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[Myocardial infarct without pathologic Q waves].

J Lara Terán1, A G Hermosillo, A Andrade Freire

  • 1Instituto Nacional de Cardiología, Ignacio Chávez, México, D.F.

Archivos Del Instituto De Cardiologia De Mexico
|January 1, 1988
PubMed
Summary
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Diagnosing acute myocardial infarction without pathological Q waves is possible with specific imaging and lab tests. Diffuse myocardial uptake on Tc 99m pyrophosphate scans suggests the condition, especially with elevated enzymes.

Area of Science:

  • Cardiology
  • Nuclear Medicine

Background:

  • Pathological Q waves are not always indicative of acute myocardial infarction (AMI) localization.
  • Prognosis for AMI without pathological Q waves remains debated.

Purpose of the Study:

  • To investigate the diagnostic utility of technetium-99m pyrophosphate scintigraphy in patients with suspected AMI but without pathological Q waves on EKG.
  • To correlate pyrophosphate uptake patterns with enzymatic levels and clinical outcomes.

Main Methods:

  • Studied 23 hospitalized patients with prolonged chest pain, elevated enzymes, and EKG changes but no pathological Q waves.
  • Utilized Tc 99m pyrophosphate scintigraphy to assess myocardial uptake.
  • Classified patients into focal (Group A) versus diffuse (Group B) uptake groups.

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Main Results:

  • Serum glutamic transaminase levels were significantly higher in the focal uptake group (Group A) compared to the diffuse uptake group (Group B).
  • No significant differences in creatine kinase or lactic dehydrogenase levels between groups.
  • Clinical hospital course was similar for both groups.
  • Long-term follow-up (31.7 months) showed chronic angina, coronary bypass surgery, recurrent MI, but no deaths.

Conclusions:

  • Suspect acute myocardial infarction in patients with prolonged angor pectoris, EKG repolarization changes, elevated enzymes, and positive Tc 99m pyrophosphate scintigraphy with diffuse myocardial uptake.
  • Focal uptake pattern on Tc 99m pyrophosphate scintigraphy can confirm the diagnosis of acute myocardial infarction.