Prognostic implications of intraventricular conduction delays in a general population: the Health 2000 Survey.

Aims: We examined the prognostic impact of eight different intraventricular conduction delays (IVCD) in the standard electrocardiogram (ECG) in a community cohort.

Methods And Results: Data were collected from 6299 Finnish individuals. During a mean 8.

Prinzmetal angina: ECG changes and clinical considerations: a consensus paper.

Background: We will focus our attention in this article in the ECG changes of classical Prinzmetal angina that occur during occlusive proximal coronary spasm usually in patients with normal or noncritical coronary stenosis.

Results: The most important ECG change during a focal proximal coronary spasm is in around 50% of cases the appearance of peaked and symmetrical T wave that is followed, if the spasm persist, by progressive ST-segment elevation that last for a few minutes, and later progressively resolve. The most frequent ECG changes associated with ST-segment elevation are: (a) increased height of the R wave, (b) coincident S-wave diminution, (c) upsloping TQ in many cases, and (d) alternans of the elevated ST-segment and negative T wave deepness in 20% of cases.

Updated electrocardiographic classification of acute coronary syndromes.

Unlabelled: The electrocardiogram (ECG) findings in acute coronary syndrome should always be interpreted in the context of the clinical findings and symptoms of the patient, when these data are available. It is important to acknowledge the dynamic nature of ECG changes in acute coronary syndrome. The ECG pattern changes over time and may be different if recorded when the patient is symptomatic or after symptoms have resolved.

Physiological and pathological remodeling in acute inferior wall myocardial infarction.

In acute myocardial ischemic syndrome the electrocardiogram is capable of providing sophisticated information on coronary artery anatomy (the culprit artery, the level of obstruction, the arterial dimension), along with the hemodynamics, molecular biological characteristics and ionic changes that occur in the involved and uninvolved ischemic musculature. In acute myocardial ischemia, during a sudden obstruction of a distal co-dominant right coronary artery the ECG may be able to discriminate between physiological and pathological remodeling, providing predictive information to differentiate low from high risk cases during acute inferior wall infarction.

Correlation between ECG presentation and cardiovascular magnetic resonance imaging in Takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TTC) is characterized by acute and reversible ventricular dysfunction in the absence of significant coronary artery disease, typically triggered by acute emotional or physical stress. In the acute phase of TTC, the electrocardiogram (ECG) shows ST-segment elevation, which rapidly evolves into negative T waves and QT prolongation. However, different types of ventricular dysfunction may be associated with different patterns of ECG presentation.

ST-segment deviation pattern of takotsubo cardiomyopathy similar to acute pericarditis: diffuse ST-segment elevation.

Background: Possible similarities or differences in the ST- and PR-segment deviations in the electrocardiogram of takotsubo cardiomyopathy (TTC) and acute pericarditis (AP) are not well defined.

Methods: We compared different parameters of the admission electrocardiogram in eight patients with TTC and eight patients with AP with ST-segment elevation in the acute phase.

Results: We found significant differences in the maximal magnitude of the T wave in the precordial leads, but not in the ST- and PR-segment deviation patterns between the two patient groups.

Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report.

Acute coronary syndromes (ACS) with narrow QRS are divided into 2 groups: ST-elevation ACS that requires emergency percutaneous coronary intervention, and non-ST elevation ACS. The classification of ACS into these 2 groups is not always straightforward. In this document, we discuss several electrocardiogram patterns of acute ischemia that are often misinterpreted.

Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: the Health 2000 Survey.

Aims: The prevalence of eight different ventricular conduction blocks and their association with risk factors and major cardiovascular diseases were studied in a major Finnish population study.

Methods: Data, including 12-lead electrocardiograms, were collected from 6315 subjects. The prevalence of left bundle branch block (LBBB), right bundle branch block (RBBB), non-specific ventricular block, incomplete LBBB, incomplete RBBB, R-R'-pattern, left anterior hemiblock (LAHB), and left posterior hemiblock (LPHB) was calculated for both genders in three age groups.

Prominent precordial T waves as a sign of acute anterior myocardial infarction: electrocardiographic and angiographic correlations.

In clinical practice, one occasionally encounters patients with symptoms lasting for relatively long time showing prominent positive T waves combined with minor ST elevation, or ST depression in the precordial leads. This electrocardiographic pattern has been described as Sclarovsky-Birnbaum grade 1 ischemia. We present 3 cases of patients with predominantly grade 1 ischemia, in whom the culprit site was in the left anterior descending coronary artery.

Factors associated with failure to identify the culprit artery by the electrocardiogram in inferior ST-elevation myocardial infarction.

Background: Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored.

Methods: Patients with inferior preinfarction syndrome (n = 266) were included to the Danish Trial in Acute Myocardial Infarction-2 substudy.

Electrocardiographic presentation of global ischemia in acute coronary syndrome predicts poor outcome.

Background: Global ischemia (GI) electrocardiogram (ECG), wide-spread ST depression with inverted T waves maximally in leads V(4-5), and lead aVR ST elevation (STE), is a marker of an adverse outcome in patients with non-ST elevation acute coronary syndromes (ACS), perhaps because this pattern is indicative of left main stenosis. The prognostic value of this ECG pattern has not been established.

Aims: The distribution of ECG changes and the prognostic value of the GI ECG were studied.

Electrocardiographic presentation of left main disease in patients undergoing urgent or emergent coronary artery bypass grafting.

Background: Widespread ST-segment depression with inverted T waves maximally in leads V4-V5 (ie, the global ischemia electrocardiogram [ECG] pattern) is a marker of adverse outcome in patients with non-ST-segment elevation acute coronary syndrome (ACS), perhaps because this pattern is indicative of left main stem stenosis. However, the prognostic value of this ECG pattern has not yet been established.

Objective: We studied the predictive value of a prespecified ECG pattern in patients who underwent urgent or emergent coronary artery bypass grafting (CABG).

Severe hypocalcemia simulating ST-elevation myocardial infarction.

ST-elevation myocardial infarction (STEMI) is an emergency situation in which immediate measures for myocardial reperfusion are needed. The diagnosis is based on the recognition of ST-segment elevation in the electrocardiogram (ECG). In case of coronary artery occlusion, ST-segment elevation is caused by an injury current from the ischemic myocardium.

Prognostic implications of quantitative ST-segment characteristics and T-wave amplitude for cardiovascular mortality in a general population from the Health 2000 Survey.

Aims: We determined the gender-specific prognostic importance of quantitative measures of the ST segment and T wave in a community cohort.

Methods: Data were collected from 5613 Finnish individuals. Four electrocardiogram (ECG) lead groups were used: anterior, lateral, inferior, and lead V5.

Prevalence and prognostic value of poor R-wave progression in standard resting electrocardiogram in a general adult population. The Health 2000 Survey.

Aims: We examined the prevalence and prognostic impact of poor R-wave progression (PRWP) in a standard electrocardiogram (ECG) in a general population.

Methods: Data and standard resting ECG recording were collected from a large nationally representative (random sample) health examination survey conducted in Finland in 2000-2001. The final study population consisted of 5613 individuals.

Early repolarization in young children with attention-deficit/hyperactivity disorder versus normal controls: a retrospective preliminary chart review study.

Objective And Background: Early repolarization (ER), considered a common and benign electrocardiographic pattern on the surface 12-lead electrocardiogram (ECG), was recently found to be prevalent among patients with idiopathic ventricular fibrillation. It is also highly predominant in physically active young males. Reports on sudden cardiac death (SCD) of children and adolescents treated with psychotropic agents have raised concerns regarding the need for cardiovascular monitoring and risk stratification schedules.

Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology.

The electrocardiogram (ECG) remains the most immediately accessible and widely used diagnostic tool for guiding emergency treatment strategies. The ECG recorded during acute myocardial ischemia is of diagnostic, therapeutic, and prognostic significance. In patients with myocardial ischemia as a result of decreased blood supply, the initial 12-lead ECG typically shows (1) predominant ST-segment elevation (STE) as part of STE acute coronary syndrome (STE-ACS), or (2) no predominant STE, that is, non-STE ACS (NSTE-ACS).

The electrocardiographic paradox of tako-tsubo cardiomyopathy-comparison with acute ischemic syndromes and consideration of molecular biology and electrophysiology to understand the electrical-mechanical mismatching.

From the electrocardiographic (ECG) point of view, the tako-tsubo cardiomyopathy (TTC) behaves like an acute subepicardial circumferential ischemic syndrome. The electrical manifestations are significantly different from those of acute transmural segmental ischemia, in which the ECG primarily expresses the electrophysiologic and metabolic changes occurring in the subepicardial layer. In comparison with transmural anterior ischemia and despite acute contraction impairment (circumferential middle and apical dyskinesis and basal hyperkinesis), in TTC there is typically only moderate ST elevation in the precordial leads.

Predicting the culprit artery in acute ST-elevation myocardial infarction and introducing a new algorithm to predict infarct-related artery in inferior ST-elevation myocardial infarction: correlation with coronary anatomy in the HAAMU Trial.

Aims: The objective of this study is to predict the culprit artery from the electrocardiogram (ECG) by predefined criteria and to compare a new algorithm with a previous one for predicting the culprit artery in inferior ST-elevation myocardial infarction (STEMI).

Methods And Results: In "all-comers" (n = 187) with acute STEMI, with ECG and angiography from the acute phase, the positive and negative predictive values for the prediction of the left anterior descending coronary artery, left circumflex coronary artery, or right coronary artery as the infarct-related artery were 96% and 96%, 65% and 95%, 92% and 97%, respectively. In inferior STEMI (n = 98), positive and negative predictive values to predict the right coronary artery or the left circumflex coronary artery as the culprit artery were 92% and 75% and 75% and 94%, respectively.