By study definition, all patients developed ST elevation in at least one anterior precordial lead during coronary occlusion. No patient developed ST depression in any of the anterior precordial leads; three patients did develop ST depression in lead V5. Increases in PW were seen in all patients (mean, 14.9 ±8.1 mm Hg; range, 4 to 29 mm Hg). Electrocardiographic and corresponding hemodynamic data were obtained at approximately 169 ±62 s (range, 75 to 300 s) of coronary occlusion with the total occlusion being 216 ±73 s (range, 110 to 415 s). The inflations were to 6 ± 1 atm.
Elect roca rdiogra phy
Leads V, through V4: Sum of R-wave amplitude in the four precordial leads increased in 17 patients, was unchanged in ten patients, and was decreased in seven patients. Sum of S-wave amplitude decreased in 33 patients (two with complete loss of S wave) and increased in one (Fig 1). Mean R-wave change was 2.7 ± 6.2 mm (range, – 5.5 to 25 mm) and mean S-wave change was —12.9 ±9.0 mm (range, — 38 to 1 mm). The mean precordial ST elevation was 12.5 ±8.7 mm (range, 1.5 to 35 mm). R-wave change correlated directly with ST elevation, (r=.423, p = .013) while S-wave change correlated inversely (Fig 2). R- and S-wave changes were not related (r= — .164, p= .355).
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FIGURE 1. An example of an ECG demonstrating increased R waves (+ 5.5 mm), decreasing S waves (- 8.0 mm), and ST segment elevations (5.5 mm) with coronary occlusion. This case is of special interest as R waves are seen in lead V, with coronary occlusion while they appear absent at baseline.
Lead ST Maximum: The precordial lead with the most prominent ST elevations was Vj in one patient, V2 in 14 patients, V3 in 14 patients, and V4 in five patients. R wave increased in 16 patients, was unchanged in seven patients, and was decreased in 11 patients. S wave decreased in 29 patients (16 with complete loss of S wave), was unchanged in four patients (one with absent S waves on baseline ECG), and increased in one patient. Mean R-wave change was 1.0 ±3.1 mm (range, —3 to 11.5 mm), mean S- wave change was —5.1 ±3.6 mm (range, — 13 to 0.5 mm), and mean ST elevation was 5.4 ± 3.5 mm (range, 1 to 15 mm). The R-wave change correlated significantly with ST elevation (r=.518, p=.002), but the S-wave change did not (r= — .267, p= .127).
FIGURE 2. The correlation between change in S-wave amplitude and ST segment elevations in leads V, through V4. Changes are in millimeters.
Lead V5: R wave increased in 14 patients, was unchanged in nine patients, and decreased in 11 patients. S wave decreased in 17 patients (11 with complete loss of S wave), was unchanged in 13 patients (ten with absent S waves at baseline), and was increased in four patients (two with none at baseline). ST segment was elevated in 23 patients, was unchanged in eight patients, and was depressed in three patients. Mean R-wave change was 0.31 ±1.8 mm (range, —2.5 to 5 mm), mean S-wave change was — 0.91 ±1.6 (range, —6 to 2 mm), and mean ST elevation was 1.0 ±1.5 mm (range, —1 to 5.5 mm) (Fig 3). Changes in R wave did not correlate significantly with ST deviation (r=.256, p=.145), but changes in S wave had a significant negative correlation (r= .545, p= .001). buy antibiotics canada
FIGURE 3. Changes in R-wave and S-wave amplitudes and ST segment elevations in the entire study population.