mdlinx mdlinx
Latest (458) Full Text Articles (5583) Article Summary

Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction
Annals of Emergency Medicine,

Smith SW et al. – R–wave amplitude is lower, ST–segment elevation greater, and corrected QT interval (QTc) longer for subtle anterior ST–segment elevation myocardial infarction (STEMI) versus early repolarization. In combination with other clinical data, this derived and validated ECG equation could be an important adjunct in the diagnosis of anterior STEMI.

Methods
  • This was a retrospective study of patients with anterior STEMI (2003 to 2009) and early repolarization (2003 to 2005) at 2 urban hospitals, one of which (Minneapolis Heart Institute) receives 500 STEMI patients per year.
  • The authors compared the ECGs of nonobvious (“subtle”) anterior STEMI with emergency department noncardiac chest pain patients with early repolarization.
  • ST-segment elevation at the J point and 60ms after the J point, T-wave amplitude, R-wave amplitude, QTc, upward concavity, J-wave notching, and T waves in V1 and V6 were measured.
  • Multivariate logistic regression modeling was used to identify ECG measurements independently predictive of STEMI versus early repolarization in a derivation group and was subsequently validated in a separate group.

Results
  • Of 355 anterior STEMIs identified, 143 were nonobvious, or subtle, compared with 171 early repolarization ECGs.
  • ST-segment elevation was greater, R-wave amplitude lower, and T-wave amplitudeavg/R-wave amplitudeavg higher in leads V2 to V4 with STEMI versus early repolarization.
  • Computerized QTc was also significantly longer with STEMI versus early repolarization.
  • T-wave amplitude did not differ significantly between the groups, such that the T-wave amplitudeavg/R-wave amplitudeavg difference was entirely due to the difference in R-wave amplitude.
  • An ECG criterion based on 3 measurements (R-wave amplitude in lead V4, ST-segment elevation 60ms after J-point in lead V3, and QTc) was derived and validated for differentiating STEMI versus early repolarization, such that if the value of the equation ([1.196 x ST-segment elevation 60ms after the J point in lead V3 in mm]+[0.059 x QTc in ms]-[0.326 x R-wave amplitude in lead V4 in mm]) is greater than 23.4 predicted STEMI and if less than or equal to 23.4, it predicted early repolarization in both groups, with overall sensitivity, specificity, and accuracy of 86% (95% confidence interval [CI] 79, 91), 91% (95% CI 85, 95), and 88% (95% CI 84, 92), respectively, with positive likelihood ratio 9.2 (95% CI 8.5 to 10) and negative likelihood ratio 0.1 (95% CI 0.08 to 0.3).
  • Upward concavity, upright T wave in V1 or T wave, in V1 greater than T wave in V6, and J-wave notching did not provide important information.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Nursing

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Nursing Articles

Last month's top read Top Articles of 2013

1 Ticks may cause double trouble, Stanford scientists find Full Text EurekAlert!, February 21, 2014    Free full text

2 'Putting the next generation of brains in danger' Full Text CNN Health, February 18, 2014    Free full text

3 How grazing affects your digestive function U.S. News & World Report - Health, January 30, 2014

4 A meta-analysis of coffee intake and risk of urolithiasis Urologia Internationalis, February 7, 2014    Clinical Article

5 Personal health: tackling menopauses side effects The New York Times, February 12, 2014

6 Yogurt consumption and impact on health: focus on children and cardiometabolic risk American Journal of Clinical Nutrition, March 21, 2014    Review Article

7 Long-term coffee consumption and risk of cardiovascular disease Circulation, February 11, 2014    Evidence Based Medicine    Review Article    Clinical Article

8 Tea consumption and leukemia risk: A meta-analysis Tumor Biology, February 12, 2014    Evidence Based Medicine    Clinical Article

9 Coffee intake and gastric cancer risk Cancer Epidemiology, Biomarkers & Prevention, March 19, 2014    Clinical Article

10 Effects of pomegranate juice consumption on inflammatory markers in patients with type 2 diabetes: A randomized, placebo-controlled trial Journal of Research in Medical Sciences, March 20, 2014    Clinical Article

11 Egg consumption and cardiovascular disease among diabetic individuals: A systematic review of the literature Full Text Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, March 28, 2014    Free full text    Review Article

12 Could you relationship with your mom increase your childs chances of obesity? Full Text EurekAlert!, February 3, 2014    Free full text

13 Coffee consumption and prostate cancer risk: An updated meta-analysis Cancer Causes and Control, March 3, 2014    Evidence Based Medicine    Clinical Article

14 Heated vegetable oils and cardiovascular disease risk factors Vascular Pharmacology, March 20, 2014    Review Article

15 Animal protein intake is associated with higher-level functional capacity in elderly adults: The Ohasama study Journal of the American Geriatrics Society, March 5, 2014    Clinical Article

16 Coffee consumption and risk of prostate cancer: A meta-analysis of prospective cohort studies Carcinogenesis, January 17, 2014    Evidence Based Medicine    Review Article

17 Vascular dysfunction and chronic obstructive pulmonary disease Hypertension, February 26, 2014    Clinical Article

18 Egg consumption and risk of GI neoplasms: dose–response meta-analysis and systematic review European Journal of Nutrition, February 6, 2014    Evidence Based Medicine    Review Article

19 Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis International Journal of Cardiology, March 17, 2014    Evidence Based Medicine    Review Article    Clinical Article

20 Is ginger effective for the treatment of irritable bowel syndrome? A double blind randomized controlled pilot trial Complementary Therapies in Medicine, March 4, 2014    Clinical Article

Indexed Journals in Nursing: Journal of Advanced Nursing, Journal of Clinical Nursing, Nurse Education In Practicemore

Other Topics in Nursing

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Stay current - Media Tool

Newsletter
RSS
Follow
Like

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close