & Methods: The participants in this prospective study were 50 patients at the SNMC and HSK Hospital in Bagalkot. Patients with ST segment elevation on the ECG were assessed to determine the responsible vascular and afterwards correlated with a 2D ECHO coronary angiography. Results: In this study, 50 patients, 36 of whom had anterior wall and 14 of whom had inferior wall myocardial infarction. The most specific criteria in proximal RCA occlusion were ST elevation > 1mm in V4R, and ST depression V3 / ST elevation LIII Lead II was also the most sensitive . While in the patients with distal RCA occlusion, ratio of ST depression V3/ST elevation LIII >1.2 was sensitive. The maximum sensitivity for localising occlusion in proximal D1occlusion was also found in inferior leads ST depression > 1mm. The most sensitive criterion for blockage distal to S1 and in distal D1 in AWMI is the absence of ST depression in inferior leads. Conclusion: In patients with ST elevation AMI, the admission ECG is useful not only for deciding on early reperfusion therapy but also for providing crucial information to direct therapeutic decision-making. [ABSTRACT FROM AUTHOR]

ST‐elevation myocardial infarction (STEMI) is a life‐threatening clinical condition that requires immediate intervention, mostly caused by complete occlusion of epicardial vessels. Other diseases such as myocarditis, pericarditis, electrolyte disturbance, and early repolarization may mimic. We present a rare case of atrial lead‐related atrial perforation which mimics inferior STEMI. [ABSTRACT FROM AUTHOR]

Complement factor I deficiency (CFID; OMIM #610984) is a rare immunodeficiency caused by deficiencies in the serine protease complement factor I (CFI). CFID is characterized by predisposition to severe pneumococcal infection, often in infancy. We report a previously healthy adolescent male who presented with respiratory failure secondary to pneumococcal pneumonia and severe systemic inflammatory response. Rapid genome sequencing (rGS) identified compound heterozygous variants in CFI in the proband, with a novel maternally inherited likely pathogenic variant, a single nucleotide deletion resulting in premature stop (c.1646del; p.Asn549ThrfsTer25) and a paternally inherited novel likely pathogenic deletion (Chr 4:110685580-110692197del). [ABSTRACT FROM AUTHOR]

Biventricular metastatic heart tumors from gynecological malignancies presented as an acute coronary syndrome with ST segment elevation are an unusual finding. We present a case of stage-4 vulvar carcinoma that metastasized in both the left and right ventricle. The particularity of the case is the echocardiographic aspect in the emergency room: multiple, large, hyperechogenic masses disseminated in the myocardium, with pericardial extension, in context of acute coronary syndrome with ST segment elevation. [ABSTRACT FROM AUTHOR]

Abstract The patient is a 73‐year‐old female with peripheral vascular disease, coronary artery disease, and systemic lupus erythematosus, who underwent mesenteric artery bypass surgery. She suffered from a pneumonia after surgery, causing acute hypoxic respiratory failure and septic shock. Due to shock, she developed acute renal failure. She was intubated, ventilated, and received continuous veno‐venous hemodialysis for renal failure. ST elevation was first observed on telemetry and subsequently confirmed on electrocardiogram. Marked ST elevation is present in the anterior leads with reciprocal ST depression in the inferior leads. A prolonged QT interval is also present. What is the most likely diagnosis?

Systemic immune-inflammation index (SII), on the basis of lymphocyte, neutrophil and platelet counts had been published to be a good prognostic factor in coronary artery disease. Nevertheless, the prognostic value of Systemic immune-inflammation index (SII) in a condition of no-reflow phenomenon (NRP) remains inconsistent, we evaluated the SII as a simple calculated tool for predicting the NRP among patients with STEMI who underwent primary percutaneus coronary intervention (PCI). 510 consecutive acute STEMI patients who underwent primary PCI within 12 h from symptom onset from October 2015 to January 2020 were enrolled in our study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. Multivariate stepwise logistic regression, including covariates found to have a significant association with NRP in univariate analysis, was used to identify independent predictors of no-reflow. A ROC curve analysis showed that the best cut-off value of SII for predicting no-reflow was 1028, with sensitivity and specificity of 79% and 70, respectively (AUC, 0.839; 95% CI 0.797–0.881). An ROC curve comparison analysis was performed to compare the SII with NLR and PLR. Multivariate analysis revealed that SII ≥1028 value (OR = 6.622, 95% confidence interval (CI): 3.802–11.627, p <.001), not using aspirin prior to admission (OR = 0.431, 95%CI: 0.236–0.786, p =.006), and CRP (OR = 1.004, 95%CI: 1.001–1.008, p =.041) were independent predictors related to occurrence of NRP after primary PCI in patients with acute STEMI. SII levels are independently associated with the NRP in patients undergoing primary PCI for acute STEMI. High SII may be a promising indicator for the prediction of NRP in these patients. [ABSTRACT FROM AUTHOR]

Electrocardiography (ECG) is an auxiliary test applied for differential diagnosis of Pulmonary Thromboembolism (PTE). However, its specificity is low, but it is more often used for differential diagnosis. Although there are some changes on ECG in PTE, ST elevation is not a finding that we expect to see. With this case report, we aimed to draw attention to the issue with the diagnosis of PTE in a patient with ST elevation in ECG. 52- year-old male patient presented to the emergency department with a complaint of convulsion after chest and back pain. During the examination in the emergency department, he had a convulsion and woke up on his own without entering a postictal phase. After that, he had a chest pain. For this reason, ECG was performed to the patient and revealed ST elevation in leads DI, AVL, V1-4. The results of the patient's EEG and head computer tomography (CT) were normal, so coronary CT angiography was performed. And it was observed that the coronary arteries were patent but embolism was detected in his cross-sectional pulmonary arteries. Thus, he was treated with the diagnosis of PTE. By the obtained results in this case that ST elevation may be a finding of PE, although it is rare. [ABSTRACT FROM AUTHOR]

The patient is a 73‐year‐old female with peripheral vascular disease, coronary artery disease, and systemic lupus erythematosus, who underwent mesenteric artery bypass surgery. She suffered from a pneumonia after surgery, causing acute hypoxic respiratory failure and septic shock. Due to shock, she developed acute renal failure. She was intubated, ventilated, and received continuous veno‐venous hemodialysis for renal failure. ST elevation was first observed on telemetry and subsequently confirmed on electrocardiogram. Marked ST elevation is present in the anterior leads with reciprocal ST depression in the inferior leads. A prolonged QT interval is also present. What is the most likely diagnosis? [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors of post-operative fragmented QRS complex (fQRS) in patients with acute ST segment elevation myocardial infarction (STEMI), and to analyze its relationship with myocardial perfusion and short-term prognosis. Methods: 108 patients with STEMI in Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of traditional Chinese Medicine from April 2017 to April 2019 were selected for retrospective study. All patients underwent 12 lead electrocardiogram examination after operation, according to the presence or absence of fQRS, they were divided into fQRS group (n=52), non-fQRS group (n=56). The clinical data of the two groups were compared, and the Univariate and multivariate logistic regression analysis was used to determine the influencing factors of postoperative fQRS. Myocardial perfusion was compared between the two groups. Myocardial perfusion was analyzed using myocardial blush grades (MBG). Followed up for 1 year, the incidence of major adverse cardiovascular events, including heart failure, angina pectoris, cardiogenic death, and cardiogenic shock were analyzed, and it is used to evaluate the short-term prognosis. Results: Univariate analysis suggested that age, number of coronary vascular lesions, Gensini score, and angina pectoris attack to vascular opening time were related to postoperative fQRS (P<0.05). Multivariate logistic regression analysis showed that age, number of coronary vascular lesions, Gensini score, angina pectoris attack to vascular opening time were the influencing factors of postoperative fQRS (P<0.05). The proportion of MBG 3 grades in the fQRS group was 46.15%, which was significantly lower than 76.79% in the non-fQRS group (P<0.05). The incidence of adverse cardiovascular events in the fQRS group was 26.92%, which was significantly higher than 10.71% in the non-fQRS group (P<0.05). Conclusions: Influencing factors of postoperative fQRS in patients with STEMI include age, number of coronary vascular lesions, Gensini score, and angina pectoris attack to vascular opening time, and postoperative fQRS can predict myocardial perfusion and increase the incidence of adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

The effect of COVID-19 on the cardiovascular system still needs to be clarified. Patients can develop a spectrum of cardiac diseases, from mild myocarditis to acute coronary syndrome with an impaired systolic fraction. We describe an interesting case of transient ST segment elevation in a COVID-19 patient admitted to ICU for severe respiratory distress syndrome. During his stay in ICU, the patient developed transient ST segment elevation in inferior-lateral leads which promptly resolved without requiring any additional invasive and/or pharmacological treatment. Transthoracic echocardiography showed a preserved ejection fraction without any regional abnormalities and the rise in enzyme biomarkers was insignificant. The case highlights the importance of avoiding invasive procedures in this subset of patients to reduce both patient complications and medical staff exposure. Careful evaluation including echocardiogram and second-line examinations should be performed before invasive and aggressive treatment is undertaken.

We continue to learn about cardiac involvement in patients with COVID-19. These patients can develop acute coronary syndrome and severe myocarditis with a reduced ejection fraction. We describe two critically ill COVID-19 patients who developed ST elevation that resolved on repeat ECG without any intervention.

Background and Objective: Global longitudinal peak systolic strain (GLPS) is an accurate and repeatable technique for assessment of left ventricular systolic function. The aim of this study was to comparison of GLPS in subjects with ER pattern in ECG with patients with STsegment elevation myocardial infarction (STEMI) and healthy subjects by speckle tracking echocardiography. Subjects and Methods: This case-control study was conducted on 30 patients with STEMI and 19 subjects with ER pattern on ECG admitted to Imam and Golestan hospitals in Ahvaz. The control group was 30 healthy subjects without cardiovascular disease and with normal ECG. ER pattern, defined as notching or slurring of the terminal part of QRS complex, J-point elevation ≥0.1 mV in more than 2 contiguous leads on ECG and QRS0.05). Moreover, the incidence of left ventricular diastolic dysfunction (LVDD grade 1) in the STEMI group was higher than in two groups of ER and healthy (60%, 10.5% and 9.7%, respectively; P <0.001). Conclusions: Echocardiography parameters including LVEF, PAP, HR, SV, TAPSE, GLPS and LVDD could be used to differentiate between STEMI and people with ER pattern in ECG. [ABSTRACT FROM AUTHOR]

Introduction: ST segment elevation (STE) in the standard 12‑lead surface electrocardiography (ECG) is a well-known finding in patients with metastatic cardiac tumors. It is important to identify the specific characteristics of STE among those patients to prevent unnecessary aggressive treatments. In the present study, we aimed to demonstrate the ECG characteristics of patients with metastatic cardiac tumors who has STE.Material and Methods: Medical literature was searched from Pubmed database with key words "metastatic cardiac tumors" or "cardiac tumors" and "ST segment elevation" or "ST elevation". In addition, remaining articles were explored using the references of case reports which were obtained during former screening (snowball procedure).Results: Thirty six of 46 case reports were included and ECG characteristics of each case were evaluated. Convex- shaped STE was observed in all patients and it showed a specific coronary territory in 35 of 36 patients (97.2%). Pathologic Q wave and/or loss of R wave progression were observed in only one patient. T wave inversion following STE was detected in 34 patients (94.4%). STE evolution was absent in 32 of 36 patients while the information regarding STE evolution were not provided in the remaining cases.Conclusion: STE due to tumor invasion has certain characteristics which could help clinicians in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Avrupa Kardiyoloji Cemiyetinin 2018 yılında yayınladığı ‘Miyokardiyal enfarktüsün dördüncü evrensel tanımı’ isimli kılavuzunda ST segment elevasyonlu miyokard enfarktüs; göğüs ağrısı veya başka iskemik semptomu olan hastada elektrokardiyogramda (EKG) komşu iki derivasyonda yeni gelişen ST segment elevasyonu veya yeni gelişimli dal bloğu olarak tanımlanmıştır. EKG’de ST segmentinde görülen elevasyon nadiren kardiyak dışı sebeplere bağlı olarak da görülmektedir. Toraks cerrahilerinde mediastinal yapıların yer değiştirmesi de psödoiskemik EKG değişikliklerinin sebebi arasında yer almaktadır. Vakamız; geçmişte sigara içiciliği dışında kardiyovasküler risk faktörü olmayan 63 yaşındaki erkek hastadır. Akciğer malignitesi sebebiyle sağ akciğer rezeksiyonu yapılan hastanın postoperatif EKG’sinde yeni gelişimli anterior derivasyonlarda ST segment elevasyonu görüldü. Bu yazıda; yapılan koroner anjiyografide koroner arterleri normal tespit edilen hastanın, iskemik koroner patolojiler dışında, nadir de olsa EKG’de ST segment elevasyonuna sebep olabilecek bir pnömonektomi vakasının sunulması amaçlanmıştır.

Abstract Background To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model. Methods A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed. Results We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors. Conclusion We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.

Objective To explore the clinical characteristics of ST segment elevation in elderly patients with acute myocarditis and provide reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on 87 elderly patients with acute myocarditis treated in our hospital. Patients with ST segment elevation were included in group A,while patients with non-ST segment elevation were included in group B. The clinical characteristics of ST segment elevation,including treatment,outcome,laboratory and auxiliary examinations were analyzed. The incidence of cardiac events such as cardiogenic shock,ventricular fibrillation and death were counted. Results The rate of ventilator application in group A was significantly higher than that in group B(P <0. 05). The incidence of temporary pacemaker,CRRT,IABP and ECMO treatment in group A were slightly higher than that in group B,and there was no statistical difference(all P > 0. 05). The levels of myocardial injury markers such as CK peak value,CKMB peak value,and Tn I peak value in group A were significantly higher than that in group B(all P < 0. 05). Cardiac adverse events in group A occurred. The rate was 20. 8%,which was significantly higher than 2. 5% in group B,and the difference was statistically significant(P < 0. 05). Conclusion ST-segment elevation in elderly patients with acute myocarditis is characterized by acute onset,severe illness,and rapid progress,and the risk of cardiac adverse events such as ventricular fibrillation is greater. Therefore,clinicians should attach great importance to ST-segment elevation in elderly patients with acute myocarditis and provide timely targeted treatment. [ABSTRACT FROM AUTHOR]

Introduction: Some studies suggest that ST elevation in aVR (aVR-STE) can predict the presence of left main or multivessel disease (MVD) and relates to prognosis. Our purpose was to analyze the relationship of aVR-STE to MVD disease or cardiogenic shock (CS) in patients with inferior myocardial infarction (inferior STEMI).Methods: We analyzed two cohorts of consecutive patients admitted for inferior STEMI in the Coronary Unit of two university hospitals. ST elevation and ST depression in each derivation were compared between patients with and without MVD and with and without CS.Results: We included 342 patients-19.6% women and 80.4% men-with a median age of 60 (52, 70); 18 patients (5.2%) had MVD, and 25 (7.3%) patients presented CS. There was no relationship between ST elevation or ST depression in either derivation and MVD. In contrast, CS was associated with aVR-STE, ST-segment depression in lead aVL, and the sum of ST-segment depression. aVR-STE of 0.25 mm had a sensitivity of 24.0% and a specificity of 95.9% for CS. After multivariate analysis including clinical variables, aVR-STE was independently associated with CS.Conclusions: In patients with inferior STEMI, ST-segment analysis was not useful in predicting multivessel disease. aVR-STE was an independent predictor of CS, with high specificity but low sensitivity. [ABSTRACT FROM AUTHOR]

ST elevation on ECGs immediately after cardiac surgery is usually considered to be non-specific. However, these ST changes can be the first clues to serious condition such as graft occlusion and myocardial infarction. We present two patients with ST elevation on ECGs immediately following coronary artery bypass surgery to illustrate that ST changes early after surgery can represent significant pathology and true ischemia after cardiac surgery, which warrants prompt investigation. More studies are needed to see if different thresholds for ST elevation should be used for detecting STEMI after heart surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of exercise and heart rate on the early repolarization (ER) pattern; focusing on the new criteria for identification of ER.Methods: The ECG measurements on the terminal QRS notch or slur found in early repolarization were quantitated before, during and after exercise; specifically: (i) the amplitude at the onset of the notch (Jo) (ii) the amplitude at the peak of the notch (Jp), (iii) the amplitude at the end of the notch (Jt), (iv) the duration from Jo to Jp (D1) and (v) the duration from Jo to Jt (D2).Results: All individuals (N = 21) fulfilling the criteria for ER showed complete disappearance of ER after 3 min of exercise. After 5 min of recovery, 29% of subjects showed return of the ER. The return of ER was dynamic with QRS notching of varying extent, without ST elevation, being evident first. The relationship between heart rate and ER was significant and nonlinear, best fit by a second-order polynomial, suggesting that changes in heart rate with exercise was a factor influencing the presence of the ER pattern and the parameters that define ER.Conclusion: Each of the newly defined characteristics of the ER are modified and eventually disappear with exercise. The return of ER was dynamic with QRS notching of varying extent being evident first. The changes correlated with variations in heart rate, during both exercise and recovery, suggesting, in part, a role in the underlying mechanism of ER. [ABSTRACT FROM AUTHOR]

Objective: In a subgroup of patients with the anterior wall myocardial infarction (MI), the electrocardiogram (ECG) records a concomitant inferior ST-segment elevation (STE), which is generally explained by a "wrap-around" left anterior descending (LAD) artery occlusion. However, recent evidence indicates that this may be due to a distal LAD occlusion, which may be irrelevant to the LAD length. We investigated the relationship between inferior ST-T changes in anterior MI and the presence of a wrap-around LAD. Methods: Consecutive patients diagnosed with anterior MI due to an acute LAD occlusion were enrolled into the study. All ECGs were measured manually by a cardiologist, who was blinded to the angiographic outcomes. The site of the LAD occlusion was determined using multiple angiographic views. A wrap-around LAD was defined as a LAD artery from a post-reperfusion coronary angiogram that perfused at least one-fourth of the inferior wall of the left ventricle in the right anterior oblique projection. Results: A total of 379 anterior MI cases were enrolled, and the final study population consisted of 259 patients. The presence of a wrap-around LAD was more frequent in patients presenting with inferior STE compared with patients without inferior STE (62.1% vs. 30.4%, p=0.001), however, this relationship was weak (f=0.211). Inferior STE was more frequent in distal occlusions (22.9% vs. 4.3%, p<0.001), which showed a stronger relationship (f=0.285). The polarity of the T-wave in lead III did not give any clues about the LAD anatomy. Conclusion: Contrary to the popular acceptance, our results indicate that a wrap-around LAD cannot be reliably diagnosed by ECG. (Anatol J Cardiol 2019; 21: 253-8). [ABSTRACT FROM AUTHOR]

Background: ST-segment elevation (STE) and an increased Tpeak-Tend interval (Tp-e) have prognostic value for malignant arrhythmia events (MAEs) in patients with ST-segment elevation myocardial infarction (STEMI) and Brugada syndrome. Whether STE could predict MAEs and has an electrophysiological relationship with Tp-e in electrocardiogram (ECG) of vasospastic angina (VA) patients needs to be elucidated.Methods: Sixty-five patients with VA and 23 patients with VA complicated by MAEs were enrolled. The relationship of ECG parameters and MAEs (defined as ventricular tachycardia/ventricular fibrillation (VT/VF), syncope, and aborted sudden death) was analyzed by t-test, regression and receiver operating characteristic (ROC) curve analyses.Results: Patients with MAEs showed greater STE (P<0.001) and corrected QT dispersion (cQTd) (P=0.021), a longer corrected Tp-e interval (cTp-e) (P<0.001), and a larger Tp-e/QT ratio (P<0.001) than those in non-MAE groups. Univariate analysis revealed that cQTd (odds ratio (OR)=1.065; P=0.020), cTp-e (OR=1.159; P=0.001), Tp-e/QT (OR=1.344, P=0.002), and STE (OR=5.655, P<0.001) were significantly associated with MAEs. In the multivariate analysis, Tp-e/QT and STE remained predictors of MAEs. ROC curve analysis showed that the areas under curve (AUCs) for Tp-e/QT (AUC=0.944) and STE (AUC=0.974) were not significantly different (P>0.05), but both were significantly different than AUCs for cQTd (AUC=0.724) and cTp-e (AUC=0.841) (all P<0.05). STE was well fitted with the Tp-e/QT ratio in a multivariable linear regression model.Conclusions: STE and increased Tp-e/QT ratio had related electrophysiological properties and were independent prognostic indicators of MAEs in patients with VA. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to study the usefulness of electrocardiography in localizing the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and to assess the diagnostic accuracy of the electrocardiogram (ECG) findings by comparing them with coronary angiographic findings. Materials and Methods: This study is prospective observational study, conducted on fifty patients in tertiary care center attached to medical college. Patients with ST-segment elevation in ECG was evaluated to identify culprit vessel and later correlated with their coronary angiography. Results: Among fifty patients in the study, 34 had anterior wall, and 16 had inferior wall myocardial infarction. ST↑ >1 mm in V4R, ST↓V3/ST↑LIII lead II was the most sensitive and ratio of ST↓V3/ST↑LIII >1.2 was the most specific criterion. In anterior wall STEMI, 52.9% patients had occlusion proximal to first septal (S1), 17.6% had occlusion proximal to first diagonal (D1), 8.8% had occlusion distal to S1, and 20.5% had occlusion distal to D1. Q wave in aVL had maximum sensitivity for identifying occlusion proximal to D1 and Q wave in leads V4-V6 for occlusion distal to S1. Conclusion: The admission ECG in patients with STEMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

Although phrenic nerve and esophageal injury are commonly known risks associated with cryoablation, there is limited literature regarding coronary artery spasm (CAS), a serious and potentially fatal complication of cryoablation. We report the case of a 68-year-old Caucasian female who developed a left main CAS with a significant hemodynamic compromise during cryoablation. The patient, with a history of hyperlipidemia, hypertension, and symptomatic persistent atrial fibrillation, was admitted for elective catheter ablation for atrial fibrillation. During the ablation of the left superior pulmonary vein (LSPV), the patient developed severe hypotension and bradycardia. The patient's monitor revealed ST elevation, confirmed by a 12-lead ECG. Immediate coronary angiography revealed the left main coronary spasm, which improved with nitroglycerine administration with resolution of ST elevation and return of the patient's hemodynamics to stability. The patient's left main CAS was induced by cryoablation of LSPV. Literature on atrial fibrillation ablation-induced CAS is scant, but a Japanese study has shown that it occurs more commonly in cryoablation than in radiofrequency, hot balloon, or laser ablation. The study showed LSPV as the most common site of ablation right before the spasms happened. Further studies about this topic are needed to delineate further the risk factors and the precautions that could prevent CAS. In the meantime, prompt recognition and appropriate intervention are critical for a good patient outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Seri et al.)

Coronary artery vasospasm is an important cause of chest pain syndromes that can lead to myocardial infarction, ventricular arrhythmias, and sudden death. In 1959, Prinzmetal et al described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography. Persistent angina is challenging, and repeated coronary angioplasty may be required in this syndrome. Calcium antagonists are extremely effective in treating and preventing coronary spasm, and may provide long-lasting relief for the patient. Whereas the Wellens' syndrome is characterized by symmetrically inverted T-waves with preserved R waves in the precordial leads suggestive of impending myocardial infarction due to a critical proximal left anterior descending stenosis, the pseudo-Wellens' syndrome caused by coronary artery spasm has also rarely been reported in literature. We present a pseudo-Wellens syndrome as a cause of vasospastic angina, and a diffuse ST segment elavation on electrocardiogram resembling the Greek letter lambda, called also 'action potential-like' ECG in a patient with vasospastic-type Printzmetal angina.

Objectives: The purpose of the study resides in estimating initial myocardial necrosis as well as reperfusion quality in ST segment elevation myocardial infarction(STEMI) patients involving electrocardiographic (ECG) changes. Methodology: The dynamics of both ST segment elevation and R wave amplitude was followed in 146 STEMI cases upon admission and after reperfusion therapy, in 3 different moments. Demographics, the symptom onset to presentation interval, co-morbidities, traditional risk factors, echocardiography findings, cardiovascular events and mortality during hospitalization were assessed. Results: The changes in ST-segment elevation magnitude and R-wave amplitude characterizing the infarction territory upon admission and up to 48 hours after revascularization were described as indirectly correlated in a significant manner.Therefore, the increased ST elevation found in late admission patients was associated with a decreased R wave amplitude, both being related to major cardiovascular events, poor left ventricular function and increased mortality. Conclusions: The R wave amplitude in STEMI patients provides additional information with important clinical implications. The relationship between this parameter and the ST segment mayrepresent a challenge in estimating myocardial perfusion and eventually improved outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Acute myocardial infarction is the most important and feared consequence of coronary artery disease. STEMI is the one of that kind and it occurs by formation of a vulnerable plaque from atherosclerosis and transforms into coronary artery thrombosis in the end. Streptokinase has been used as a thrombolytic agent in patients with acute STEMI. It combines with the circulatory plasminogen to form an activator complex and it converts into plasmin, where, the plasmin breaks the fibrin complex in the blood clot. Streptokinase can be given as 1,500,000U a slow I.V infusion over 30 min. Each STEMI subject is different with the aetiology, pain, ST segment elevation. By considering these factors the clinical efficacy of streptokinase will be evaluated. Materials and Methods: A total number of 75 subjects presenting with acute STEMI to the department of cardiology, King George Hospital, Visakhapatnam, and, those were thrombolysed with streptokinase are included in the study. pain was assessed before and 90 min after administration of streptokinase on numerical pain rating scale from 0-10. ST segment resolution was assessed as percentage reduction in ST segment elevation before administration of streptokinase and the reduction of ST segment elevation 90 min after administration of streptokinase. Student t-test and chi-square test were applied to evaluate the results by using software SPSS. Results: A significant resolution in the pain and ST segment elevation were identified by comparing the numerical pain rating scale and ST segment elevation on pre and post streptokinase administration. Conclusion: Streptokinase has been shown to have significant effect on pain resolution and ST segment resolution in subjects with acute ST segment elevation myocardial infarction. [ABSTRACT FROM AUTHOR]

An ST-segment elevation myocardial infarction represents a time-sensitive cardiac pathology with utmost importance placed upon timely coronary angiography with percutaneous coronary intervention. While emphasis is placed on atherosclerotic or thrombotic coronary occlusion, it is important to recognize other etiologies which may present in a similar fashion. This case demonstrates a 71-year-old female patient with prior coronary artery disease and stenting who presented with acute abdominal pain and elevated cardiac biomarkers as well as ST-segment elevation on initial EKG. Coronary angiography revealed only mild to moderate coronary lesions and patent stents while echocardiography was essential unchanged from prior evaluation. Computed tomography of the abdomen would show findings suggestive of infectious colitis and empiric antibiotics led to full resolution of symptoms. While no definitive cause for her cardiac manifestations was discovered, the authors propose coronary vasospasm or myopericarditis as likely etiologies in response to an overwhelming inflammatory state. The case underscores the importance of formulating a comprehensive differential diagnosis during the initial workup of a ST-segment elevation myocardial infarction. [ABSTRACT FROM AUTHOR]

Prompt diagnosis of acute ST segment elevation myocardial infarction (STEMI) by the initial ECG is important in order to perform an urgent coronary angiography as soon as possible and achieve successful revascularization, therewith improving mortality and morbidity. Several diseases and conditions can mimic an acute myocardial infarction (AMI) but may not benefit from a (percutaneous) revascularization strategy. This narrative clinical review will discuss the ECG features of some of the causes of nonischemic ST segment elevation to facilitate early recognition, prevent wrongful diagnosis and improve treatment outcomes. [ABSTRACT FROM AUTHOR]

The article is about contemporary views on thrombolytic drugs usage. Although there is a great improvement in endovascular treatments, systemic thrombolysis is still one of the most important approaches to MI with ST elevation. The data of a few studies of thrombolytics with percutaneous intervention is provided, as with it or instead of it. Also the importance of thrombolytic drug pharmacokynetic profile is underlined.

Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.Methods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses.Results: In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P

We present segments from a 24-hour 12-lead digital Holter recording in a 48-year-old man demonstrating transient ST elevations in the inferior leads that triggered sustained ventricular tachycardia/ventricular fibrillation (VT/VF) requiring cardioversion. The onset of VT was preceded by a gradual increase in the ST with marked QRS broadening that lacked distinction between the end of the QRS and the beginning of the ST (QRS–ST–T “triangulation”), and shortening of the QT interval not caused by an increased heart rate. This is a relatively rare documentation of the mechanisms immediately triggering sustained ventricular arrhythmias during acute myocardial ischemia obtained with 12-lead ECG.

Introduction: Precordial normal variant ST elevation (NV-STE), previously often called "early repolarization," may be difficult to differentiate from subtle ischemic STE due to left anterior descending (LAD) occlusion. We previously derived and validated a logistic regression formula that was far superior to STE alone for differentiating the two entities on the ECG. The tool uses R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B). The 3-variable formula is: 1.196 x STE60V3 + 0.059 × QTc-B - 0.326 × RAV4 with a value ≥23.4 likely to be acute myocardial infarction (AMI).Hypothesis: Adding QRS voltage in V2 (QRSV2) would improve the accuracy of the formula.Methods: 355 consecutive cases of proven LAD occlusion were reviewed, and those that were obvious ST elevation myocardial infarction were excluded. Exclusion was based on one straight or convex ST segment in V2-V6, 1 millimeter of summed inferior ST depression, any anterior ST depression, Q-waves, "terminal QRS distortion," or any ST elevation >5 mm. The NV-STE group comprised emergency department patients with chest pain who ruled out for AMI by serial troponins, had a cardiologist ECG read of "NV-STE," and had at least 1 mm of STE in V2 and V3. R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B) had previously been measured in all ECGs; physicians blinded to outcome then measured QRSV2 in all ECGs. A 4-variable formula was derived to more accurately classify LAD occlusion vs. NV-STE and optimize area under the curve (AUC) and compared with the previous 3-variable formula.Results: There were 143 subtle LAD occlusions and 171 NV-STE. A low QRSV2 added diagnostic utility. The derived 4-variable formula is: 0.052*QTc-B - 0.151*QRSV2 - 0.268*RV4 + 1.062*STE60V3. The 3-variable formula had an AUC of 0.9538 vs. 0.9686 for the 4-variable formula (p = 0.0092). At the same specificity as the 3-variable formula [90.6%, at which cutpoint (≥23.4), 123 of 143 MI were correctly classified for 86% sensitivity], the sensitivity of the new formula at cutpoint ≥17.75 is 90.2%, with 129/143 correctly classified MI, identifying an additional 6 cases. The cutpoint with the highest accuracy (92.0%) was at a cutoff value ≥18.2, with 88.8% sensitivity, 94.7% specificity, and a positive and negative likelihood ratio of 16.9 (95% CI: 8.9-32) and 0.12 (95% CI: 0.07-0.19). At this cutpoint, it correctly classified an additional 11 cases (289 of 315, vs. 278 of 315): 127/143 for MI (an additional 4 cases) and 162/171 for NV-STE (an additional 7 cases).Conclusion: On the ECG, a 4-variable formula was derived which adds QRSV2; it differentiates subtle LAD occlusion from NV-STE better than the 3-variable formula. At a value ≥18.2, the formula (0.052*QTc-B - 0.151*QRSV2 - 0.268*RV4 + 1.062*STE60V3) was very accurate, sensitive, and specific, with excellent positive and negative likelihood ratios. This formula needs to be validated. [ABSTRACT FROM AUTHOR]

While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wherein extreme abdominal distension and hemi-diaphragm elevation resulted in extrinsic cardiac and epicardial coronary compression manifesting as STE. Subsequent relief of the abdominal distension resulted in resolution of STE representing a noncoronary cause of STE. A brief literature review, illustrating the importance of considering abdominal etiologies as a cause of STE is provided. [ABSTRACT FROM AUTHOR]