PR Depression With Multilead ST Elevation and ST Depression in aVR by Left Circumflex Artery Occlusion: How To Differentiate From Acute Pericarditis

PR-segment depression with multilead ST-segment elevation and ST-segment depression in lead aVR are classic ECG manifestation of acute pericarditis. We present a patient, where the etiology of these ECG features was acute ST-elevation myocardial infarction due to left circumflex artery occlusion. To avoid misdiagnosis, unnecessary examinations, and inappropriate therapeutic decisions, the possibility of ST-segment elevation myocardial infarction should be kept in mind even when ECG changes typical for pericarditis are encountered in chest pain patients. Findings of QRS widening and QT interval shortening in leads with ST-segment elevation could help to differentiate acute ST-segment elevation myocardial infarction from acute pericarditis

Electrocardiogram Acquisition Errors or Myocardial Infarct

Incorrect lead placement may result in unnecessary therapeutic interventions. We present a case report of 53-year-old man with new inferior T-wave inversions in the 12-lead electrocardiogram (ECG) noted during routine followup of hypertension without any cardiovascular symptoms

Aikuisurheilijan EKG-muutokset

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

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

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

Large-scale analyses of common and rare variants identify 12 new loci associated with atrial fibrillation

Atrial fibrillation affects more than 33 million people worldwide and increases the risk of stroke, heart failure, and death. Fourteen genetic loci have been associated with atrial fibrillation in European and Asian ancestry groups. To further define the genetic basis of atrial fibrillation, we performed large-scale, trans-ancestry meta-analyses of common and rare variant association studies. The genome-wide association studies (GWAS) included 17,931 individuals with atrial fibrillation and 115,142 referents; the exome-wide association studies (ExWAS) and rare variant association studies (RVAS) involved 22,346 cases and 132,086 referents. We identified 12 new genetic loci that exceeded genome-wide significance, implicating genes involved in cardiac electrical and structural remodeling. Our results nearly double the number of known genetic loci for atrial fibrillation, provide insights into the molecular basis of atrial fibrillation, and may facilitate the identification of new potential targets for drug discovery