The natural history of postischemic T-wave inversion: a predictor of poor short-term prognosis?

Background: This study followed up the natural history of T-wave inversion and assessed the short-term prognosis associated with the condition.

Methods: Forty patients with acute ischemic syndrome, without infarction, and with postischemic T-wave inversion (group 1) were followed during the persistence (inverted T-wave period) and after the resolution of T-wave inversion (positive T-wave period). Another 40 patients with acute ischemic syndrome, without infarction and with normal T waves (group 2), were also followed.

[Postischemic inverted T waves: does gradual regression indicate improved prognosis?].

This study has followed up the natural history of postischemic inverted T waves and assessed the prognosis. 40 consecutive patients with unstable angina with postischemic precordial inverted T waves in the noninfarcted, previously ischemic area were followed during the persistence (negative T wave period) and after resolution of inverted T waves (positive T wave period). The outcome with frequencies of acute myocardial infarction, acute ischemic syndrome, angina pectoris, positive exercise test, silent myocardial ischemia, anterior wall motion abnormalities on echocardiogram, positive coronary arteriography were determined and compared in the negative versus positive T wave periods.

[Significance of the ECG in the diagnosis of so-called "stunned myocardium"].

The common feature of these 3 case reports can be characterized by the negative symmetric giant T waves developing 1-2 days after an acute myocardial ischemic attack, producing no enzymatic evidence of necrosis, persisting for several days or some weeks. The negative transient T waves are considered to fulfil neither the classical electrocardiographic characteristics of acute or chronic myocardial ischemia nor the criteria of subendocardial necrosis, but are believed to designate the existence of myocardial stunning. The authors suggest, that transient Q waves having been declared as the only electrocardiographic marker of myocardial stunning, reflect severe "transmural stunning" and can be detected relatively rarely, for a short time.

[A case of surgically treated septum perforation associated with acute myocardial infarct].

The authors present the case-history of an elderly female patient with acute myocardial infarction complicated by ventricular septal defect (VSD). She was operated on in order the VSD to be corrected but--probably because of sutural insufficiency--it temporarily reopened, later closed spontaneously. The significance of certain tests in the differential diagnosis of systolic murmur after acute myocardial infarction is discussed, and the importance of these findings compared to the clinical picture is emphasized.

[Successful surgical management of rupture of the papillary muscle diagnosed by ultrasound].

The rupture of the papillary muscle is an infrequent complication of myocardial infarction. Survival of the acute phase depends on the severity of the rupture and the remaining function of the left ventricle. Permanent survival may be ensured however only by surgical intervention.