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T wave changes consistent with epicardial involvement in acute myocardial infarction. Observations in patients with a
P B Oliva1, S C Hammill, J V Talano
1Heart Research and Education Association of Colorado, Rose Medical Center, Denver 80220.
Insights
Atypical T wave evolution is common in patients with postinfarction pericardial effusion, even without diagnosed pericarditis. This finding suggests T wave changes may indicate transmural infarction more reliably than Q waves.
Area of Science:
- Cardiology
- Electrocardiography
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) T wave evolution patterns have been described in postinfarction pericarditis.
- Atypical T wave evolution showed high sensitivity (100%) and moderate specificity (77%) for regional postinfarction pericarditis.
Purpose of the Study:
- To determine if atypical T wave evolution occurs in patients with postinfarction pericardial effusion but no clinical pericarditis.
- To assess the frequency of atypical T wave evolution in patients with diagnosed postinfarction pericarditis.
Main Methods:
- Reviewed ECGs and records of 20 patients with postinfarction pericarditis (Group I).
- Reviewed ECGs and records of 20 patients with postinfarction pericardial effusion but no diagnosed pericarditis (Group II).
- Classified T wave patterns as typical or atypical in both groups.
Main Results:
- All 20 patients in Group I exhibited atypical T wave evolution.
- All 20 patients in Group II also showed atypical T wave evolution.
- Fifteen percent of all 40 patients had non-Q wave infarction with definite or inferred postinfarction pericarditis.
Conclusions:
- Atypical T wave evolution is highly sensitive for diagnosing regional postinfarction pericarditis.
- Similar T wave changes are present with postinfarction pericardial effusion, even without clinical pericarditis.
- Atypical T wave evolution may be a more sensitive marker for transmural infarction than Q wave development.
Objectives:
This study was designed to evaluate the presence or absence of atypical T wave evolution in patients with a postinfarction pericardial effusion but without clinically recognized postinfarction pericarditis. A second purpose was to evaluate the frequency of atypical T wave evolution in a previous study of postinfarction pericarditis.
Background:
Electrocardiographic (ECG) criteria involving the evolution of the T wave after an acute myocardial infarction were recently described in patients with regional postinfarction pericarditis. Atypical T wave evolution was found to have a sensitivity of 100% and a specificity of 77% for clinically recognized regional postinfarction pericarditis with or without a pericardial effusion.
Methods:
The hospital records and serial ECGs of 20 patients with clinically recognized postinfarction pericarditis (Group I) were reviewed. The records and serial ECGs of 20 additional patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis (Group II) were also examined. The type of postinfarction T wave pattern, typical or atypical, was recorded in both groups.
Results:
All 20 patients in Group I had atypical T wave evolution. Among the 20 patients in Group II, every patient also had atypical T wave evolution. Fifteen percent of all 40 patients with atypical T wave evolution had a non-Q wave infarction with definite or inferred postinfarction pericarditis.
Conclusions:
The high sensitivity of atypical T wave evolution in diagnosing regional postinfarction pericarditis was confirmed. However, similar T wave alterations were also observed when a postinfarction pericardial effusion existed in the absence of clinically recognized pericarditis. Fifteen percent of patients with atypical T wave evolution had a non-Q wave infarction with definite or inferred pericardial involvement. Thus, the presence of atypical T wave evolution may be a more sensitive indicator of a transmural infarction than the development of a Q wave.
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