Fine grid computer simulation of QRS-T and criteria for the quantitation of regional ischemia

A comprehensive fine grid simulation of excitation and recovery (QRS-T), realistic cardiac and torso anatomy, and electrophysiologic properties has been developed that produces a total body surface electrocardiogram (ECG) as output. The simulation leads to the specific hypothesis that additional leads on the upper and lower torso, and on the back, are required to optimize the quantitation and localization of regional ischemia and infarction. Criteria in the STT portion of the ECG for quantitating the severity of the ischemia were developed and presented. The combination of the leads in which the STT changes occur and the severity of the STT change provide a testable set of hypotheses for predicting the severity of ischemia, the probable coronary perfusion bed involved, the severity of the perfusion defect, and the severity of the proximal coronary obstruction.