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      Diagnosis of Acute Myocardial Infarction in Patients with Chronic Right Bundle-Branch Block Using Standard 12-Lead Electrocardiogram Compared with Dynamic Vector Cardiography

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          The aim of the study was to evaluate standard 12-lead electrocardiogram (ECG) criteria and to compare them with dynamic vector cardiography in patients with chronic right bundle-branch block for diagnosing acute myocardial infarction. We used standard 12-lead ECGs recorded on admission and after 12–24 h and compared them with dynamic vector cardiography with trend analysis during the first 12 h. In patients with right bundle-branch block, ST segment changes occurred in the same way as for patients with narrow QRS complexes. By adding 4 h of continuous vector cardiographic monitoring we were able to identify patients with acute myocardial infarction with a high diagnostic accuracy.

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          Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room.

          The possibility of early prediction of acute myocardial infarction (AMI) was assessed in 7,157 consecutive patients coming to our emergency room during a 21-month period with chest pain or other symptoms suggestive of AMI. Of these patients 921 developed an AMI during the first 3 days in the hospital. Of the 4,690 patients admitted to hospital, 1,576 (34%) had a normal admission electrocardiogram, and 90 of these (6%) developed AMI. Of 1,964 patients with an abnormal electrocardiogram without signs of acute ischemia (42% of those admitted), 268 (14%) developed AMI, and 563 (51%) of 1,109 patients with acute ischemia on the electrocardiogram (24%) developed AMI. All patients were prospectively classified in the emergency room on the basis of history, clinical examination and electrocardiogram into 1 of 4 categories, according to the initial degree of suspicion of AMI. Of 279 admitted patients judged to have an obvious AMI (6% of the 4,690), 245 (88%) actually developed AMI; of 1,426 with a strong suspicion of AMI (30%), 478 (34%) developed one; of 2,519 with a vague suspicion of AMI (54%), 192 (8%) developed one; and of 466 with no suspicion of AMI (10%), 6 (1%) developed one. Thus, only a low percentage of the patients with a normal initial electrocardiogram or a vague initial suspicion of AMI developed a confirmed AMI.
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            MEDICAL SCIENCE GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction


              Author and article information

              S. Karger AG
              July 1998
              14 August 1998
              : 90
              : 1
              : 58-62
              Clinical Experimental Research Laboratory, Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
              6818 Cardiology 1998;90:58–62
              © 1998 S. Karger AG, Basel

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              Page count
              Pages: 5
              Coronary Care


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