Importance of reciprocal leads in acute myocardial infarction
G P Parale1, P M Kulkarni, S K Khade
1Department of Medicine, Dr. VM Medical College and Ashwini Hospital, Solapur.
Insights
Reciprocal ECG changes in myocardial infarction (MI) can indicate culprit artery location and left ventricular (LV) function. Anterior wall MI with inferior Q waves suggests smaller infarcts and better LV function, while inferior wall MI with apicolateral ST depression indicates multivessel disease and dysfunction.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
- Interventional Cardiology
Background:
- Acute myocardial infarction (MI) diagnosis and management rely heavily on electrocardiogram (ECG) findings.
- Reciprocal ECG changes, often overlooked, may provide crucial information about infarct location and severity.
- Understanding the correlation between reciprocal changes, coronary artery anatomy, and left ventricular (LV) function is vital for patient stratification.
Purpose of the Study:
- To investigate the diagnostic relevance of ECG reciprocal lead changes in acute anterior wall MI (AWMI) and inferior wall MI (IWMI).
- To correlate these ECG findings with culprit coronary artery localization.
- To assess the impact of reciprocal changes on left ventricular (LV) function.
Main Methods:
- A study of 300 patients with acute MI (180 anterior, 120 inferior) aged 30-90 years.
- Analysis of reciprocal ECG lead changes in relation to culprit coronary artery and LV function.
- Echocardiography (n=285) and coronary angiography (CAG, n=62) were performed to assess LV ejection fraction (LVEF) and coronary anatomy.
Main Results:
- In AWMI, inferior Q waves (38.8%) correlated with distal/mid Left Anterior Descending (LAD) artery occlusion (80% in single-vessel disease) and preserved LVEF (>40% in 78.9%).
- Reciprocal ST depression in inferior leads in AWMI was associated with higher LV dysfunction (LVEF <40% in 72.05%).
- In IWMI, apicolateral ST depression (80%) indicated multivessel disease (77.8%) and significant LV dysfunction (LVEF <40% in 78.12%). ST depression in leads I, aVL suggested Right Coronary Artery (RCA) lesions (85.2%).
Conclusions:
- Inferior Q waves in AWMI signify smaller infarcts, distal LAD occlusion, and better LV function.
- Absence of reciprocal changes in AWMI predicts better LVEF.
- Apicolateral ST depression in IWMI points to multivessel disease and LV dysfunction, while reciprocal changes in leads I, aVL suggest RCA lesions.
Objectives:
To study the relevance of the ECG changes in the reciprocal leads in patients with acute anterior and inferior wall myocardial infarction, with regard to culprit artery localization and left ventricular (LV) function.
Methods:
Three hundred patients of acute myocardial infarction (AMI) (180 anterior, 120 inferior) aged between 30-90 years (mean age - 60 yrs; M:F - 220:80) were studied with regard to the reciprocal lead changes which were correlated with the culprit coronary artery and LV function. 285/300 (95%) patients underwent echocardiography and 62/300 (20.67%) underwent coronary angiography (CAG).
Results:
In patients with acute anterior wall MI (AWMI), Q wave in inferior leads was found in 38.8% (70/180) patients. Nineteen patients underwent (CAG) and all 70 patients underwent 2D echocardiography. CAG revealed 10/19 and 9/19 patients to have single vessel disease (SVD) and multivessel disease (MVD), respectively. In presence of SVD, 80% (8/10) patients were found to have a distal/mid LAD occlusion. The echocardiogrpahy of these 19 patients showed that 15/19 (78.94%) of these had LV ejection fraction (EF) > 40% as against only 4/19 (21.05%) patients with LVEF < 40%. The echocardiographic study of patients with and without reciprocal ST depression in inferior leads more than or equal to the ST elevation in anterior leads, showed higher incidence of LV dysfunction i.e. LVEF < 40% in patients with reciprocal changes (72.05%) as compared to patients without the reciprocal changes (27.94%). In patients with acute inferior wall MI (IWMI), anterior and lateral ST depression more than or equal to ST elevation in inferior leads was found in 80% (96/120) patients. 27/96 patients underwent coronary angiography and all 96 underwent echocardiography. Patients with ST depression in I, a VL, V4-V6 (apicolateral leads) > or = ST elevation in inferior leads were found to have more occurrence of multivessel disease (21/27) with LVEF < 40% (50/64 i.e. 78.12%, P < 0.001). 12.5% (4/32) patients with reciprocal changes in anterior i.e. VI-V3 leads and 15% (3/20) patients without significant reciprocal changes in anterior and lateral leads had LVEF < 40%. Also, patients with ST depression in I, aVL showed higher incidence of right coronary artery (RCA) lesion (23/27) (P < 0.001).
Conclusions:
Patients of acute AWMI with Q waves in inferior leads indicate a smaller infarct with higher incidence of mid/distal LAD occlusion and a relatively preserved LV function. AWMI patients without reciprocal changes in inferior leads have a better LVEF. Patients of acute IWMI with ST depression in apicolateral leads have more occurrence of multivessel disease with significant LV dysfunction. Reciprocal ST depression in I, aVL suggests a possibility of RCA lesion.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:27Myocarditis II: Clinical Features and Diagnostic Tests