Document Detail

Improved detection of posterior myocardial wall ischemia with the 15-lead electrocardiogram.
MedLine Citation:
PMID:  10539826     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A routine 12-lead electrocardiogram is commonly obtained to evaluate for possible acute myocardial infarction during the initial screening of patients with chest discomfort. Posterior myocardial infarction is commonly missed because it is not usually visible in the standard leads. In this study, we compared the sensitivity and specificity of posterior chest leads (V(7), V(8), and V(9)) and 12-lead electrocardiography in detecting posterior injury pattern during single-vessel percutaneous transluminal coronary angioplasty. METHODS AND RESULTS: Three posterior chest leads in addition to the routine 12-lead electrocardiogram were monitored simultaneously during single-vessel percutaneous transluminal coronary angioplasty of the right, circumflex, and left anterior descending coronary arteries in a total of 223 patients. Posterior injury patterns (95%) were detected mostly during circumflex coronary occlusion. Posterior leads were able to detect injury pattern in 49% (36 of 74) of patients, whereas the 12-lead electrocardiogram was able to detect only 32% (P <.04). When all 15 leads were used to detect all ST elevations, sensitivity increased to 57%, with a specificity of 98% for the circumflex coronary artery. If maximal ST depressions in leads V(2) to V(3) are considered to be from posterior myocardial injury, then the overall sensitivity is increased to 69%. CONCLUSIONS: Posterior leads significantly increased the detection of posterior injury pattern compared with the standard 12-lead electrocardiogram. Using all 15 leads significantly further improved the detection of circumflex coronary-related injury pattern over the standard 12-lead electrocardiogram.
K Khaw; A E Moreyra; A K Tannenbaum; M N Hosler; T J Brewer; J B Agarwal
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  138     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 Nov 
Date Detail:
Created Date:  1999-11-19     Completed Date:  1999-11-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  934-40     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Diagnosis, Differential
Electrocardiography / methods*
Middle Aged
Myocardial Ischemia / diagnosis*,  physiopathology,  therapy
Sensitivity and Specificity

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