Relação entre o ECG convencional e a artéria coronária responsável no infarto agudo do miocárdio / The relationship between conventional ECG and the culprit coronary artery in acute myocardial infarct

PURPOSE--To evaluate electrocardiogram (ECG) in detecting acute myocardial infarction (AMI) during the first 12 hours of symptoms and its relationship to the culprit coronary artery. METHODS--We studied 68 patients aged 55.6 (30 to 76) years, 61 males, with AMI confirmed by elevated CKMB isoenzyme and cinecoronariography (CINE). In all of them we obtained two ECG: first (i), with < 12 hours of symptoms and a second, > or = 5 days during evolution. ECG were analyzed in order to disclose up and downward ST-T segments > or = 1 mm, new Q waves > or = 0.04 s and R/S > or = 1 plus downward ST-T segment in leads V1 and V2. Then we have done correlation between these and the culprit coronary lesions at CINE. RESULTS--The culprit coronary lesions were: right coronary artery (RCA) in 16, left circumflex (LC) in 26 and left anterior descending (LAD) in 31 cases. According to the ECG, the RCA determined inferior AMI in all patients and the LC only in 62 por cento of cases. Posterior AMI due to LC was seen in 81 por cento of cases at ECG and, associated with lateral AMI, in 52 por cento . Lone lateral AMI was seen in 5 por cento and true posterior in 14 por cento of cases, all of them due to LC. CONCLUSION--False negative ECG (i) in AMI is in fact due to LC occlusion which, frequently, causes posterior wall more then inferior wall myocardial infarction at ECG

Diagnóstico das arritmias cardíacas / Diagnosis of cardiac arrhythmias

Para o diagnóstico das arritmias cardíacas é fundamental a determinaçäo do risco e prognóstico. Na elaboraçäo do processo diagnóstico säo analisados: 1. Anmnese, onde a sintomatologia é o fator mais importante; 2. Exame clínico; 3. Eletrocardiograma convencional, que permite muitas vezes o diagnóstico; 4. Holter, busca resolver a limitaçäo do ECG convencional, que é o curto período de observaçäo; 5. ECG de esforço, importante para avaliar a eficácia da terapêutica antiarrítmica; 6. ECG de alta resoluçäo e 7. Estudo eletrofisiológico, mais invasivo que tem indicaçäo nas arritmias de alto risco