Viljo Rissanen

Changes in the QRS complex and ST segment in transmural and subendocardial myocardial infarctions. A clinicopathologic study.

The QRS complex and ST segment in the ECGs of 80 patients who died of an acute myocardial infarction (MI) were studied in relation to the extent of the MI (subendocardial vs. transmural). Changes in the QRS complex developed in nine out of the 15 cases with an acute subendocardial MI. Five of these cases fulfilled the conventional QRS criteria for a myocardial infarction. A definite ST segment depression (a J point depression of 2 mm. or more in at least one lead, and a horizontal or downward sloping ST segment with a minimum duration of 0.08 sec.) occurred most frequently in connection with a circumferential subendocardial MI (88 per cent), but it was also found in a regional subendocardial (43 per cent) and transmural MI (43 per cent). In 17 per cent of the cases with a transmural MI, this was the only ECG abnormality. It is concluded that cases with a subendocardial MI cannot always be distinguished from transmural MI on the basis of the presence or absence of the QRS changes, and that an ST segment depression, as defined in this study, can give additional information in the evaluation of an acute phase of an MI.

Sensitivity and specificity of Minnesota Code Q-QS abnormalities in the diagnosis of myocardial infarction verified at autopsy

animal model, hoping that the technique would become a clinical reality. In January, 1982, Singer et al4 relieved the obstruction of postoperative recoarctation by transluminal balloon angioplasty in an infant. Our successful result with the transluminal balloon coarctation angioplasty offers a safe alternative method for the treatment of coarctation of the aorta without the risk of thoracotomy in acutely ill infants. Even if the coarctation is not totally relieved, such infants can grow to an age at which surgical repair may be performed at a much lower risk than during the neonatal period.

Early pronounced ST segment depression with marked J point decline heralding acute lethal clinical myocardial infarction: Necropsy-electrocardiographic correlative study

Marked ST segment depression (greater than or equal to 2 mm J point decline with horizontal or downsloping ST) was correlated with necropsy findings in 105 cases. Acute myocardial infarction (AMI) was most frequently (70%) responsible for development of the abnormal ST pattern, thereby indicating the diagnosis and severe prognosis of the AMI. In 23% of patients the ST segment depression pattern was associated with chronic heart disease without AMI; all were severely ill with 92% receiving digitalis. Sudden worsening of the basic heart disease or circulatory shock were frequently found to coincide with the abnormal ST pattern; necropsy revealed extensive old MI or myocardial fibrosis in these patients. Marked ST segment depression was also found in five patients without underlying heart disease at autopsy; an acute cerebral accident or circulatory shock was considered to have produced the abnormal ST segment pattern.

Prognostic significance of an ST segment depression of patients with an acute coronary attack

Abstract An ST-segment depression was studied in the ECGs recorded on the first and third day after admission of 580 patients with an acute heart attack. An acute myocardial infarction was found in 86% of the 115 patients in whose ECG the J-point was depressed 2 mm. or more and the ST-segment was horizontal or sloping downwards in at least one lead (a definite ST-segment depression). The degree of the J-point depression was deemed of prognostic significance. During the first four weeks, the mortality rate was lowest (4.7%) in patients with a J-point depression less than one millimeter or no depression. The corresponding figure for patients with a definite ST-segment depression was three times (21.7%) that of the patients without the pattern (7.3%). The definite ST-segment depression in an acute coronary attack seemed to be accompanied by a severe degree of coronary heart disease. Significant differences between the patients with a definite ST-segment depression and those without the pattern were found in the C T ratio, in the degree of pulmonary congestion, in the ECG signs of LVH, and in the digitalis treatment. It is concluded that the definite ST-segment depression has an important clinical and prognostic significance in cases of acute coronary attacks.

Coronary and aortic atherosclerosis in finnish men born in various regions of the country

Abstract The severity of atherosclerotic involvement in the coronary arteries and the abdominal aorta was studied in 205 men who died violently in Helsinki. The men were subdivided into 3 groups: (1) the western group, which included 52 men born in western counties of the country, where the mortality rate of coronary heart disease is below the mean level of the country; (2) the eastern group: 88 men born in counties in eastern, central and northern Finland, where the CHD mortality rate is above the mean level of the country; and (3) the Helsinki-Uusimaa group: 65 men born in the capital city or in the county surrounding it. There was no significant difference between the groups in the extent of coronary and aortic fatty streaks, raised lesions and complicated lesions, or in the severity of aortic calcification. The extent of radiologically-determined coronary calcification significantly differed between the western and eastern groups. The trend towards a difference in the severity of coronary stenosis between these groups did not achieve statistical significance. It is concluded that the more severe CHD in eastern than western Finland is related to the earlier and more severe secondary degeneration of coronary plaques in the east than in the west.

Microvasculature in the left ventricular wall of the human heart. Microangiographic study of normal and pathologic hearts.

arteries. Rather little is known about the microcirculation in the myocardium.1 A great deal of our present knowledge of the details of the coronary microvasculature has been gained from patho-anatomic studies of postmortem tissue. Histologic techniques have been applied to the study of disease changes in the wall of myocardial arterial vessels2-3 and to the study of the details of the arterioles and capillaries.4-5 The pattern of the coronary arterial vasculature has been investigated using plastic cast inj ections6-7 and many modifications of postmortem coronary angiography.8-16 Resolution of the finest details of the microcirculation has also been technically difficult in postmortem injection studies.

Aortic and coronary atherosclerosis in the finnish population A study of a series of violent deaths

Abstract The prevalence and extent of atherosclerosis in the thoracic and abdominal aortas and in the coronary arteries was assessed in a Finnish autopsy series of violent deaths, 236 males and 86 females. The absolute and percentage areas of raised atherosclerotic lesions were measured using the point-counting technique. Raised lesions were first observed in the aorta and the coronary arteries of males at the age of 15 to 24 years, in females in the aorta at the same age but in the coronary arteries about 10 years later. No sex difference was found in the prevalence or relative extent of aortic raised lesions. In the coronary arteries a tendency towards a sex difference was observed in all succeeding age groups; the difference was significant in age groups 25 to 34 and 55 to 64 years. The severity of atherosclerotic involvement in the present series was compared to that found in the five population samples included in the International Atherosclerosis Project 8 by calculating the unweighted mean for the mean values of the percentage areas involved by raised lesions in the thoracic and abdominal aortas and three coronary arteries in 10-year age groups of males and females aged 25 to 64 years. The unweighted mean in the present series was 15.0%, which is somewhat lower than the result obtained in the International Atherosclerosis Project for U.S.A. whites (18.3 %) and Norwegians (17.8 %) and slightly higher than the unweighted mean for U.S.A. Negroes (14.5 %), but clearly higher than the unweighted means for Puerto Rico whites (9.6 %) and Durban Bantus (6.2 %).

Changes occurring in the postinfarction ECG in relation to age, sex, and previous myocardial infarction

Minnesota codes (MC), expressing Q-QS, ST segment, and T wave abnormalities in ECGs taken during the acute event and at a 1-year follow-up were studied in 256 survivors of myocardial infarction (MI). On the 1-year ECGs large Q waves (MC 1.1) were more common in patients with a history of previous MI than in those with a first MI. Regression of Q-QS, ST segment, and T wave changes occurred more extensively in first MIs, whereas progression of MC Q-QS and ST segment signs tended to be common in those with recurrent MI. On the acute ECGs large Q waves were more frequent in men (52%) than in women (36%), but ST segment depression of 1 mm or more (MC 4.1) was predominant in women in both the acute and 1-year ECGs. This ECG sign was related to the advanced age of the patients. There was no significant sex difference in the regression of the Q-QS signs, but the disappearance of ST and T wave changes occurred more extensively in men. The ECG returned to normal in 12% of men with a first MI but only infrequently in women and men with recurrent MI.