Journal articles: 'Segment ST-T'

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Widodo, Gipta Galih, Elly Nurachmah, and Budiharto Budiharto. "Efek Cold Pressor Test Terhadap Pasokan dan Kebutuhan Oksigen Miokard Pada Perokok Aktif di Kecamatan Ungaran Kabupaten Semarang." Jurnal Keperawatan Indonesia 12, no. 1 (March 24, 2008): 14–20. http://dx.doi.org/10.7454/jki.v12i1.194.

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AbstrakPenelitian kuasi eksperimen ini bertujuan menguji pengaruh cold pressor test (CPT) terhadap pasokan dan kebutuhan oksigen miokard pada perokok aktif dengan pengukuran tekanan darah dan segmen ST di Kecamatan Ungaran Kabupaten Semarang. Jumlah sampel dalam penelitian ini sebanyak 76 perokok aktif di Kecamatan Ungaran Kabupaten Semarang dan ditentukan dengan cluster sampling. Pengaruh CPT terhadap tekanan darah dan segmen ST pada perokok aktif diuji dengan dependent sample t test. Hasil penelitian menunjukkan rerata tekanan darah setelah intervensi CPT mengalami penurunan. Hasil analisis dengan uji t test menunjukkan bahwa CPT menurunkan tekanan darah setelah intervensi CPT (p=0,000). Rata-rata segmen ST sebelum dan setelah intervensi CPT tidak jauh berbeda. Hasil uji t test menunjukkan bahwa CPT tidak berpengaruh dalam menurunkan segmen ST pada perokok aktif (p = 0,895). Penelitian ini menyimpulkan bahwa CPT berpengaruh terhadap perubahan tekanan darah pada perokok aktif tetapi tidak berpengaruh terhadap perubahan segmen ST. Selama CPT terjadi peningkatan tekanan darah dan berangsur menurun setelah dilakukan CPT. Segmen ST tidak mengalami perubahan. CPT dapat digunakan oleh perawat untuk memprediksi kejadian peningkatan tekanan darah. Untuk penelitian selanjutnya sebaiknya digunakan alat ukur yang lebih sensitif dan menggunakan determinan pasokan dan kebutuhan oksigen miokard yang lain seperti preload dan denyut jantung. AbstractThis quasy-experimental research was aimed to examine the effect of cold pressor test (CPT) to the myocardial oxygen demand and supply among active smokers in the Ungaran district, Semarang by measuring blood pressure and ST segment. There were 76 active smoker males involved as the cluster sampling in the research. To examine the CPT effect on the blood pressure and ST segment among the active smokers, dependent sample t test was conducted. The result of the research showed that average blood pressure is decreased after CPT. Furthermore, CPT showed its effects on decreasing blood pressure after the intervention (p = 0,000). The averages of ST segment before and after intervention of CPT were slightly different. Thus, CPT indicated no significant impact in decreasing ST segment among active smokers (p = 0,895). The research concluded that CPT caused blood pressure changes among active smokers but do not have effect in ST segment changes. On the other hand, it was observed that the initial blood pressure were increase during CPT but then gradually decreased immediately after the end of CPT. In addition, ST segment remained unchanged. Therefore, the CPT is still beneficial for predicting high blood pressure in patient compared to other cardiac stress test. Nevertheless, it is recommended to use more sensitive device and to consider other determinants of the myocardial oxygen demand and supply such as preload and heart beat for further research.

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Xiao, Li, Tao Bai, Junchao Zeng, Rui Yang, and Ling Yang. "Nonalcoholic fatty liver disease, a potential risk factor of non-specific ST-T segment changes: data from a cross-sectional study." PeerJ 8 (May 13, 2020): e9090. http://dx.doi.org/10.7717/peerj.9090.

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Background Non-specific ST-T segment changes are prevalent and are proven risk factors for early onset of cardiovascular diseases. They can increase all-cause mortality by 100∼200% and are candidate for early signs of cardiovascular changes. Nonalcoholic fatty liver disease (NAFLD) is prevalent worldwide and is one facet of a multisystem disease that confers substantial increases morbidity and mortality of nonalcoholic fatty liver-related cardiovascular diseases. It is unclear whether NAFLD is associated with non-specific ST-T changes warning early signs of cardiovascular changes. Therefore, we investigated this association. Methods A cross-sectional study was designed that included a sample consisting of 32,922 participants who underwent health examinations. Participants with missing information, excessive alcohol intake, viral hepatitis, chronic liver disease or established cardiovascular diseases were excluded. Electrocardiograms were used for analysis of non-specific ST-T segment changes. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis without other liver diseases. A multivariable logistic regression model was served to calculate the OR and 95% CI for non-specific ST-T segment changes. Results The prevalence of non-specific ST-T segment changes was 6.5% in participants with NAFLD, however, the prevalence of NAFLD was 42.9% in participants with non-specific ST-T segment changes. NAFLD was independently associated with non-specific ST-T segment changes (OR: 1.925, 95% CI: 1.727-2.143, P < 0.001). After adjusting for age, sex, heart rate, hypertension, body mass index, fasting glucose, total cholesterol, triglycerides, HDL-C, NAFLD remained an independent risk factor of non-specific ST-T segment changes (OR: 1.289, 95% CI: 1.122-1.480). Conclusion Non-specific ST-T segment changes were independently associated with the presence of NAFLD after adjusting for potential confounders.

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Rapp, H. J., S. Rabethge, T. Luiz, and P. Haux. "Perioperative ST-segment depression and troponin T release." Acta Anaesthesiologica Scandinavica 43, no. 2 (February 1999): 124–29. http://dx.doi.org/10.1034/j.1399-6576.1999.430202.x.

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Ivanov, Igor, Anastazija Stojsic-Milosavljevic, Vladimir Ivanovic, Milos Trajkovic, Aleksandra Vulin, and Milenko Cankovic. "ST elevation myocardial infarction equivalent - De Winter T-wave electrocardiography pattern." Medical review 71, no. 7-8 (2018): 265–69. http://dx.doi.org/10.2298/mpns1808265i.

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Introduction. Rapid diagnosis of acute myocardial infarction is essential for proper treatment and reduction of patient mortality. Electrocardiography plays an important role in its diagnosis. Acute myocardial infarction with ST segment elevation requires urgent reperfusion therapy, that is, primary percutaneous coronary revascularization. A small number of patients with acute myocardial infarction have ST segment depression in one or more leads, whereas ST segment elevation in augmented vector right the electrocardiogram is characteristic for a myocardial infarction without ST elevation, but the clinical course and the severity of disease correspond to the anterior myocardial infarction with ST segment elevation. De Winter T-wave electrocardiography. One of these forms is known as de Winter T-wave pattern, characterized by ST segment depression at the J-point (> 1 mm) in the precordial leads, the absence of ST segment elevation in the precordial leads, high peaked and symmetrical T-waves in the precordial leads and, in most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented vector right. These patients have occlusion of the left main coronary artery, occlusion of the proximal segment of the anterior descending artery, or a severe multivessel coronary disease. Patients with this electrocardiographic pattern, which is equivalent to acute myocardial infarction with ST segment elevation, require consideration of emergency reperfusion therapy due to high mortality, compared to other patients with acute myocardial infarction without ST elevation. Primary percutaneous intervention is recommended, or if there is no catheterization laboratory nearby, fibrinolytic therapy may be considered. Because of the lack of clear recommendations, treatment decisions are made individually, from case to case. Conclusion. We need large pro?spective studies with this specific electrocardiographic pattern to provide quick recognition and proper treatment of the anterior myocardial infarction with ST elevation.

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Meijs, Loek P. B., Loriano Galeotti, Esther P. Pueyo, Daniel Romero, Robert B. Jennings, Michael Ringborn, Stafford G. Warren, Galen S. Wagner, and David G. Strauss. "An electrocardiographic sign of ischemic preconditioning." American Journal of Physiology-Heart and Circulatory Physiology 307, no. 1 (July 1, 2014): H80—H87. http://dx.doi.org/10.1152/ajpheart.00419.2013.

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Ischemic preconditioning is a form of intrinsic cardioprotection where an episode of sublethal ischemia protects against subsequent episodes of ischemia. Identifying a clinical biomarker of preconditioning could have important clinical implications, and prior work has focused on the electrocardiographic ST segment. However, the electrophysiology biomarker of preconditioning is increased action potential duration (APD) shortening with subsequent ischemic episodes, and APD shortening should primarily alter the T wave, not the ST segment. We translated findings from simulations to canine to patient models of preconditioning to test the hypothesis that the combination of increased [delta (Δ)] T wave amplitude with decreased ST segment elevation characterizes preconditioning. In simulations, decreased APD caused increased T wave amplitude with minimal ST segment elevation. In contrast, decreased action potential amplitude increased ST segment elevation significantly. In a canine model of preconditioning (9 mongrel dogs undergoing 4 ischemia-reperfusion episodes), ST segment amplitude increased more than T wave amplitude during the first ischemic episode [ΔT/ΔST slope = 0.81, 95% confidence interval (CI) 0.46–1.15]; however, during subsequent ischemic episodes the T wave increased significantly more than the ST segment (ΔT/ΔST slope = 2.43, CI 2.07–2.80) ( P < 0.001 for interaction of occlusions 2 vs. 1). A similar result was observed in patients (9 patients undergoing 2 consecutive prolonged occlusions during elective percutaneous coronary intervention), with an increase in slope of ΔT/ΔST of 0.13 (CI −0.15 to 0.42) in the first occlusion to 1.02 (CI 0.31–1.73) in the second occlusion ( P = 0.02). This integrated analysis of the T wave and ST segment goes beyond the standard approach to only analyze ST elevation, and detects cellular electrophysiology changes of preconditioning.

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SONG, JINZHONG, HONG YAN, ZHIJUN XIAO, XIANGLIN YANG, and XIAODONG ZHANG. "A ROBUST AND EFFICIENT ALGORITHM FOR ST–T COMPLEX DETECTION IN ELECTROCARDIOGRAMS." Journal of Mechanics in Medicine and Biology 11, no. 05 (December 2011): 1103–11. http://dx.doi.org/10.1142/s0219519411004198.

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Changes of ST–T complex are the main indicators in myocardial ischemia detection based on electrocardiogram (ECG) signals. However, ST–T complex is highly sensitive to interferences (baseline wandering, postural changes, electrode interference, etc.), especially T-wave has a large morphological variability. Therefore, the feature points of ECG ST–T complex are very difficult to detect accurately. Currently, the commonly used detection methods for ST-segment include R + x and J + x, but they often misjudges the T-wave rising limb as ST-segment. Therefore, a new accurate hybrid approach for ST–T detection was proposed in this paper. First, T-wave onsets and offsets were detected using regional method and T-wave peaks were located using function comparing method. Then, a squeeze approach for ST-segment detection was proposed based on R-wave peak and T-wave onset. Long-term ST database (LTST) verification demonstrated that the accuracy of ST–T detection reached above 91%. In addition, it had a good timeliness and robustness and was easy to implement.

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Dejanovic, Jadranka, Anastazija Stojsic-Milosavljevic, Milos Trajkovic, Tanja Popov, and Aleksandra Ilic. "Atypical electrocardiographic presentations of myocardial infarction with ST elevation - ST elevation myocardial infarction equivalents." Medical review 71, no. 7-8 (2018): 241–46. http://dx.doi.org/10.2298/mpns1808241d.

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Introduction. Some patients with clinical symptoms and signs of acute myocardial and coronary artery occlusion have atypical electrocardiographic presentations - ST elevation myocardial infarction equivalents. Rapid recognition of these patterns is imperative, because the condition requires prompt reperfusion therapy following actual guidelines. De Winter pattern. Diagnostic criteria are: tall, prominent, symmetrical T-waves in the precordial leads, upsloping ST segment depression > 1 mm at the J-point in the precordial leads, absence of ST elevation in the precordial leads, ST segment elevation (0.5 mm - 1 mm) in aVR. ST Elevation in aVR. Electrocardiographic criteria include ST segment elevation in aVR ? 1 mm, ST segment elevation in aVR ? V1, and diffuse ST segment depression in lateral leads. Wellens syndrome. Wellens syndrome describes deeply inverted or bi?phasic T-waves in leads V2 - V3, highly specific for significant stenosis of the left anterior descending artery. Posterior infarction. Posterior infarction is confirmed with ST segment depression ? 0,5 mm in leads V1 - 3 and ST segment elevation ? 0.5 mm in posterior leads (V7 - V9). Conclusion. There are many electrocardiographic patterns that physicians should promptly recognize as clinical myocardial infarction with ST segment elevation equivalents in order to perform urgent reperfusion therapy for better prognosis and survival in these patients.

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Beckenbauer, Dominik, Valeria Martínez Pereyra, and Peter Ong. "STEMI-Äquivalente im EKG – eine fallbasierte Darstellung." DMW - Deutsche Medizinische Wochenschrift 145, no. 05 (March 2020): 318–26. http://dx.doi.org/10.1055/a-0999-0101.

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AbstractThe 12-lead resting ECG remains an indispensable diagnostic tool in patients with acute chest pain. This is particularly important as the identification of ST-segment elevations leads to the diagnosis of ST-segment elevation myocardial infarction (STEMI) and subsequent, immediate coronary reperfusion (usually via primary PCI). However, correct interpretation of the 12-lead ECG in patients with acute chest pain remains challenging. Apart from “classical” ST-segment elevations there are several “equivalents” in the ECG pointing towards an acute coronary occlusion. Among these, hyperacute T-waves, subtle ST-segment elevations, ST-segment elevation in leads aVR/V1 with concomitant ST-segment depression in ≥ 8 other leads and high R-peak with positive T-waves combined with horizontal ST-segment depression in leads V1/V2 can be found. This article provides a case-based presentation of STEMI equivalents on the ECG in order to improve correct ECG interpretation and prognosis of such patients.

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Kumar, Amit, and Mandeep Singh. "Statistical analysis of ST segments in ECG signals for detection of ischaemic episodes." Transactions of the Institute of Measurement and Control 40, no. 3 (October 7, 2016): 819–30. http://dx.doi.org/10.1177/0142331216667811.

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This paper highlights a new method for the detection of ischaemic episodes using statistical features derived from ST segment deviations in electrocardiogram (ECG) signal. Firstly, ECG records are pre-processed for the removal of artifacts followed by the delineation process. Then region of interest (ROI) is defined for ST segment and isoelectric reference to compute the ST segment deviation. The mean thresholds for ST segment deviations are used to differentiate the ischaemic beats from normal beats in two stages. The window characterization algorithm is developed for filtration of spurious beats in ischaemic episodes. The ischaemic episode detection is made through the coefficient of variation (COV), kurtosis and form factor. A bell-shaped normal distribution graph is generated for normal and ischaemic ST segments. The results show average sensitivity (Se) 97.71% and positive predictivity (+P) 96.89% for 90 records of the annotated European ST-T database (EDB) after validation. These results are significantly better than those of the available methods reported in the literature. The simplicity and automatic discarding of irrelevant beats makes this method feasible for use in clinical systems.

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Chronister, Connie. "Improving Nurses’ Knowledge of Continuous ST-Segment Monitoring." AACN Advanced Critical Care 25, no. 2 (April 1, 2014): 104–13. http://dx.doi.org/10.4037/nci.0000000000000029.

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Background: Continuous ST-segment monitoring can result in detection of myocardial ischemia, but in clinical practice, continuous ST-segment monitoring is conducted incorrectly and underused by many registered nurses (RNs). Many RNs are unable to correctly institute ST-segment monitoring guidelines because of a lack of education. Purpose: To evaluate whether an educational intervention, provided to 32 RNs, increases knowledge and correct clinical decision making (CDM) for the use of continuous ST-segment monitoring. Methods: At a single institution, an ST-segment monitoring class was provided to RNs in 2 cardiovascular units. Knowledge and correct CDM instruments were used for a baseline pretest and subsequent posttest after ST-segment monitoring education. Results: Statistical significance between pretest and posttest scores for knowledge and correct CDM practice was noted with dependent t tests (P = .0001). Conclusions: Many RNs responsible for electrocardiographic monitoring are not aware of evidence-based ST-segment monitoring practice guidelines and cannot properly place precordial leads needed for ST-segment monitoring. Knowledge and correct CDM with ST-segment monitoring can be improved with focused education.

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Ryadnova, Ekaterina O., Viktor P. Kitsyshin, Vladimir V. Salukhov, and Aleksandr A. Сhugunov. "Changes in the end part of the QRS complex and the ST-T segment in patients with coronavirus infection." Russian Military Medical Academy Reports 40, no. 1 (May 17, 2021): 19–25. http://dx.doi.org/10.17816/rmmar64473.

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This article is devoted to the patterns of changes in the QRS complex and the ST-T segment in patients with a new coronavirus infection. The article presents the results of a comparison of electrocardiogram data in 70 patients with COVID-19 who were treated in 1st Department of Internal Medicine Postgraduate Training from April to July 2020. Each patient had at least two electrocardiograms taken (at the beginning and at the end of the disease). In the course of the work, a new method for measuring the area of the teeth P, T, QRS complex and ST-T segment was developed and described using the dynamic mathematical program GeoGebra Classic 6.0 by correlating the millimeter grids of the electrocardiogram and the program and further constructing an irregular shape taking into account the polarity of the teeth and segments. According to the study, the sum of the ST-T segment areas in all 12 leads is statistically significantly greater at the end of the disease in individuals over 30 years old. It is also significantly higher in the right thoracic leads (V1-V2) in for all ages. Probably, these changes are associated with the severity of the underlying disease and, consequently, with the overload of the right parts of the heart.

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Grimm, Karin, Raphael Twerenbold, Roger Abaecherli, Jasper Boeddinghaus, Thomas Nestelberger, Luca Koechlin, Valentina Troester, et al. "Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction." European Heart Journal: Acute Cardiovascular Care 9, no. 8 (January 24, 2020): 857–68. http://dx.doi.org/10.1177/2048872619853579.

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Background: Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown. Methods: We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up. Results: Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69–0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49–0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin ( p<0.001) as well as clinical judgment at 90 min ( p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality. Conclusions: The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information.

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Eizadi-Mood, Nastaran, Ahmad Yaraghi, AliMohammad Sabzghabaee, Forough Soltaninejad, Farzad Gheshlaghi, and MozhganKarbalayi Mehrizi. "ST-T segment changes in patients with tricyclic antidepressant poisoning." Journal of Research in Pharmacy Practice 2, no. 3 (2013): 110. http://dx.doi.org/10.4103/2279-042x.122381.

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Choi, Kee Joon, You-Ho Kim, Jae-Joong Kim, Duk-Hyun Kang, Myung-Ki Hong, Seong-Wook Park, Chong-Hun Park, and Seung-Jung Park. "ST Segment Depression and T-wave Inversion during Superaventricular Tachycardia." Korean Circulation Journal 27, no. 12 (1997): 1233. http://dx.doi.org/10.4070/kcj.1997.27.12.1233.

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Greenhut, Saul E., Benjamin H. Chadi, Jong W. Lee, Janice M. Jenkins, and John M. Nicklas. "An algorithm for the quantification of ST-T segment variability." Computers and Biomedical Research 22, no. 4 (August 1989): 339–48. http://dx.doi.org/10.1016/0010-4809(89)90029-3.

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Yesin, Mahmut, Turgut Karabağ, Macit Kalçık, Süleyman Karakoyun, Metin Çağdaş, and Zaur İbrahimov. "The mortal cause of sudden ECG changes in patients with chronic aortic insufficiency: Aortic dissection." Interventional Medicine and Applied Science 11, no. 1 (March 2019): 68–70. http://dx.doi.org/10.1556/1646.10.2018.50.

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The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

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Namgung, June. "Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome." Clinical Medicine Insights: Cardiology 8 (January 2014): CMC.S14086. http://dx.doi.org/10.4137/cmc.s14086.

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Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

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Valo, Misa, Annette Wons, Albert Moeller, and Claudius Teupe. "Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease." Pulmonary Medicine 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/621450.

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Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T) and B-type natriuretic peptide (NT-proBNP) in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI), oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.

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Andreou, Andreas Y., George M. Georgiou, and Panayiotis C. Avraamides. "Preinfarction angina entailing precordial ST segment depression with positive T wave." Journal of Cardiovascular Medicine 12, no. 11 (November 2011): 828–32. http://dx.doi.org/10.2459/jcm.0b013e3283406413.

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Lehrke, Stephanie, Evangelos Giannitsis, Henning Steen, and Hugo A. Katus. "Cardiac Troponin T in ST-Segment Elevation Acute Myocardial Infarction Revisited." Cardiovascular Toxicology 1, no. 2 (2001): 099–104. http://dx.doi.org/10.1385/ct:1:2:099.

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Akşit, Ercan, Özge Turgay Yildirim, Fatih Aydin, Okan Bardakci, and Ayşe Hüseyınoğlu Aydin. "Transient ST Segment Elevation Caused by Intracoronary Thrombus after Acute Carbon Monoxide Poisoning." Prehospital and Disaster Medicine 34, no. 6 (October 9, 2019): 677–80. http://dx.doi.org/10.1017/s1049023x19004898.

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AbstractCarbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient’s left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.

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Kosuge, Masami, Kazuo Kimura, Toshiyuki Ishikawa, Toshiaki Ebina, Kiyoshi Hibi, Kengo Tsukahara, Masahiko Kanna, et al. "Combined Prognostic Utility of ST Segment in Lead aVR and Troponin T on Admission in Non–ST-Segment Elevation Acute Coronary Syndromes." American Journal of Cardiology 97, no. 3 (February 2006): 334–39. http://dx.doi.org/10.1016/j.amjcard.2005.08.049.

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Terada, Tomomasa, Kazuhiro Mori, Miki Inoue, Miki Shono, and Yoshihiro Toda. "Prominent T-wave and ST-segment elevation on electrocardiogram during neonatal seizure." Pediatrics & Neonatology 60, no. 2 (April 2019): 227–28. http://dx.doi.org/10.1016/j.pedneo.2018.05.007.

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Diercks, Gilles F. H., Hans L. Hillege, A. d. J. van Boven, Jan A. Kors, Harry J. G. M. Crijns, Diederick E. Grobbee, Paul E. de Jong, and Wiek H. van Gilst. "Microalbuminuria modifies the mortality risk associated with electrocardiographic ST-T segment changes." Journal of the American College of Cardiology 40, no. 8 (October 2002): 1401–7. http://dx.doi.org/10.1016/s0735-1097(02)02165-4.

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MORIKAMI, YASUHIRO, TOSHINOBU HIGASHI, TADASHI ISOMURA, AKIO HIRANO, KOU TANAKA, KOUICHI HISATOMI, and KIROKU OHISHI. "Cardiac lipoma with changes of ST segment and T wave on electrocardiogram." Japanese Circulation Journal 58, no. 9 (1994): 733–36. http://dx.doi.org/10.1253/jcj.58.733.

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Almeda, Francis Q., and Lloyd W. Klein. "Troponin T in ST-segment elevation myocardial infarction: Intriguing insights, unanswered questions *." Critical Care Medicine 30, no. 10 (October 2002): 2385–87. http://dx.doi.org/10.1097/00003246-200210000-00038.

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HANNA, E. B., and D. L. GLANCY. "ST-segment depression and T-wave inversion: Classification, differential diagnosis, and caveats." Cleveland Clinic Journal of Medicine 78, no. 6 (June 1, 2011): 404–14. http://dx.doi.org/10.3949/ccjm.78a.10077.

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TADA, HIROSHI, AKIHIKO NOGAMI, WATARU SHIMIZU, SHIGETO NAITO, MASATOSHI NAKATSUGAWA, SHIGERU OSHIMA, and KOIGHI TANIGUGHI. "ST Segment and T Wave Alternans in a Patient with Brugada Syndrome." Pacing and Clinical Electrophysiology 23, no. 3 (March 2000): 413–15. http://dx.doi.org/10.1111/j.1540-8159.2000.tb06773.x.

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Genzlinger, Michele A., and Mary Eberhardt. "Analyzing Prominent T Waves and ST-segment Abnormalities in Acute Myocardial Infarction." Journal of Emergency Medicine 43, no. 2 (August 2012): e81-e85. http://dx.doi.org/10.1016/j.jemermed.2009.08.032.

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Brady, William J. "ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes." Emergency Medicine Clinics of North America 24, no. 1 (February 2006): 91–111. http://dx.doi.org/10.1016/j.emc.2005.08.004.

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Emet, Samim, Ali Elitok, Ekrem Bilal Karaayvaz, Berat Engin, Erdem Cevik, Asli Tuncozgur, Mehmet Aydogan, Fehmi Mercanoglu, Mustafa Ozcan, and Aytac Oncul. "Predictors of left ventricle ejection fraction and early in-hospital mortality in patients with ST-segment elevation myocardial infarction: Single-center data from a tertiary referral university hospital in Istanbul." SAGE Open Medicine 7 (January 2019): 205031211987178. http://dx.doi.org/10.1177/2050312119871785.

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Background: Little is known about the management and mortality rates of ST-segment elevation myocardial infarction patients in developing countries. In this study, to expose independent predictors of early (24 h) in-hospital mortality and ejection fraction, we report our experience with 362 ST-segment elevation myocardial infarction patients admitted to the Istanbul Medical Faculty, Istanbul University, a tertiary referral university hospital, and treated with primary percutaneous intervention. Methods: This is a retrospective study that enrolled all patients (362) admitted with ST-segment elevation myocardial infarction to Department of Cardiology, Istanbul Medical Faculty, Istanbul University, between January 2015 and December 2016. The clinical characteristics of patients were collected retrospectively from medical chart review. Collected data were analyzed using IBM SPSS Statistics (version 21). Results: In the forward stepwise logistic regression analysis, target vessel diameter ( p = 0.001), systolic blood pressure ( p < 0.001), and troponin T levels ( p = 0.007) were independent predictors for early in-hospital mortality, while target vessel diameter ( p = 0.03), troponin T level ( p < 0.001), heart rate ( p = 0.001), and chest pain ( p = 0.001) duration were the independent predictors for ejection fraction of 50% and above. Conclusion: Our study is one of the few studies to investigate the predictors of early in-hospital mortality among patients hospitalized with ST-segment elevation myocardial infarction in a tertiary referral university hospital in a developing country. The identified predictors for mortality (including left ventricle ejection fraction and troponin T levels), left ventricle ejection fraction (including troponin T level, chest pain duration), and heart rate are consistent with what has been described in large registries in the United States and Europe.

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Drew, BJ, and MW Krucoff. "Multilead ST-segment monitoring in patients with acute coronary syndromes: a consensus statement for healthcare professionals. ST- Segment Monitoring Practice Guideline International Working Group." American Journal of Critical Care 8, no. 6 (November 1, 1999): 372–86. http://dx.doi.org/10.4037/ajcc1999.8.6.372.

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BACKGROUND: ST-segment monitoring is underused by healthcare professionals for patients with acute coronary syndromes treated in emergency departments and intensive care units. OBJECTIVE: To provide clinically practical consensus guidelines for optimal ST-segment monitoring. METHODS: A working group of key nurses and physicians met in Dallas, Tex, in November 1998. RESULTS: Consensus was reached on who should and should not have ST monitoring, goals and time frames for ST monitoring in various diagnostic categories, what electrocardiographic leads should be monitored, what equipment requirements are needed, what strategies improve accuracy and clinical usefulness of ST monitoring, and what knowledge and skills are required for safe and effective ST monitoring. CONCLUSIONS: Because changes in the ST segment can shift among various electrocardiographic leads in the same person over time owing to different ischemic mechanisms, 12-lead ST monitoring is recommended. Recommended monitoring times are as follows: myocardial infarction or unstable angina, 24 to 48 hours or until patient is event-free for 12 to 24 hours; chest pain prompting a visit to an emergency department, 8 to 12 hours; catheter-based interventions with less definitive interventional outcomes requiring monitoring in an intensive unit, 6 to 12 hours; and cardiac surgery or noncardiac surgery in patients with coronary disease or risk factors, 24 to 48 hours. An ST measurement point of J + 60 ms makes it unlikely that measurement will coincide with the upslope of the T wave, even in patients with sinus tachycardia. Accurate and consistent lead placement and careful electrode and skin preparation are imperative to improve the clinical usefulness of ST monitoring.

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Tan, Nigel S., Shaun G. Goodman, Raymond T. Yan, Basem Elbarouni, Andrzej Budaj, Keith A. A. Fox, Joel M. Gore, et al. "Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non–ST-segment elevation acute coronary syndromes." American Heart Journal 166, no. 2 (August 2013): 290–97. http://dx.doi.org/10.1016/j.ahj.2013.04.010.

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Huo, M., Q. Wei, F. Liu, S. Crozier, and L. Xia. "Electrodynamic Heart Model Construction and ECG Simulation." Methods of Information in Medicine 45, no. 05 (2006): 564–73. http://dx.doi.org/10.1055/s-0038-1634119.

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Summary Objectives: In this paper, we present a unified electrodynamic heart model that permits simulations of the body surface potentials generated by the heart in motion. The inclusion of motion in the heart model significantly improves the accuracy of the simulated body surface potentials and therefore also the 12-lead ECG. Methods: The key step is to construct an electromechanical heart model. The cardiac excitation propagation is simulated by an electrical heart model, and the resulting cardiac active forces are used to calculate the ventricular wall motion based on a mechanical model. The source-field point relative position changes during heart systole and diastole. These can be obtained, and then used to calculate body surface ECG based on the electrical heart-torso model. Results: An electromechanical biventricular heart model is constructed and a standard 12-lead ECG is simulated. Compared with a simulated ECG based on the static electrical heart model, the simulated ECG based on the dynamic heart model is more accordant with a clinically recorded ECG, especially for the ST segment and T wave of a V1-V6 lead ECG. For slight-degree myocardial ischemia ECG simulation, the ST segment and T wave changes can be observed from the simulated ECG based on a dynamic heart model, while the ST segment and T wave of simulated ECG based on a static heart model is almost unchanged when compared with a normal ECG. Conclusions: This study confirms the importance of the mechanical factor in the ECG simulation. The dynamic heart model could provide more accurate ECG simulation, especially for myocardial ischemia or infarction simulation, since the main ECG changes occur at the ST segment and T wave, which correspond with cardiac systole and diastole phases.

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Prabhakaran, Sunil Prasobh, and Abhilash Kannan. "Prognostic significance of troponin T in acute myocardial infarction." International Journal of Research in Medical Sciences 5, no. 10 (September 28, 2017): 4363. http://dx.doi.org/10.18203/2320-6012.ijrms20174559.

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Background: Cardiac markers traditionally have been used only to establish the diagnosis in patients with acute coronary syndromes. In those with suspected acute STEMI, markers have been deemed to have little value, although smaller studies have suggested that troponin T may be valuable for risk stratification. Study aim was to study the prognostic significance of admission Troponin T in acute STEMI and also the relation between Troponin positivity and ST segment resolution after thrombolysis and also relationship with ejection fraction by echocardiogram.Methods: This was a descriptive study conducted in 50 patients admitted with acute STEMI within eight hours in the department of medicine in a tertiary care centre in South Kerala. A blood sample was sent for assessing troponin T. All Patients underwent thorough clinical examination and investigations including echocardiogram was done and were managed with thrombolysis. They were closely followed up for in hospital and 30 days mortality and complications. ST segment resolution after thrombolysis with streptokinase was also assessed.Results: In present study 48% of the patients were troponin T positive. Total six patients died of which all were Troponin T positive. There was a significant increase in the complications in troponin T positive group (46% vs 16%). 44% of the patients had an anterior wall myocardial infarction of which 46% had complications. ST segment resolution after thrombolysis was below 30% in 66.7% of the troponin T positive patients. Ejection fraction was below 50% in 80% of troponin T positive patients.Conclusions: There was a statistically significant correlation between admission troponin T levels and in hospital complications and also mortality rates at 30 days. Troponin T positivity at admission was significantly associated with lower rates of reperfusion after thrombolysis with streptokinase and also lower rate of ejection fraction on echocardiogram. Troponin T positive anterior wall myocardial infarction was associated with more complications than non-anterior wall myocardial infarction.

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Farhan, Md Soumik, and KM Talha Nahiyan. "Myocardial Ischemia Detection from Slope of ECG ST Segment." Bangladesh Journal of Medical Physics 10, no. 1 (December 3, 2018): 12–24. http://dx.doi.org/10.3329/bjmp.v10i1.39147.

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Myocardial ischemia occurs when blood flow to heart is reduced preventing it from receiving enough oxygen. It is a possible indication of partial or complete blockage of coronary arteries. Though ischemia is accompanied by symptoms (fatigue, chest pain, shortness of breath etc.) sometimes it can be silent. If not treated, it can lead to various heart diseases. Most importantly it can progress to myocardial infarction (heart attack), which can be fatal. Thus detecting ischemia at an early stage is important to prevent serious implications. Nowadays personal healthcare monitoring systems are used which provide vital physiological information. In future ECG measurement devices would also be common in homes. So, the proposed work intends to develop an algorithm in detecting myocardial ischemia from ECG, which would be computationally less complex and easy to implement in homecare ECG devices. One way to do it is through continuous or long term monitoring of ECG. The ST segment elevation (or depression) indicates presence of ischemia. The proposed method measures slope of ST segment which must vary in case of ST changes. The algorithm is tested on selected records of the European ST-T database and returns an accuracy of 83.33%.Bangladesh Journal of Medical Physics Vol.10 No.1 2017 12-24

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Bébarová, Markéta, Tom O'Hara, Jan L. M. C. Geelen, Roselie J. Jongbloed, Carl Timmermans, Yvonne H. Arens, Luz-Maria Rodriguez, Yoram Rudy, and Paul G. A. Volders. "Subepicardial phase 0 block and discontinuous transmural conduction underlie right precordial ST-segment elevation by a SCN5A loss-of-function mutation." American Journal of Physiology-Heart and Circulatory Physiology 295, no. 1 (July 2008): H48—H58. http://dx.doi.org/10.1152/ajpheart.91495.2007.

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Two mechanisms are generally proposed to explain right precordial ST-segment elevation in Brugada syndrome: 1) right ventricular (RV) subepicardial action potential shortening and/or loss of dome causing transmural dispersion of repolarization; and 2) RV conduction delay. Here we report novel mechanistic insights into ST-segment elevation associated with a Na+ current ( INa) loss-of-function mutation from studies in a Dutch kindred with the COOH-terminal SCN5A variant p.Phe2004Leu. The proband, a man, experienced syncope at age 22 yr and had coved-type ST-segment elevations in ECG leads V1 and V2 and negative T waves in V2. Peak and persistent mutant INa were significantly decreased. INa closed-state inactivation was increased, slow inactivation accelerated, and recovery from inactivation delayed. Computer-simulated INa-dependent excitation was decremental from endo- to epicardium at cycle length 1,000 ms, not at cycle length 300 ms. Propagation was discontinuous across the midmyocardial to epicardial transition region, exhibiting a long local delay due to phase 0 block. Beyond this region, axial excitatory current was provided by phase 2 (dome) of the M-cell action potentials and depended on L-type Ca2+ current (“phase 2 conduction”). These results explain right precordial ST-segment elevation on the basis of RV transmural gradients of membrane potentials during early repolarization caused by discontinuous conduction. The late slow-upstroke action potentials at the subepicardium produce T-wave inversion in the computed ECG waveform, in line with the clinical ECG.

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Tung, Robert T. "Significance of New, Isolated T-wave Inversion in Multiple Electrocardiogram Leads with Regadenoson Injection in Patients with Normal Myocardial Perfusion Imaging." Kansas Journal of Medicine 12, no. 3 (August 21, 2019): 80–82. http://dx.doi.org/10.17161/kjm.v12i3.11797.

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Introduction The pharmacologic (regadenoson) stress myocardial perfusion imaging (MPI) is used widely in patients who cannot exercise for detecting coronary artery disease (CAD). The interpretation of these studies depends primarily on the imaging results because the sensitivity of electrocardiograms (ECG) in this setting is poor. Prior study showed that effects of regadenoson on ST-segment occurred infrequently and had low sensitivity for detecting CAD. The significance of T-wave inversion in multiple ECG leads without ST-segment depression with regadenoson injection in patients with normal MPI is described and reported. Methods ECGs were reviewed retrospectively in 64 patients who had regadenoson MPI and coronary angiography for evaluation of CAD from June 1, 2016 to August 31, 2018. Five cases were identified with new, isolated T-wave inversion in multiple ECG leads. Results All five cases had new and isolated T-wave inversion in multiple leads without ST segment depression with regadenoson injection and normal MPI. At coronary angiography, three of the five cases showed obstructive coronary artery disease who received coronary percutaneous intervention. One case had nonobstructive coronary artery disease and one had a normal coronary artery. Conclusions Despite nonspecific ST-T changes on baseline ECGs and normal MPI in all patients, three of five cases had obstructive CAD by coronary angiography. New, isolated T-wave inversion in multiple ECG leads with regadenoson injection were observed in our patients with normal MPI. These ECG findings may be associated with false negative MPI. Therefore, careful observation and scrutiny of all ECG changes, especially new, isolated T-wave inversion in multiple ECG leads during regadenoson MPI is advisable to identify potential obstructive CAD despite normal MPI findings.

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Ünsal, Erkan, Kadir Eltutar, and İlkay K. Muftuoglu. "Morphologic Changes in the Anterior Segment using Ultrasound Biomicroscopy after Cataract Surgery and Intraocular Lens Implantation." European Journal of Ophthalmology 27, no. 1 (June 27, 2016): 31–38. http://dx.doi.org/10.5301/ejo.5000812.

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Purpose To evaluate morphologic changes in the anterior segment using ultrasound biomicroscopic imaging (UBM) after phacoemulsification and foldable intraocular lens implantation (IOL). Methods Thirty-six patients with a mean age of 68.68 ± 8.44 years (range 51-89) who had phacoemulsification and foldable IOL implantation were included in this prospective study. Several anterior segment parameters including aqueous depth (AQD), trabecular meshwork-iris angle (TIA), ciliary body thickness (CBT), sclera thickness (ST), trabecular meshwork-ciliary process distance (T-CPD), iris-ciliary processes distance (I-CPD), and iris thickness (IT) were measured using UBM preoperatively and at postoperative month 2. Results There was a significant increase in AQD (p<0.001) and TIA (p<0.001) at postoperative month 2. However, CBT, ST, T-CPD, I-CPD, and IT did not significantly change (p>0.05) during the study period. Conclusions Removal of the crystalline lens results in change in the anterior segment parameters. Our results confirmed that UBM is a helpful option for the analysis of anterior segment structures both qualitatively and quantitatively.

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Kordić, Krešimir, Marin Pavlov, Ana Đuzel, and Zdravko Babić. "Acute cholecystitis associated with electrocardiographic ST-T segment changes and cardiac biomarker elevation." Cardiologia Croatica 11, no. 10-11 (November 2016): 448. http://dx.doi.org/10.15836/ccar2016.448.

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Harvey, Richard A., and Frederick P. Fuller. "The Dynamic Nature of ST-Segment and T-Wave Changes During Acute MI." Prehospital and Disaster Medicine 12, no. 4 (December 1997): 80–84. http://dx.doi.org/10.1017/s1049023x00037869.

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AbstractObtaining aprehospital 12-lead electrocardiogram (ECG) diagnostic of acute myocardial injury has been demonstrated to hasten the administration of thrombolytic agents in the emergency department. This case demonstrates that aprehospital electrocardiogram diagnostic of acute anterior wall infarction can become non-diagnostic following routine administration of oxygen, nitroglycerin, and morphine by paramedics. Although this phenomenon has been observed in the in-hospital setting, it has not been reported in patients with a prehospital ECG.

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Ndrepepa, Gjin, and Adnan Kastrati. "High-sensitivity cardiac troponin T in patients with ST-segment elevation myocardial infarction." Journal of Cardiology 73, no. 4 (April 2019): 333–34. http://dx.doi.org/10.1016/j.jjcc.2018.11.002.

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Kawada, Tomoyuki. "High-sensitivity cardiac troponin T in patients with ST-segment elevation myocardial infarction." Journal of Cardiology 73, no. 4 (April 2019): 333. http://dx.doi.org/10.1016/j.jjcc.2018.11.014.

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Agrawal, Akanksha, Nuzhat Sayyida, Jorge Luis Penalver, and Mary R. Ziccardi. "Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction." Case Reports in Cardiology 2018 (October 24, 2018): 1–3. http://dx.doi.org/10.1155/2018/9382904.

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Introduction. Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report. A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion. Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

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Parr, Christopher J., Rajat Sharma, and Philip J. Garber. "Apical hypertrophic cardiomyopathy treated as ST-elevation myocardial infarction." CJEM 20, S2 (October 2, 2017): S51—S55. http://dx.doi.org/10.1017/cem.2017.409.

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AbstractElectrocardiographic changes resulting from apical hypertrophic cardiomyopathy may mimic an acute coronary syndrome. A 67-year-old Sudanese male without cardiac risk factors presented to hospital with chest pain and electrocardiographic findings of septal ST-segment elevation, ST-segment depression in V4-V6, and diffuse T-wave inversion. He was treated as an acute ST-elevation myocardial infarction with thrombolytics. There was no cardiac biomarker rise and coronary angiography did not reveal evidence of significant coronary arterial disease. Ventriculography, transthoracic echocardiography, and cardiac magnetic resonance imaging were consistent with apical hypertrophic cardiomyopathy. The patient was discharged three days later with outpatient cardiology follow-up. We highlight the clinical and electrocardiographic findings of apical hypertrophic cardiomyopathy, with an emphasis on distinguishing this from acute myocardial infarction.

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Mallick, Sambhu Kumar, Mahboob Ali, and Amal Kumar Chowdhury. "Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease." Cardiovascular Journal 9, no. 2 (May 8, 2017): 135–41. http://dx.doi.org/10.3329/cardio.v9i2.32426.

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Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high STsegment changes score (>18 mm (100%) &/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality & morbidity.Cardiovasc. j. 2017; 9(2): 135-141

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Lomakovsky, O. M., T. I. Gavrilenko, O. M. Parkhomenko, M. І. Lutay, O. A. Pidgaina, and N. O. Rizhkova. "Comparative characteristics of the state of the immune system in patients with coronary artery disease with stable angina pectoris and acute coronary syndrome." Ukrainian Journal of Cardiology 28, no. 3 (September 9, 2021): 30–40. http://dx.doi.org/10.31928/1608-635x-2021.3.3040.

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The aim – to assess the relationship between the state of the immune system and the development of acute coronary syndrome in patients with IHD.Materials and methods. The first group consisted of 64 patients with ST-segment elevation acute coronary syndrome, mean age 54 (49–64) years; the second group – 223 patients with coronary artery disease with stable exertional angina, FC II–III, mean age 56 (49–63) years; the third group – 47 patients with acute coronary syndrome without ST segment elevation, mean age 61 (52–65) years. The material for the immunological study was peripheral venous blood. To determine the parameters of cellular and humoral innate and adaptive immunity in blood serum and supernatants of mononuclear cells, enzyme immunoassay was used.Results and discussion. In patients with coronary artery disease with acute coronary syndrome with ST segment elevation compared with patients with coronary artery disease with stable angina pectoris, the levels of indicators of the immune status in the blood were: CRP – 9.3 (5.3–12.0) versus 4.8 (2.4–8.1) mg/L (p=0.0001), sICAM – 785 (690–830) versus 565 (406–744) ng/ml (p=0.0001), IL-10 in blood mononuclear cells – 48 (1–228) versus 194 (21–758) pg/ml (p=0.0007), circulating immune complexes – 90 (70–108) versus 76 (54–105) od. (p=0.045), lymphocytes with apoptosis (CD95) – 16 (9–27) versus 11 (8–17) % (p=0.029), spontaneous oxygen-dependent metabolism of monocytes – 16 (12–21) versus 13 (9–17) (p=0.001). The levels of indicators of the immune system in the blood in patients with coronary artery disease with acute coronary syndrome with ST segment elevation compared with patients with coronary artery disease with acute coronary syndrome without ST segment elevation were: T-helpers – 37 (32–41) versus 42 (37–48) % (p=0.0006) (R=–0.33; p=0.0005), reaction of lymphocyte blast transformation to nonspecific antigen – 38 (32–47) versus 50 (42–61) % (p=0.0004) (R=–0.37; p=0.0003).Conclusions. The development of acute coronary syndrome is directly combined with increased activity of the immune system, as evidenced by the high production of proinflammatory CRP, IL-8, sICAM with a low level of anti-inflammatory IL-10, a pronounced humoral adaptive immune response (in terms of antibodies to the myocardium and vascular tissues, CD40, circulating immune complexes) and active functional state of monocytes (according to cNCT test, functional reserve, phagocytosis) in patients with coronary artery disease with acute coronary syndrome, regardless of the position of the ST segment in comparison with patients with stable coronary artery disease. Elevated levels of antibodies to the myocardium in patients with stable coronary heart disease indicate moderate myocardial damage due to temporary ischemia in angina attacks, even with a stable course of the disease. In patients with acute coronary syndrome, high levels of antibodies to the myocardium indicate myocardial damage due to increased ischemia in plaque destabilization much earlier than the clinical manifestations of acute coronary syndrome. In acute coronary syndrome with ST-segment elevation, compared with ACS patients without ST-segment elevation, activation of neutrophils and suppression of the activity of adaptive T-cell immunity is noted (by the level of T-helpers, sCD40L, blast transformation of lymphocytes, γ-interferon in mononuclear cells, apoptosis of lymphocytes).

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Garcia-Garcia, C., F. Rueda, J. Lupon, T. Oliveras, C. Labata, M. Ferrer, G. Cediel, et al. "Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study." European Heart Journal: Acute Cardiovascular Care 9, no. 4_suppl (September 3, 2018): S161—S168. http://dx.doi.org/10.1177/2048872618797599.

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Background: Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation. Methods: Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011–August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used. Results: A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively ( p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35–11.39) in patients with primary ventricular fibrillation ( p=0.012) and 1.72 (95% confidence interval 1.23–2.40) in patients without primary ventricular fibrillation ( p=0.001). Conclusions: Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.

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Pranata, Raymond, Ian Huang, and Vito Damay. "Should de Winter T-Wave Electrocardiography Pattern Be Treated as ST-Segment Elevation Myocardial Infarction Equivalent with Consequent Reperfusion? A Dilemmatic Experience in Rural Area of Indonesia." Case Reports in Cardiology 2018 (2018): 1–4. http://dx.doi.org/10.1155/2018/6868204.

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Background. Although de Winter T-wave electrocardiography pattern is rare, it signifies proximal left anterior descending artery occlusion and is often unrecognized by physicians. The aim of this case report was to highlight the dilemma in the management of a patient with de Winter T-wave pattern in the hospital without interventional cardiology facility. Case Presentation. A 65-year-old male presented with typical chest pain since 2 hours before admission, and ECG showed sinus rhythm of 57 bpm and >1 mm upsloping ST depression with symmetric tall T in lead V2-3 characteristic of de Winter T-wave ECG pattern. He was given dual antiplatelet therapy, nitrate, statin, and anticoagulant. He refused referral to interventional cardiology available hospital. 3 hours after admission, the electrocardiography transformed into Q-waves consistent with final stages of acute STEMI and ST-segment elevation that barely meets the threshold in the guideline, and thrombolytic was administered and successful. There is a suggestion that de Winter T-wave electrocardiography should be treated as ST-segment myocardial infarction equivalent and should undergo coronary angiography; however, not every hospital has the luxury of interventional cardiology facility. The other modality for reperfusion is thrombolysis; however, without a clear guideline and scarcity of study, we prefer to resort to conservative treatment. “Fortunately,” transformation into ST-segment elevation helps us to determine the course of action which is reperfusion using thrombolytic. Conclusions. de Winter T-wave ECG pattern is not mentioned in any guidelines regarding acute coronary syndromes, and there are no clear recommendations. Physicians in rural area without interventional cardiology facility face a dilemma with the lack of evidence-based guideline. Fibrinolytic may be appropriate in those without contraindications with strong chest pain consistent with acute coronary occlusion, less than 3 hours of symptoms, and convincing de Winter T-wave ECG pattern for a rural non-PCI hospital far away from PCI capable hospital.

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Grandjean, Thierry, Sophie Degrauwe, Elena Tessitore, and Juan F. Iglesias. "The ‘de Winter’ electrocardiogram pattern as a ST-elevation myocardial infarction equivalent: a case report." European Heart Journal - Case Reports 3, no. 4 (November 27, 2019): 1–5. http://dx.doi.org/10.1093/ehjcr/ytz210.

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Abstract Background A ‘STEMI equivalent’ electrocardiogram (ECG) pattern reflects an acute thrombotic occlusion of a large epicardial coronary artery without ST-segment elevation. These ECG patterns are less known by caregivers. Case summary We describe the case of a 56-year-old patient suffering from acute chest pain, presenting in our emergency department with a ‘de Winter’ ECG pattern: an upsloping ST-segment depression with tall symmetrical T waves associated with left anterior descending artery occlusion. Discussion The ‘de Winter’ ECG pattern, as other ‘STEMI equivalent’, must be recognized promptly and treated as soon as possible with emergent reperfusion by percutaneous coronary intervention.

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Journal articles on the topic 'Segment ST-T'

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