Document Detail

Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9: "hidden" ST-segment elevations revealing acute posterior infarction.
MedLine Citation:
PMID:  10483956     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study was done to determine whether electrocardiographic (ECG) isolated ST-segment elevation (ST) in posterior chest leads can establish the diagnosis of acute posterior infarction in patients with ischemic chest pain and to describe the clinical and echocardiographic characteristics of these patients. BACKGROUND: The absence of ST on the standard 12-lead ECG in many patients with acute posterior infarction hampers the early diagnosis of these infarcts and thus may result in inadequate triage and treatment. Although 4% of all acute myocardial infarction (AMI) patients reveal the presence of isolated ST in posterior chest leads, the significance of this finding has not yet been determined. METHODS: We studied 33 consecutive patients with ischemic chest pain suggestive of AMI without ST in the standard ECG who had isolated ST in posterior chest leads V7 through V9. All patients had echocardiographic imaging within 48 h of admission, and 20 patients underwent coronary angiography. RESULTS: Acute myocardial infarction was confirmed enzymatically in all patients and on discharge ECG pathologic Q-waves appeared in leads V7 through V9 in 75% of the patients. On echocardiography, posterior wall-motion abnormality was visible in 97% of the patients, and 69% had evidence of mitral regurgitation (MR), which was moderate or severe in one-third of the patients. Four patients (12%), all with significant MR, had heart failure, and one died from free-wall rupture. The circumflex coronary artery was the infarct related artery in all catheterized patients. CONCLUSIONS: Isolated ST in leads V7 through V9 identify patients with acute posterior wall myocardial infarction. Early identification of those patients is important for adequate triage and treatment of patients with ischemic chest pain without ST on standard 12-lead ECG.
S Matetzky; D Freimark; M S Feinberg; I Novikov; S Rath; B Rabinowitz; E Kaplinsky; H Hod
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  34     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-09-24     Completed Date:  1999-09-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  748-53     Citation Subset:  AIM; IM    
Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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MeSH Terms
Coronary Angiography / statistics & numerical data
Echocardiography / instrumentation,  methods,  statistics & numerical data
Electrocardiography / instrumentation,  methods*,  statistics & numerical data
Middle Aged
Myocardial Infarction / diagnosis*
Comment In:
J Am Coll Cardiol. 2000 Aug;36(2):658-9   [PMID:  10933388 ]

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