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급성 하벽심근경색증에 동반된 ST 절의 상호 하강 ( V₁ - V₃ ) 에 대한 연구
류혜영(Hyae Young Lew),윤용선(Yong Sun Yun),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Wha Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Background: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. Methods: From January 1991 to December 1994, 38 patients with acute inferior myocardial infarction were treated at the Department of Internal Medicine in Kyung Hee University Hospital. Clinical characteristics, serial electrocardiograms, and angiographic findings of coronary artery and left ventriculography, echocardiography were reviewed. Reciprocal ST-segment depression was defined as ST-segment depression≥1.0mm in two or more adjacent precordial leads(V₁-V₃) in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and echocardiography were performed within 24 hours from admission. In this study, angiographic distribution score was used to define the perfusion territory causing inferior ischemia. Results : 1) The summation of ST-segment elevation in II, III, aVF leads was significantly more higher in group H than group A (P<0.05). 2) However, the angiographic distribution score, peak CK levels, in-hospital complications and ejection fraction showed no difference between two groups (P>0.05). 3) There were no evidence of anterior wall motion abnormality in two groups. Conclusions: Our results suggest that the S'I'- segment depression on the precordial leads in acute myocardial infarction can be explained mainly by benign reciprocal electrical change.
급성 하벽 심근 경색증 환자에서 우흉부 유도 심전도와 관동맥 조영술 소견
박종수(Jong Soo Park),이명곤(Myung Kon Lee),안영근(Young Keun An),박주형(Ju Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang),박옥규(Ock Kyu Park) 대한내과학회 1993 대한내과학회지 Vol.45 No.3
N/A Background: The right ventricular infarction is frequently associated with acute inferior myocardial infarction. It is seldom diagnosed by the conventional 12 lead electrocardiogram (EKG). However, right precordial EKG has been proved highly sensitive and specific in diagnosing the right ventricular infarction. The right ventriculr infarction is said to be associated with proximal right coronary lesions. The present study was performed to evaluate the value of the right precordial EKG in predicting the proximal RCA lesion in acute inferior wall myocardial infarction. Methods: In order to observe the relation of the EKG change and coronary angiographic findings in the RV infarction, 40 patients (men 36, women 4, mean age 57±2.4 years) with an acute inferior myocardial infarction were examined. The right precordial electrocardiogram recorded with 10 hours after the onset of chest pain, and coronary angiogram were analysed. Results: 1) The mean amplitudes of r-waves were 1.4±0.9 mm in V3R and 1.2±0.8 mm in V4R. The mean amplitudes of s-waves were 6.6±3.6mm in V3R, 4.2±1.9 mm in V4R, 2.7±1.4 mm in V5R, 1.7±1.6mm in V6R. The mean r/s ratio in right precordial leads was less than 1. The configuration of T-wave was inverted in 40. 8% of the patients in V3R, 38.6% in V4R, 38.5% in V5R and 35.9% in V6R. 2) Of the 40 studied subjects, 22 were one-vessel disease, 14 two-vessel disease, 3 three-vessel disease and one normal coronary artery. 3) Twenty eight patients had ST segment elevation in V3R, V4R and/or V5R, in which 23 had right proximal coronary stenosis and 5 had right middle or distal coronary stenosis. Among twenty three patients who had proximal right coronary stenosis & ST segment elevation in V3R, V4R and/or V5R, 19 had single proximal right coronary stenosis, 4 had left anterior descending or left circumflex coronary stenosis coincidently, All five patients that had middle or distal right coronary stenosis and ST segment elevation in V3R, V4R and/or V5R had associated left anterior descending or left circumflex stenosis. 4) In the diagnosis of proximal right coronary stenosis, the sensitivity of ST segment elevation in V3R, V4R and/or V5R is 92%, the specificity is 83%, and the predictive accuracy is 82%. Conclusion: Above results suggested that right precordial lead electrocardiogram in acute inferior myocardial infarction is a good predictor of the proximal right coronary arterial stenosis.
급성 하벽 심근경색증에서 전흉부 유도의 ST절의 상호하강이 나타난 부위에 따른 임상적 의의
이낙원,김성구 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1
Background : The clinical implication of precordial ST-segment depression during acute inferior myocardial infarction are controversal. But it is widely accepted that ST-segment depression in precordial leads is associated with high rate of complications. There has been some reports that patients with inferior wall infarction and maximal ST-segment depression in leads V4 to V6 harbor an increased risk for hospital mortality. Method : Clinical characteristics, electrocardiograms,hemodynamic findings and coronary angiographic findings were reviewed in 34 patients with acute inferior myocardial infarction. Patients were classified into 3 types based on their pattern of ST-segment depression in precordial leads.(Group Ⅰ : no ST depression, Group Ⅱ : maximal ST depression in Ⅴ1 to Ⅴ3, Group Ⅲ : maximal ST depression in Ⅴ4 to Ⅴ6) Result : There was no significant difference in demographic data of the patients except LDH, which tended to be higher in group Ⅲ than group Ⅰ. Patients in group Ⅲ presented lower mean aortic pressure and higher pulmonary wedge pressure. The prevalence of left anterior descending coronary stenosis and three vessel disease were more frequent in group Ⅲ than group Ⅰ. Conclusion : Patients with acute inferior myocardial infarction and maximal precordial ST-segment depression in leads Ⅴ4 to Ⅴ6 had more extensive myocardial damage probably due to concomittant left anterior descending coronary artery disease.
급성하벽심근경색 환자에서 흉부유도 ST 절하강의 임상적 의의
이성구(Sung Ku Lee),백효종(Hyo Jong Baek),서상문(Sang Moon Suh),천병도(Byung Do Chun),이중기(Choong Ki Lee),김신우(Shin Woo Kim),우언조(Eon Jo Woo),강승완(Seung Wan Kang),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun P 대한내과학회 1992 대한내과학회지 Vol.43 No.4
N/A The prognostic significance of precordial ST segment depression during early stages of acute inferior myocardial infarction is controversial. To examine this problem, electrocardiographic findings on admission were compared with the clinical variables in 50 patients with a first transmural inferior infarction. Patients were classified according to the admission ECG obtained an average of 7.0hours after the onset of chest pain. Twenty-five patients (group I) had≥1.0mm ST depression in at least one of leads V1 to V6 and 25 (group II) did not. There were no significant differences between the two groups in peak creatinine kinase activity, prevalence of in-hospital complications (i, e., congestive heart failure, hypotension, arrhythmias requiring treatment and death), and maximal ST elevation in inferior lead. A weak correlation existed between the quantities (mV) of inferior ST segment elevation and precordial ST depression (r=0.43, p<0.05). Thus, precordial ST depression during acute inferior infarction is not a reliable marker of the extent of myocardial damage or an adverse hospital course. Precordial ST segment depression might represent a benign electrical phenomenon.
Two Cases of Multivessel Coronary Artery Ectasias Resulting in Acute Inferior Myocardial Infarction
Huseyin Gunduz,Saadet Demirtas,Mehmet Bulent Vatan,Mehmet Akif Cakar,Ramazan Akdemir 대한심장학회 2012 Korean Circulation Journal Vol.42 No.6
The incidence of multivessel coronary artery ectasias (CAEs) among patients undergoing coronary artery angiography is very rare. All three coronary vessels can be affected by CAE, but most patients have an isolated arterial ectasia, commonly the right coronary artery. In this report we present two cases with inferior myocardial infarction that was likely caused by thrombotic occlusion of CAEs.
症例(증례) : 급성 하벽 심근경색증의 합병증으로 발생한 심실 중격 결손증심실 중격 파열 1예
이규선 ( Kyu Sun Lee ),황유정 ( Yu Jeong Hwang ),박재형 ( Jae Hyeong Park ),김현숙 ( Hyun Sook Kim ),김원호 ( Won Ho Kim ),이재원 ( Jae Won Lee ),고재기 ( Jae Ki Kop ) 전북대학교 의과학연구소 2004 全北醫大論文集 Vol.28 No.1
저자들은 급성 하벽 심근 경색증 후 발생한 복합 형태의 기저 하후부 심실 중격 파열로 인하여 우심실 기능 부전과 심인성 쇼크가 동반된 확자에서 대동맥내 풍선 펌프 삽입과 혈관 확장제 투여 등의 적극적인 내과적 치료 뿐 만 아니라 외과적으로 응급 첩포 건술을 통해 성공적으로 치료한 예를 경험 하였기에 문헌 고찰과 함께 보고하는 바이다. Ventricular septal rupture complicates 1 to 3% of all patients with myocardial infarction (MI). It is more common after anterior than inferior MI, but overall mortality is higher when it complicates inferior MI. We report a case of successful management of ventricular septal rupture complicating inferior MI with early operation. A 70-year-old male with a history of diabetes was admitted for chest pain for three days. He complained of shortness of breath and his blood pressure was 80/50mmHg at admission. The chest roentgenogram showed pulmonary edema and his electrocardiogram revealed pathologic Q wave with subtle ST segment elevation and T wave inversion in inferior leads. The echocardiography demonstrated the ventricular septal rupture involved the basal inferoposterior septum and right ventricular dysfunction. The coronary angiogram showed totally obstructed distal part of right coronary artery without collateral circulation. His circulation was supported with intraaortic balloon counterpulsation and the ventricular septal rupture was repaired with Teflon patch after resection of infracted septum successfully. He was discharged without other complications after the surgery.