Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

Type 2 Myocardial Infarction Following Generalized Tonic-Clonic Seizure

Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction.

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients

BACKGROUND AND OBJECTIVES: Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. SUBJECTS AND METHODS: Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. RESULTS: Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4+/-14.8 mmHg, 143.7+/-15.2 mmHg and 129.4+/-20.0 mmHg, respectively. OPR was 106.3+/-19.9% and nocturnal dipping was 10.2+/-10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (beta=0.097, p=0.043) and nocturnal dipping (beta=-0.098, p=0.046) were independent determinants of OPR as well as age (beta=0.130, p=0.025) and body mass index (BMI) (beta=0.363, p25 kg/m2). CONCLUSION: The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

The Relationship Between Ambulatory Arterial Stiffness Index and Blood Pressure Variability in Hypertensive Patients

BACKGROUND AND OBJECTIVES: Ambulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction. SUBJECTS AND METHODS: Consecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI. RESULTS: AASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352, p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (beta=1.246, p<0.001), SD of DBP (beta=-1.067, p<0.001), SD of SBP (beta=-0.197, p<0.001), and non-dipper (beta=0.054, p=0.033). CONCLUSION: AASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability.

Recurrent Infective Endocarditis Associated With Pyogenic Spondylodiskitis

Infective endocarditis is a life-threatening condition caused by microbial infection of the heart's endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy.

The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

BACKGROUND AND OBJECTIVES: The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT). SUBJECTS AND METHODS: Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program. RESULTS: In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC. CONCLUSION: BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

BACKGROUND AND OBJECTIVES: The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT). SUBJECTS AND METHODS: Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program. RESULTS: In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC. CONCLUSION: BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

Bone Mineral Density is an Independent Determinant of Left Ventricular Mass Index in the General Female Population

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. SUBJECTS AND METHODS: Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). RESULTS: Age of the subjects was 59.4+/-12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (beta=-13.703, p=0.016), but not in male subjects (beta=-1.235, p=0.841). CONCLUSION: BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women.

Development of acute myocardial infarction in a young female patient with essential thrombocythemia treated with anagrelide: a case report

Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with a prolonged clinical course. Since this disorder is considered to be at increased risk of thromboembolism, therapy is mainly focused on the decreased risk of thrombohemorrhagic events by use of cytotoxic agents. Anagrelide is a phosphodiesterase III inhibitor which is utilized in the treatment of ET for the reduction of platelets. However, patients treated with anagrelide might experience cardiovascular adverse effects including myocardial infarction (MI), although these events are rare. Herein, we report a case of a 30-year-old female with well controlled ET by anagrelide, who eventually developed an acute non-ST elevation myocardial infarction (MI). There has no found any cardiovascular risk factors in this ET patient, strongly suggesting that anagrelide might be the cause of MI. Therefore, cardiovascular function should be monitored in those patients prescribed with anagrelide.

Association Between Inappropriateness of Left Ventricular Mass and Left Ventricular Diastolic Dysfunction: A Study Using the Tissue Doppler Parameter, E/E'

BACKGROUND AND OBJECTIVES: The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique. SUBJECTS AND METHODS: Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of LV mass (OPR) >130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group. RESULTS: Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (beta=0.163, p=0.003), as well as age (beta=0.286, p=0.0001), systolic blood pressure (beta=0.120, p=0.019), fasting blood glucose (beta=0.098, p=0.042), and male gender (beta=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (beta=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7+/-3.4 vs. 10.8+/-3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9+/-15.1 vs. 75.5+/-17.6, p=0.03). CONCLUSION: Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction.

Clinical Factors Associated with Brachial-Ankle Pulse Wave Velocity in Patients on Maintenance Hemodialysis

Pulse wave velocity (PWV) is a main parameter for arterial stiffness. In patients with end-stage renal disease (ESRD), PWV is known to be associated with increased mortality. But factors related to the increased PWV in ESRD patients are not well defined. In addition, the carotid-femoral PWV (cfPWV) measurement, which traditionally has been used to evaluate arterial stiffness, has low reproducibility. Recently, brachial-ankle PWV (baPWV) measurement, which can be performed more easily than cfPWV measurement, has become available as a means of measuring PWV. The aim of this study is to investigate the clinical factors associated with increased baPWV in ESRD patients. BaPWV was examined for 65 ESRD patients on maintenance hemodialysis during the period between the 7th to the 11th of February in 2005 using VP-1000. The clinical factors included age, sex, smoking history, blood pressure, diabetes, body mass index, interdialytic weight gain, duration of dialysis, lipid profile, uric acid, albumin, creatinine, C-reactive protein, calcium, phosphate, intact parathyroid hormone, and hematocrit were analyzed regarding associations (or to determine associations) with baPWV. The median age was 53.8+/-12.0, 31 males and 34 females. BaPWV was 18.9+/-5.2 m/s and there was no significant difference between gender (18.1+/-4.4 m/s vs 19.4+/-5.9 m/s, p=NS). In multiple regression models, age, predialysis systolic blood pressure, and diabetes were independent variables. In conclusion, age, systolic blood pressure, and diabetes were correlated with baPWV in ESRD patients. Thus baPWV measured by simple, noninvasive methods may become available for screening high risk groups in ESRD patients, although further longitudinal studies are necessary.

Association with Left Ventricular Diastolic Function Parameters and Right Brachial-ankle Pulse Wave Velocity in Hemodialysis Patients / 대한신장학회지

PURPOSE: Arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in hemodialysis patients. It is hypothesized that arterial stiffness factor is attributable to the structural and functional changes of left ventricle (LV) caused by increased cardiac workload. So we investigated the relationship between brachial-ankle pulse wave velocity (baPWV) and diastolic dysfunction of left ventricle using echoardiographic transmitral blood flow pattern. METHODS: For 96 subjects (48 control patients, 48 hemodialysis patients), baPWV and echocardiographic indices for diastolic function, i.e. transmitral E, A, E/A, DT, IVRT were measured just before hemodialysis session. Role of baPWV was tested in a multiple regression model including age, gender, body mass index, predialysis blood pressure, heart rate, LV mass index and interdialysis weight gain. RESULTS: In the control group, LV mass index (beta=-0.350) and rbaPWV (beta=-0.403) had an independently correlation with E/A ratio. Rt-baPWV was independently correlated with DT (beta=-0.410) and IVRT (beta=0.500). In the hemodialysis group, systolic blood pressure (beta=-0.389) and heart rate (beta=-0.403) were the factors of E/A ratio. Rt-baPWV (beta=-0.557) was the factor determining E/A ratio only in female hemodialysis patients. CONCLUSION: PWV is independently correlated with E/A ratio only in female hemodialysis patients. Their relationship is limited or weak compared to normal control group.

A Case of Aortic Root Abscess Causing Fatal Myocardial Infarction

Despite the major advances in diagnostic technology and improvements in antimicrobial selection and monitoring accompanied by parallel advances in surgical techniques, the morbidity and mortality of infective endocarditis(IE) still remain high. Because of this high mortality rate, it is worthy of investigating the clinical features of IE and it's complications thoroughly. The main causes of mortality in IE are congestive heart failure and septic embolization. In 9% of active IE, acute myocardial infarction(AMI) developed. AMI caused by coronary artery obliteration by occlusion or embolization is a rare but recognized complication of aortic valve endocarditis with annular abscess. We reported a case of aortic valve endocarditis with aortic root abscess which was complicated by AMI and death.

A Case of Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography

The coronary artery-left ventricular microfistula is an extremely rare congenital anomaly. Little is known about their epidemiologic and clinical features. Moreover, to our knowledge, only two cases of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography have been reported in the literature. Recently we experienced a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography, who was a 63 year old woman and visited for evaluation of chest pain. Herein, along with a review of the pertinent literature regarding this disorder, we report a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography.

Significance of QT Dispersion as a Prognostic Factor in Hyperkalemia

PURPOSE: To date, it has been impossible to relate the occurrence of ventricular arrhythmia to survival in hyperkalemia. QT dispersion is thought to reflect the inhomogeneity of ventricular repolarization and to be related to ventricular-arrhythmia-induced sudden cardiac death in various medical conditions. Therefore, the purpose of this study was to investigate to use QT dispersion as a prognostic marker in hyperkalemia and to suggest treatment guidelines for hyperkalemia by analyzing the correlations between the QT dispersion on the initial ECG and the treatment outcomes. METHODS: This study's population was comprised of 104 patients with serum potassium concentrations > or =5.5 mEq/L, who were divided into 2 groups; group 1 was the survival group (n=81), group 2 was the death group (n=23). We reviewed retrospectively the underlying diseases, electrolytes, treatment outcomes and the clinical and ECG findings during the initial and the recovery states. The QT interval for each lead was measured manually on an enlarged (X1.5) ECG. The QT interval was measured from the first deflection of the QRS complex to the point of the T wave offset, and the corrected QT interval was obtained by using B a z e t t's formula. The QT dispersion and the corrected QT dispersion were defined as the differences between the minimal and the maximal QT values and between the corresponding corrected QT values for each of the 12 leads, respectively. RESULTS: The treatment outcomes were not related to the initial serum potassium and the hourly serum potassium change rates. For hyperkalemia > or =7.0 mEq/L, the death group had significantly larger QT dispersion than the survival group (death group = 95.6+/-15.4 msec, survival group = 51.8+/-17.5 msec, p or =7.0mEq/L, QT dispersion above 65 msec had a 93.8% sensitivity, a 79.4% specificity, and a 68.2% positive predictive value for death. CONCLUSION: For hyperkalemia > or =7.0 mEq/L, QT dispersion above 65 msec should be considered to be a prognostic marker for prediction of the treatment outcome.

Characteristics of QT Dispersion during Recovery Phase after Treadmill Exercise in Airlines Pilots

BACKGROUND: QT dispersion (QTD) represents the inhomogeneity of ventricular repolarization and has been suggested to predict ventricular arrhythmia in patients with coronary artery disease. The purpose of this article is to study the characteristics of QTD during recovery phase after maximal treadmill exercise in airlines pilots. METHODS: The study population included 45 healthy airlines pilots. QTpeak D (QTpD) was defined as the difference between maximum and minimum QTp interval measured on 12 lead ECG at single cardiac beat. Paired t test was used between QTpD at rest and QTpD during recovery phase after maximal treadmill exercise. RESULTS: The QTpD at early recovery phase (1 minute) after maxial treadmill exercise was significantly decreased compared to QTpD at rest (22+/-11 msec. vs 27+/-12 msec., P<0.05), but there was no significant difference between QTpD at rest and QTpD at late recovery phases (3 minutes, 5 minutes and 7 minutes). CONCLUSION: This finding suggests that antiarrhythmogenic effect is present at early recovery phase (1 minute) after maxial treadmill exercise in healthy airlines pilots.

Four Cases of Management of Congenital Coronary Arteriovenous Fistula

Four cases of congenital coronary arteriovenous fistula were diagnosed using coronary angiography. Three cases had fistula-related chest pain and the remaining case showed no symptoms but displayed electrocardiographic changes suggesting myocardial ischemia. As he was elderly and had a potential for future complications, we decided to close the fistulas of all cases. Three cases were closed with transcatheter coil embolization and one with surgical ligation due to a suspicious accompanying pericardial cyst. None of the patients demonstrated periprocedural or perioperative complications and all were relieved from symptoms during the 2 year follow-up period. We concluded that transcatheter coil embolization and surgical ligation are effective methods for use in the management of coronary arteriovenous fistula.

QTp Interval Behavior during Treadmill Exercise in Airlines Pilots

BACKGROUND AND OBJECTIVES: QT interval on ECG strongly depends on heart rate. Prolonged early phase of repolarization may be responsible for mechanisms of arrhythmogenesis. Investigation of physiologic behavior of QT interval and their relation to cardiac cycle length may explain mechanisms of arrhythmogenesis. The aim of this study is to investigate the physiologic behavior of the QT intervals during various stages of treadmill exercise test in healthy airlines pilots. METHOD: A retrospective analysis of treadmill exercise test ws done in 60 healthy men. Each underwent 10 ECG recordings, which were performed in resting, 1 minute, 2 minute and 3 minute of exercise stage 1, 2 and 3 of Bruce protocol respectively. The QT interval was measured as the time interval from the earliest Q onset to the peak T wave (QTp) in precordial lead V2. RESULTS: The mean heart rate before exercise was 72 +/-5 beats/minute, and at 1, 2 and 3 minute of exercise stage 1, 2 and 3 were 96 +/-8, 97 +/-7, 99 +/-9, 112 +/-9, 117 +/-9, 120 +/-10, 137 +/-12, 145 +/-12 and 152 +/-10, respectively. The d-QTp/d-RR at 1, 2 and 3 minute of exercise stage 1, 2 and 3 were 10.4 +/-5.9, 14.1 +/-5.8, 15.1 +/-6.2, 14.8 +/-4.2, 16.1 +/-3.7, 16.3 +/-3.5, 16.8 +/-2.9, 17.1 +/-3.0%, respectively. The QTp interval respond slowly for rapid changes in cycle length. The change of QTp interval showed a linear correlation with the change of the RR interval (y=0.189x-10.864, r=0.83, P<0.0001). CONCLUSION: The changes in QT interval lagged behind the rapid and sustained changes in the heart rate elicited by treadmill exercise test. It is concluded that the d-QTp/d-RR showed hysteresis in the changes in the RR interval may be useful in assessing in the dynamic regulation of the ventricular repolariza-tion process.

Characteristics of QT Interval Dispersion During Exercise-induced Changes of Heart Rate

BACKGROUND: QT interval dispersion (QTD) reflects the regional inhomogeneity of ventricular repolarization, and heart rate variability reflects the autonomic tone of the heart. The relation between QTD and heart rate is not clarified yet. The object of this study was to examine the influence of heart rate on QTD using exercise treadmill test in healthy subjects. METHODS: The influence of heart rate on QTD was studied in 42 young healthy pilots by evaluating the changes in QTD induced by hyperventilation and exercise. QTpeak interval dis-persion (QTp D) was defined as the difference between maximum and minimum QTpeak interval measured on 12 lead ECG at single cardiac beat. Paired t test was used between QTp D at rest, QTp D after hyperventilation and QTp D after exercise to determine the effect of heart rate on QTp D. RESULTS: The QTp D after hyperventilation (37+/-11 msec) was greater compared to QTp D at rest (35 +/-14 msec), but there was no difference (P>0.05). The QTp D after exercise was 31 +/-11 msec at stage 1, 28 +/-13 msec at statge 2 and 31 +/-12 msec at stage 3. and there was the significant difference in QTp D at statge 2 compared to QTp D at rest (P<0.05). CONCLUSION: The QTp D significantly decreased at stage 2 after graded exercise in healthy men. This finding suggests that anti-arrhythmogenic effect associated with decreased QTp D during physiologic exercise is present in apparently healthy men.

Relationship between ST segment of lateral leads and culprit arteries in acute inferior myocardial infarction

BACKGROUND AND OBJECT: We intended to assess the characteristics of ST segment deviation in lateral leads(aVL, I, V5, V6) in patients with acute inferior myocardial infarction(AIMI) and find out the relationship with culprit arteries. MATERIALS AND METHOD: The subjects were 51 patients diagnosed as AIMI by standard electrocardiogram, cardiac enzymes and typical chest pain. Subjects were devided into two groups by angiographically proven culprit arteries ; left circumflex artery(LCx) group and right coronary artery(RCA) group. We compared the frequencies of ST segment depression more than 1 mm and less than 1 mm in aVL and I, and ST segment elevation more than 0.5 mm and less than 0.5 mm in V5 and V6 in each culprit artery group. RESULTS: Among 51 patients with AIMI, 42 were RCA group and 9 were LCx group. The frequency of ST segment depression more than 1 mm in aVL was 44% in LCx group and 71% in RCA group(p=0.140). 11% of LCx group and 43% of RCA group showed more than 1 mm ST segment depression in lead I (p=0.128). 56% of LCx group showed more than 0.5 mm ST segment elevation in V5 and V6 and 81% of RCA group showed less than 0.5 mm ST segment elevation in V5 and V6 (p=0.036). CONCLUSION: Culprit arteries in patients with AIMI and ST segment deviation in V5 and V6 are significantly related with each other. ST segment elevation more than 0.5 mm in V5 and V6 was predominantly found in LCx group than RCA group. Observation for ST segment deviation in lateral precordial lead V5 and V6 would be important in predicting the culprit artery in AIMI.