Maximal spatial ST-vector patterns in patients with acute anteroseptal myocardial infarction.

Seventy patients with acute myocardial infarction were studied by serial vectorcardiography. Eleven out of 70 patients had acute myocardial infarction, which consistently met the vectorcardiographic QRS-loop criteria of anteroseptal myocardial infarction within the 21 days follow-up period. From the first vectorcardiographic tracings three types of the maximal spatial ST-vector were seen. Their directions belonged to one of the following octants: (1) right-anterior-superior, (2) left-anterior-superior, or (3) left-anterior-inferior. The directions were the same as the types of initial activity of the normal depolarization process of the interventricular septum revealed by the intracardiac mapping in dogs. The subsequent vectorcardiograms showed no change in direction of the maximal spatial ST-vector in all patients except one. This study suggested that there are three types of the maximal spatial ST-vector concealed in patients with first acute anteroseptal myocardial infarction. Each type of the maximal spatial ST-vectors is capable of causing S-T segment elevation from leads V1 to V3 in the acute electrocardiogram. Why the subgroup of the right-anterior-superior maximal spatial ST-vector in patients with acute anteroseptal myocardial infarction had poor outcomes during the acute stage needs further investigation.

[1]  J. Fallon,et al.  Creatine kinase release not associated with myocardial necrosis after short periods of coronary artery occlusion in conscious baboons. , 1985, Journal of the American College of Cardiology.

[2]  G S Wagner,et al.  Transient alterations of the QRS complex and ST segment during percutaneous transluminal balloon angioplasty of the left anterior descending coronary artery. , 1988, The American journal of cardiology.

[3]  V. Froelicher,et al.  Can areas of myocardial ischemia be localized by the exercise electrocardiogram? A correlative study with thallium-201 scintigraphy. , 1984, American heart journal.

[4]  Noboru Okamoto,et al.  Diagnostic accuracy of the vectorcardiogram and electrocardiogram: A cooperative study , 1966 .

[5]  R. Walmsley,et al.  The outflow tract of the left ventricle. , 1966, British heart journal.

[6]  G. Whipple,et al.  A Clinical Appraisal of the Vectorcardiogram in Myocardial Infarction: I. The Cube System , 1961, Circulation.

[7]  B. Hoffman,et al.  Activation of the interventricular septal myocardium studied during cardiopulmonary bypass. , 1960, American heart journal.

[8]  A. DeMaria,et al.  Clinical Applications of Two-Dimensional Echocardiography and Cardiac Doppler , 1989 .

[9]  B. Khandheria.  Aortic dissection. The last frontier. , 1993, Circulation.

[10]  W. Carson.  Patterns of maximal spatial ST vector of S-T segment elevation in the right praecordial leads of the electrocardiogram in patients with acute inferior myocardial infarction. , 1988, European Heart Journal.

[11]  A J KERWIN,et al.  A method for the accurate placement of chest electrodes in the taking of serial electrocardiographic tracings. , 1960, Canadian Medical Association journal.

[12]  E. Simonson,et al.  Differentiation between normal and abnormal in electrocardiography , 1962 .

[13]  J. .. Abildskov,et al.  Application of a Theoretic T‐Wave Model to Experimentally Induced T‐Wave Abnormalities , 1966, Circulation.

[14]  Y Z Tseng,et al.  Vectorcardiographic criteria for acute right ventricular infarction. , 1988, European heart journal.

[15]  A. Benchimol,et al.  Serial vectorcardiograms with the Frank system in patients with acute inferior wall myocardial infarction. , 1969, Journal of electrocardiology.

[16]  G. B. Myers,et al.  Correlation of electrocardiographic and pathologic findings in infarction of the interventricular septum and right ventricle. , 1949, American heart journal.