Document Detail

Sequence of electrocardiographic and acoustic cardiographic changes and angina during coronary occlusion and reperfusion in patients undergoing percutaneous coronary intervention.
MedLine Citation:
PMID:  19419398     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies have suggested that ventricular function may be impaired without or prior to electrocardiographic changes or angina during ischemia. Understanding of temporal sequence of electrical and functional ischemic events may improve the detection of myocardial ischemia. METHODS: A prospective study was performed in 21 subjects undergoing percutaneous coronary intervention (PCI) who had both ST amplitude changes >2 standard deviations above baseline on 12-lead electrocardiography (ECG), and new or increased third or fourth heart sound (S3 or S4) intensity measured by computerized acoustic cardiography. The sequence of the onset and resolution of these signs of ischemia were examined following coronary balloon inflation and deflation. RESULTS: Electrocardiographic ST amplitude and diastolic heart sound changes occurred contemporaneously, shortly after coronary occlusion (mean onset from balloon inflation; ST changes, 21 +/- 17 seconds; S4, 25 +/- 26 seconds; S3, 45 +/- 43 seconds). In 40% of patients, a new or increased S3 or S4 developed earlier than ST changes. Anginal symptoms occurred in only 2 of the 21 subjects during ischemia with a mean onset time of 68 seconds. ST-segment changes resolved earliest (33 seconds after balloon deflation) while diastolic heart sounds (89 +/- 146 seconds) and angina (586 +/- 653 seconds) resolved later. CONCLUSION: A new or intensified S3 and/or S4 occurred contemporaneously with electrocardiographic changes during ischemia. These diastolic heart sounds persisted longer than ST changes following coronary reperfusion. Acoustic cardiographic assessment of diastolic heart sounds may aid in the early detection of myocardial ischemia, particularly in those patients with an uninterpretable ECG.
Eunyoung Lee; Barbara J Drew; Ronald H Selvester; Andrew D Michaels
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  14     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-07     Completed Date:  2009-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  137-46     Citation Subset:  IM    
Department of Physiological Nursing, University of California-San Francisco, 2 Koret Way, San Francisco, CA 94143-0610, USA.
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MeSH Terms
Angina Pectoris / diagnosis*,  physiopathology
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Occlusion / diagnosis*,  physiopathology
Electrocardiography / methods*
Heart Auscultation / methods
Heart Sounds*
Middle Aged
Myocardial Reperfusion / methods*
Prospective Studies
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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