Anterior wall ST-elevation myocardial infarction in biventricular paced rhythm.

There is a lack of evidence on electrocardiographic criteria for ST-elevation myocardial infarction (STEMI) in patients with biventricular paced rhythm. In all previous case reports of STEMI in biventricular paced rhythm, concordant ST-elevations and/or discordant ST-elevations >5 mm were present. This report describes the case of a patient with anterior STEMI and discordant ST-elevations of less than 5 mm during biventricular stimulation with epicardial left ventricular lead and highlights the importance of comparing the electrocardiogram to previous recordings when STEMI is suspected.

Compression test (Gaenslen's squeeze test) positivity, joint tenderness, and disease activity in patients with rheumatoid arthritis.

OBJECTIVE: Gaenslen's test (GT) positivity is characterized by tenderness upon lateral compression (squeezing) of the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joints. We aimed to assess the factors related to a positive GT and to explore differences in disease activity between GT-positive and -negative patients. METHODS: The GT was performed routinely in outpatients with rheumatoid arthritis (RA). In total, 229 patients had a positive GT (GT-positive group). To this group, we matched a GT-negative group (n = 222) comparable in sex, age, disease duration, and rheumatoid factor (RF) positivity. Disease activity scores, swollen and tender joint counts, patient pain and global assessments, evaluator's global assessment, morning stiffness, disability assessments, acute phase reactants, RF, and anti-citrullinated protein antibody levels were assessed and used for correlation analyses. A comparison between the GT-positive and -negative groups was performed and a regression model was calculated. RESULTS: All clinical variables, including disease activity scores, joint counts, and disability assessments, were significantly higher in the GT-positive group than the GT-negative group. Also, there were significantly fewer patients in remission or with low disease activity in the GT-positive group. GT positivity correlated most strongly (r > 0.5) with joint tenderness (32- and 28-joint counts). Tender proximal interphalangeal, MCP, and MTP joints appeared mostly responsible for a positive GT, but more than 1 MCP/MTP joint had to be tender to explain a positive GT. CONCLUSION: The GT is related primarily to tenderness in MCP and MTP joints and signifies a moderate to high disease activity among patients with RA.