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      ST elevation occurring during stress testing

      case-report

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          Abstract

          A case is presented of significant reversible ST elevation occurring during treadmill testing, and the coronary anatomy and subsequent course are described, indicating that ischemia is a potential cause of this electrocardiographic finding.

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          ST-segment elevation: Distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies.

          Alok S. Deshpande, Yochai Birnbaum (2014)
          The benefits of early perfusion in ST elevation myocardial infarctions (STEMI) are established; however, early perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In addition, ST elevation (STE) caused by conditions other than acute ischemia is common. Non-ischemic STE may be confused as STEMI, but can also mask STEMI on electrocardiogram (ECG). As a result, activating the primary percutaneous coronary intervention (pPCI) protocol often depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting the ECG in its clinical context and appropriately activating the pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, as reflected in the 2013 American College of Cardiology Foundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studied, and are currently being further perfected. No matter the strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be better outcomes.
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            The clinical significance of exercise-induced ST-segment elevation.

            T Ishimori, Albert Raizner, R Chahine (1976)
            The significance of exercise-induced ST-segment elevation remains unsettled. We reviewed the treadmill tests of 840 consecutive patients and exercise-induced ST-segment elevation was noted in 29 (3.5%). Only eight of these (28%) stopped because of angina. Anterior myocardial infarction (AMI) was found on the resting electrocardiogram in 25 (85%). Angiographic studies performed on 21 showed critical lesions of the left anterior descending (LAD) in 19 (90%) and left ventricular aneurysm in 18 (86%). When all the patiens who had AMI or critical LAD obstruction during the study period were reviewed, only 22% and 18% respectively showed exercise-induced ST-segment elevation, while 64% of the cases with left ventricular aneurysm displayed this phenomenon. Thus, exercise-induced ST elevation seems to reflect the presence of severe coronary artery disease most commonly with an associated left ventricular aneurysm and may relate more to the abnormal wall motion than to the myocardial ischemia per se.
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              ST elevation in the lead aVR during exercise treadmill testing may indicate left main coronary artery disease.

              Ejder Kardesoglu, Omer Yiginer, Halil Tolga Kocum … (2010)
              exercise treadmill testing (ETT) is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery (LMCA) disease before invasive procedures is very important in risk assessment because of its severe clinical outcome. To examine whether ST elevation in lead aVR during ETT may suggest LMCA disease since the lead aVR is the reciprocal lead of LMCA. in this study, 61 patients with positive ETT were included. The study group consisted of 21 patients with ST elevation in lead aVR. Forty patients, also having positive ETT, but without ST elevation in lead aVR comprised the control group. All patients underwent coronary angiography. coronary angiography in the study group revealed significant LMCA stenosis in 16 (76%) patients, whereas LMCA disease was present in only 3 (8%) patients from the control group. There was no significant coronary artery stenosis in 5 patients in the study group and 12 patients in the control group. Of the 16 patients who had LMCA stenosis, 9 had isolated LMCA disease and 7 had additional stenotic lesions in LAD or circumflex coronary arteries. The sensitivity and specificity of ST segment elevation in lead aVR during ETT was 84% and 88%, respectively. The values of positive and negative predictive value of this finding in diagnosing the presence of LMCA were 76% and 93%, respectively. ST segment elevation in lead aVR during ETT may point to a high probability of the presence of LMCA disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Community Hosp Intern Med Perspect
                Journal ID (iso-abbrev): J Community Hosp Intern Med Perspect
                Journal ID (publisher-id): JCHIMP
                Title: Journal of Community Hospital Internal Medicine Perspectives
                Publisher: Co-Action Publishing
                ISSN (Electronic): 2000-9666
                Publication date (Electronic): 25 April 2016
                Publication date Collection: 2016
                Volume: 6
                Issue: 2
                Electronic Location Identifier: 10.3402/jchimp.v6.30799
                Affiliations
                [1 ]Internal Medicine Training Program, Medstar Union Memorial Hospital/Good Samaritan Hospital, Baltimore, MD, USA
                [2 ]Division of Cardiology, Medstar Union Memorial Hospital, Baltimore, MD, USA
                Author notes
                [* ]Correspondence to: Marc Mugmon, Division of Cardiology, Medstar Union Memorial Hospital, Baltimore, MD, USA, Email: marc.mugmon@ 123456gmail.com
                Article
                Publisher ID: 30799
                DOI: 10.3402/jchimp.v6.30799
                PMC ID: 4848440
                PubMed ID: 27124164
                SO-VID: fd8c9d46-caec-4020-b1da-baff86d7e854
                Copyright © © 2016 Diana Malouf and Marc Mugmon
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 December 2015
                Date revision received : 17 January 2016
                Date accepted : 21 January 2016
                Categories
                Subject: Case Report

                Keywords: st elevation,myocardial ischemia,stress testing,electrocardiography
                Data availability:
                Keywords: st elevation, myocardial ischemia, stress testing, electrocardiography

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