Akut inferiyor miyokard infarktüsünde elektrokardiyografinin anjiyografik bulgularla ilişkisi
Küçük Resim Yok
Tarih
1999
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akut inferiyor miyokard infarktüsü (MÎ) ile gelen hastalarda sol ventrikül fonksiyonları, tutulan damar sayısı ve infarkttan sorumlu arteri tespit etmede elektrokardiyografinin (EKG) değerini araştırmak amacıyla bu çalışmayı planladık. Materyal ve Metod : Tipik göğüs ağrısının başlangıcından itibaren ilk altı saatte gelen, CK-MB değeri normalin en az iki katı olan ve EKG 'de inferiyor derivasyonlann en az iki tanesinde lmm ve üzeri ST segment yüksekliği bulunan 168 hasta (137 erkek, 31 kadın) çalışmaya alındı. EKG'de J noktasından itibaren en az 80 msn süren 0.5 mm ve üzerindeki tüm ST segment değişiklikleri kaydedildi. Ayrıca EKG'de sol ön hemiblok (LAHB) ve QRS distorsiyonu da araştırıldı. Kabulden sonraki ilk iki hafta içinde tüm vakalara koroner anjiyografi (KAG) uygulandı. KAG'de infarkttan sorumlu arter (İSA), sol ventrikül (LV) ejeksiyon fraksiyonu (EF) ve LV segmenter duvar hareket indeksi belirlendi. Bulgular : KAG'de İSA 118 hastada sağ koroner arter (RCA), 41 hastada da sol circumflex arter (LCX) olarak tespit edildi. EKG'de aVL'de DPden daha fazla ST çökmesi (A kriteri) veya DlII'de DIFdeıı daha fazla ST yükselmesi (B kriteri) RCA'nın İSA olmasını belirleme yönünden oldukça sensitif bulundu (sırasıyla % 92, %96 ). QRS distorsiyonun İSA'nın RCA olduğunu tespit etmede en spesifısik parametre olduğu bulundu (% 78). B kriteri ve QRS distorsiyonunun birlikte bulunmaları halinde ise İSA RCA için spesifisite %93 olarak belirlendi. QRS distorsiyonu ve yeni gelişen LAHB varlığı, LV fonksiyonları ile ilişkili bulundu. LAHB gelişenlerde (23 hasta) LVEF LAHB gelişmeyenlere göre düşük bulundu (% 51'e karşın % 56, p=0.04). Ayrıca LAHB gelişenlerde LAD tutulumu daha sık gözlendi (pO.001). QRS distorsiyonu bulunan grupta da (83 hasta) LVEF daha düşük bulundu. (% 50'ye karşın % 59, pO.001). Buna paralel olarak QRS distorsiyonu bulunan grupta LV duvar hareket indeksi ise yüksek bulundu (1.69'a karşın 1.48, p<0.001). Sonuç olarak; noninvaziv, değerli bir test olan EKG ile çalışmamızda belirtilen özgün değişikliklerin değerlendirilmesi hastanın takip ve tedavisinde yol gösterici olabilir. 4SAnahtar Kelimeler : Elektrokardiyografi, inferiyor miyokard infarktüsü, koroner anjiyografi
Correlation Of Electrocardiogram With Angiographic Findings İn Acute Myocardial infarction In this study, we aimed to investigate the significance of electrocardiogram (ECG) to determine infarct related artery, the number of vessels involved and left ventricular functions in patients with acute inferior myocardial infarction. Material and Methods: A total of 168 patients with 137 men and 3 1 women who applied to the hospital in first six hours of typical chest pain, in whom CK-MB levels increased to two times of normal levels and who had ST segment elevation of 1 mm or more on at least two of inferior derivations were included in the study. All ST segment deviations of 0.5 mm or more lasting 80 ms from J point on ECG were recorded. Additionally, left anterior hemiblock and QRS distortion was investigated on ECG. Coronary angiography was performed to all patients in first two weeks of admission. Infarct related artery, left venticular ejection fraction and wall motion index was determined on coronary angiography. Results: Infarct related artery was determined to be right coronary artery in 118 patients and circumflex artery in 41 patients on coronary angiography. More depression of ST segment on aVL than on DI (criteria A) or more elevation of ST segment on Dili than on DII (criteria B) was fairly sensitive to show right coronary artery as infarct related artery (92 % and 96 % respectively). It was found that QRS distortion was the most specific criteria to show right coronary artery being infarct related artery (78 %). In the coexistence of criteria B and QRS distortion, specificity of RCA to be infarct related artery was 93 % QRS distortion and presence of currently developed left anterior hemiblock was found to be related with left ventricular functions. Left ventricular ejection fraction was lower in patients with left anterior hemiblock (n=23) in comparison to the ones without left anterior hemiblock (51 % to 56 %, p=0.04). Besides, involvement of left anterior descending artery was more frequent in patients having left anterior hemiblock (p<0.001). Again, left ventricular ejection fraction was 50found to be lower in the patients with QRS distortion (n=83) (50 % to 59 %, pO.001). In parallel to this, left ventricular wall motion index was found to be high in patients with QRS distortion (1.69 to 1.48, p<0.001). In conclusion, evaluation of specific changes on ECG which is a valuable and noninvasive diagnostic tool, may be usefull for management and follow-up of patients in acute inferior myocardial infarction. Key Words : Coronary angiography, electrocardiogram, inferior mycardial infarction.
Correlation Of Electrocardiogram With Angiographic Findings İn Acute Myocardial infarction In this study, we aimed to investigate the significance of electrocardiogram (ECG) to determine infarct related artery, the number of vessels involved and left ventricular functions in patients with acute inferior myocardial infarction. Material and Methods: A total of 168 patients with 137 men and 3 1 women who applied to the hospital in first six hours of typical chest pain, in whom CK-MB levels increased to two times of normal levels and who had ST segment elevation of 1 mm or more on at least two of inferior derivations were included in the study. All ST segment deviations of 0.5 mm or more lasting 80 ms from J point on ECG were recorded. Additionally, left anterior hemiblock and QRS distortion was investigated on ECG. Coronary angiography was performed to all patients in first two weeks of admission. Infarct related artery, left venticular ejection fraction and wall motion index was determined on coronary angiography. Results: Infarct related artery was determined to be right coronary artery in 118 patients and circumflex artery in 41 patients on coronary angiography. More depression of ST segment on aVL than on DI (criteria A) or more elevation of ST segment on Dili than on DII (criteria B) was fairly sensitive to show right coronary artery as infarct related artery (92 % and 96 % respectively). It was found that QRS distortion was the most specific criteria to show right coronary artery being infarct related artery (78 %). In the coexistence of criteria B and QRS distortion, specificity of RCA to be infarct related artery was 93 % QRS distortion and presence of currently developed left anterior hemiblock was found to be related with left ventricular functions. Left ventricular ejection fraction was lower in patients with left anterior hemiblock (n=23) in comparison to the ones without left anterior hemiblock (51 % to 56 %, p=0.04). Besides, involvement of left anterior descending artery was more frequent in patients having left anterior hemiblock (p<0.001). Again, left ventricular ejection fraction was 50found to be lower in the patients with QRS distortion (n=83) (50 % to 59 %, pO.001). In parallel to this, left ventricular wall motion index was found to be high in patients with QRS distortion (1.69 to 1.48, p<0.001). In conclusion, evaluation of specific changes on ECG which is a valuable and noninvasive diagnostic tool, may be usefull for management and follow-up of patients in acute inferior myocardial infarction. Key Words : Coronary angiography, electrocardiogram, inferior mycardial infarction.
Açıklama
Anahtar Kelimeler
Elektrokardiyografi, Electrocardiography, Kalp, Heart, Koroner hastalık, Coronary disease, Miyokard enfarktüsü, Myocardial infarction
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Uluca, Y. (1999). Akut inferiyor miyokard infarktüsünde elektrokardiyografinin anjiyografik bulgularla ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
