Document Detail


Patients with circumflex occlusions miss out on reperfusion: how to recognize and manage them.
MedLine Citation:
PMID:  22565144     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: To review the diagnosis of circumflex occlusion, and why it is important for patient care. RECENT FINDINGS: The ECG is an essential tool for identifying patients who might benefit from reperfusion therapy with ST segment elevation being a requirement. However, circumflex occlusions are often not recognized. Patients with circumflex acute coronary syndromes (ACSs) often present without ST segment elevation even when there is a total occlusion causing a full-thickness inferobasal (previously called posterior) infarction. Recent registries and trials show overrepresentation of circumflex occlusions in non-ST elevation ACS and underrepresentation in ST elevation myocardial infarction populations. This is because usually only the 12-lead ECG has been recorded.Leads V7-V9 should be recorded if there is a clinical suspicion of circumflex territory involvement, such as ST depression in leads V1-V3, or presentation with a normal 12-lead ECG with hemodynamic compromise. SUMMARY: If ST elevation in the circumflex territory is not recognized, patients may be treated inappropriately as having a non-ST elevation ACS without having primary percutaneous coronary intervention or receiving early administration of fibrinolytic therapy. There is a large opportunity for saving thousands of lives worldwide if circumflex occlusions are recognized and treated appropriately.
Authors:
Cheuk-Kit Wong; Harvey D White
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-4
Journal Detail:
Title:  Current opinion in cardiology     Volume:  -     ISSN:  1531-7080     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aDivision of Cardiology, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin bGreen Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
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