Myocardial infarction location

Table 5.4 Proportions of agreement between electrocardiographic patterns and contrast-enhanced cardiovascular magnetic resonance for the different myocardial infarction locations and their 95% confidence interval. (Bayes de Luna 2006a)...

Myocardial infarction location Proportions of Agreement 95% Confidence Interval ... 

Bayes de Luna A, Cino JM, Pujadas S et al. Concordance of electrocardiographic patterns and healed myocardial infarction location detected by cardiovascular magnetic resonance. Am J Cardiol 2006a 97 443. 

No information on potentially susceptible populations was located for HCFC-141b. A structurally related chemical, 1,1,1,2-tetrafluoroethane, has been tested in metered-dose inhalers for the treatment of asthma. Test subjects included adult and pediatric asthma patients as well as individuals with severe COPD. No adverse effects were reported (Smith et al. 1994 Taggart et al. 1994 Ventresca 1995 Woodcock 1995). The structurally related chemicals trichlorofluoromethane (CFC-11) and dichlorodifluoromethane (CFC-12) are presently used in metered-dose inhalers for the treatment of asthma but are phased out under the Montreal Protocol of 1987 (Alexander 1995). Structurally related compounds including 1,1,1-trichloroethane and trichlorofluoromethane were also tested for cardiac sensitization in a dog model with experimentally induced myocardial infarction. In these experiments cardiac sensitization occurred under the same conditions as in healthy dogs (Trochimowicz et al. 1976). 

The ACE gene encodes two isozymes (somatic ACE isozyme and germinal ACE isozyme). ACE is a membrane-bound enzyme on the surface of vascular endothelial cells that also circulates in plasma and shows great individual variability determined by an I/D polymorphism in intron 16 of the ACE gene (ACE-I/D polymorphism). More than 160 ACE polymorphisms have been reported, 34 of which are located in coding regions, and 18 are missense mutations (606). ACE-related polymorphic variants have been associated with hypertension, atherosclerosis, stroke, left ventricular hypertrophy, chronic renal failure in IgA nephropathy, Henoch-Schonlein purpura nephritis, mechanical efficiency of skeletal muscle, intracranial aneurysms, susceptibility to myocardial infarction, diabetic nephropathy, AD, and longevity (12,606,607). 

Finally, there is variability of the treatment given and the underlying disease process for any individual patient. For example, a patient may have substantial ventricular mechanical dyssynchrony and have a successfully placed CRT device with appropriate lead locations. If very careful measures of ventricular performance are made, the patient s heart functions better with CRT on than off. However, if the patient suffers from a subsequent myocardial infarction or progressive ischemia, he may not improve clinically. Accordingly, at the end of a trial period, such a patient is termed a nonresponder even though he may be doing better with the device... 

Table 5.6 Sensitivity, specificity and predictive accuracy of various electrocardiographic criteria for patients with complete LBBB and myocardial infarction, in relation to the specific location of infarction detected by 201-thallium scintigraphy.

Bay6s de Luna A, Wagner G, Birnbaum Y et al. A new terminology for the left ventricular walls and for the location of myocardial infarcts that present Q wave based on the standard of cardiac magnetic resonance imaging a statement for healthcare professionals from a committee appointed by the International Society for Holter and Non Invasive Electrocardiography. Circulation 2006c 114 1755. 

Elsman P, Van t Hof AW, de Boer MJ et al. Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention. Am Heart J 2006 151 1239.e9-14. 

Fiol M, Cino J, Carrillo A, I et al. The value of an algorithm based on ST segment deviations to locate the place of oc-clussion in left anterior descending coronary artery in case of ST-segment elevation-myocardial infarction 2007. Submitted. 

Kandzari DE, Tcheng JE, Gersh BJ et al. CADILLAC Investigators. Relationship between infarct artery location, epi-cardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J 2006 151 1288. 

Roberts WC, Gardin JM. Location of myocardial infarcts a confusion of terms and definitions. Am J Cardiol 1978 42 868. 

Shalev Y, Fogelman R, Oettinger M, Caspi A. Does the electrocardiographic pattern of anteroseptal myocardial infarction correlate with the anatomic location of myocardial injury Am J Cardiol 1995 75 763. 

Wu E, Judd RM, Vargas JD, Klocke FJ, Bonow RO, Kim RJ. Visualization of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet 2001 357 21. 

Zafrir B, Zafrir N, Gal T et al. Correlations between ST elevation and Q waves on the predischarge electrocardiogram and the extent location of MIBI perfusion defects in anterior myocardial infarction. Ann Noninvasive Electrocar-diol 2004 9 101. 

FICURE 11-6. Schematic drawing of two-dimensional echocardiography to illustrate location of cardiac structures as "seen" by the transducer. The transducer is swept in an arc so that several pictures of the heart are obtained to generate the final electrocardiogram. (Redrawn from Coryu BQ et al. Application of electrocardiography in acute myocardial infarction. Cardiovasc Clin 1995 2 113, with permission.)... 

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