The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk Stratification

136 Pages·2002·29.1 MB·English

by  Hein J.J. Wellens

THE ECG IN
ACUTE MYOCARDIAL
INFARCTION AND UNSTABLE
ANGINA
Developments in Cardiovascular Medicine
232. A. Bayés de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.):
Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X
233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease.
2000. ISBN: 0-7923-7829-6
234. J. Candell-Riera, J. Castell-Conesa, S. Aguadé Bruiz (eds): Myocardium at
Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3
235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing: New Conceptsfor the
NewCentury. 2001. ISBN: 0-7923-7378-2
236. Douglas L. Mann (ed.): The Role of Inflammatory Mediators in the Failing
Heart. 2001 ISBN: 0-7923-7381-2
237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac
Contractile Force, Second Edition. 2001 ISBN: 0-7923-7157-7
238. Brian D. Hoit, Richard A. Walsh (eds.): Cardiovascular Physiology in the
Genetically Engineered Mouse, Second Edition. 2001 ISBN 0-7923-7536-X
239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians
2001 ISBN 1-4020-0097-9
240. Stephen M. Factor, Maria A.Lamberti-Abadi, Jacobo Abadi (eds.): Handbook of
Pathology and Pathophysiology ofCardiovascular Disease. 2001
ISBN0-7923-7542-4
241. Liong Bing Liem, Eugene Downar (eds): Progress in Catheter Ablation. 2001
ISBN 1-4020-0147-9
242. Pieter A. Doevendans, Stefan Kääb (eds): Cardiovascular Genomics: New
PathophysiologicalConcepts. 2002 ISBN 1-4020-7022-5
243. Antonio Pacifico (ed.), Philip D. Henry, Gust H. Bardy, Martin Borggrefe,
Francis E. Marchlinski, Andrea Natale, Bruce L. Wilkoff (assoc. eds):
Implantable Defibrillator Therapy: A Clinical Guide. 2002
ISBN 1-4020-7143-4
244. Hein J.J. Wellens, Anton P.M. Gorgels, Pieter A. Doevendans (eds.):
The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk
Stratification. 2002 ISBN 1-4020-7214-7
Previous volumes are still available
THE ECG IN
ACUTE MYOCARDIAL
INFARCTION AND UNSTABLE
ANGINA
Diagnosis and Risk Stratification
by
Hein J.J. Wellens
Anton P.M. Gorgels
Academic Hospital, Maastricht
The Netherlands
and
Pieter A. Doevendans, MD
Interuniversity Cardiology Institute of The Netherlands
Utrecht, The Netherlands
KLUWER ACADEMIC PUBLISHERS
NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW
eBookISBN: 0-306-48202-9
Print ISBN: 1-4020-7214-7
©2002 Kluwer Academic Publishers
NewYork, Boston, Dordrecht, London, Moscow
Print ©2003 Kluwer Academic Publishers
Dordrecht
All rights reserved
No part of this eBook maybe reproducedortransmitted inanyform or byanymeans,electronic,
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Createdin the United States of America
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CONTENTS
Chapter 1 Introduction 1
Chapter 2 Determining the size of the area at risk, the severity
of ischemia, and identifying the site of occlusion in
the culprit coronary artery 5
A. The ST segment deviation score 9
B. The terminal QRS-ST segment pattern 11
C. Specific ECG patterns indicating the site of
coronary artery occlusion: 13
I Infero-posterior myocardial infarction with
or without right ventricular infarction 13
II Anterior wall myocardial infarction 24
Chapter 3 Conduction disturbances in acute myocardial
infarction 43
A. The sino-atrial region 45
B. The AV nodal conduction system 49
C. The sub-AV nodal conduction system 53
Chapter 4 Myocardial infarction in the presence of abnormal
ventricular activation 65
A. Left bundle branch block 68
B. Paced ventricular rhythm 76
C. Pre-excitation 79
Chapter 5 Arrhythmias in acute myocardial infarction:
Incidence and prognostic significance 85
A. Supraventricular arrhythmias 87
B. Ventricular arrhythmias 91
Chapter 6 The electrocardiographic signs of reperfusion 99
Chapter 7 The electrocardiogram in unstable angina 117
Recognition of multivessel and left main disease
Recognition of critical narrowing of the left anterior
descending coronary artery
Index 127
ERRATA
The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and
Risk Stratification
by: Hein J.J. Wellens, Anton P.M. Gorgels and PieterA. Doevendans
ISBN: 1-4020-7214-7
The publisher regrets that due to a publishingerror, the incorrect series number
appears on the series page and the back cover. The correct series number is
DICM245. The corrected series page appears below.
Kluwer Academic Publishers
Developments in Cardiovascular Medicine
232. A. Bayés de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.):
Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X
233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease.
2000. ISBN: 0-7923-7829-6
234. J. Candell-Riera, J. Castell-Conesa, S. Aguadé Bruiz (eds): Myocardium at
Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3
235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing: New Conceptsfor the
New Century. 2001. ISBN: 0-7923-7378-2
236. Douglas L. Mann (ed.): The Role ofInflammatory Mediators in the Failing
Heart. 2001 ISBN:0-7923-7381-2
237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac
Contractile Force,SecondEdition. 2001 ISBN: 0-7923-7157-7
238. BrianD. Hoit,RichardA.Walsh(eds.): CardiovascularPhysiologyinthe
Genetically EngineeredMouse, Second Edition. 2001 ISBN 0-7923-7536-X
239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians
2001 ISBN 1-4020-0097-9
240. Stephen M. Factor, Maria A.Lamberti-Abadi, Jacobo Abadi (eds.): Handbook of
Pathology and Pathophysiology of Cardiovascular Disease. 2001
ISBN 0-7923-7542-4
241. Liong Bing Liem, Eugene Downar(eds): Progress in Catheter Ablation. 2001
ISBN 1-4020-0147-9
242. Pieter A. Doevendans, Stefan Kääb (eds): Cardiovascular Genomics: New
Pathophysiological Concepts. 2002 ISBN 1-4020-7022-5
243. Daan Kromhout, Alessandro Menotti, Henry Blackburn (eds.): Prevention
ofCoronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven
Countries Study. 2002 ISBN 1-4020-7123-X
244. Antonio Pacifico (ed.), Philip D. Henry, Gust H. Bardy, Martin Borggrefe,
Francis E. Marchlinski, Andrea Natale, Bruce L. Wilkoff (assoc. eds):
Implantable Defibrillator Therapy: A Clinical Guide. 2002
ISBN 1-4020-7143-4
245. Hein J.J. Wellens, AntonP.M. Gorgels, Pieter A. Doevendans (eds.):
The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk
Stratification. 2002 ISBN 1-4020-7214-7
Previous volumes are still available
Authors
Pieter A. Doevendans, M.D.
Associate Professor of Cardiology,
Department of Cardiology
Academic Hospital Maastricht
University of Maastricht, the Netherlands
Anton P. Gorgels, M.D.
Associate Professor of Cardiology
Department of Cardiology
Academic Hospital Maastricht
University of Maastricht, the Netherlands
Hein J.J.Wellens, M.D.
Professor of Cardiology
Medical Director of the Interuniversity Cardiology Institute of the Netherlands
(ICIN)
Utrecht, the Netherlands
Acknowledgements
Over the years the cardiologists, residents, fellows and nursing staff, working at
the Department of Cardiology of the Academic Hospital of Maastricht, have
carefully collected the electrocardiograms published in this book. We are very
much indebted to them for their enthusiasm and willingness to donate those
pearls to us!
To have the electrocardiograms perfectly reproduced we had the good fortune
to have Adrie van den Dool working for us. She and the medical photography
group of the hospital did a perfect job, demonstrating again their ability to
make beautiful illustrations.
Excellent secretarial assistance was provided by Birgit van den Burg, Miriam
Habex, Vivianne Schellings and Willemijn Gagliardi. We greatly appreciated
their pleasant, never complaining way of helping us again and again!
Manja Helmers played an important role in the final phase by expertly
producing the layout of the manuscript.
Hein J.J. Wellens
Anton P.M. Gorgels
Pieter A. Doevendans
1
Chapter
Introduction