ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00692.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00693.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00694.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00695.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00696.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

AbstractIn a consecutive series of 401 patients admitted to the Coronary Care Unit of the Copenhagen County Hospital at Glostrup suspected of acute myocardial infarction (AMI) less than 24 hours old, blood samples for enzyme analysis were drawn at admission and 12, 24, 36, 48, and 72 hours later, and ECG in 9 leads was recorded daily during the first week. From usual diagnostic criteria — clinical symptoms, ECG‐findings, and enzyme analyses, not including and not knowing the results of CK—MB analyses — the series was divided into patients with AMI and those without AMI.Comparison is made between the predictive values in the diagnosis of AMI of a positive and a negative result (PV‐pos. and PV‐neg.) of either of the tests: ECG and serum levels of aspartate aminotransferase (ASAT), lactate dehydrogenase (LD), creatine kinase (CK), and MB‐fraction of CK determined by electrophoresis. The salient features were: PV‐neg. i.e. diagnostic sensitivity was low (0.78) for ECG, but high for all enzyme tests (0.97–1.00). PV‐pos. i.e. diagnostic specificity was rather low for the three standard enzymes (0.73–0.87), but high for CK—MB (0.98) and also for ECG (1.00). Thus, determination of CK—MB seems to offer the best combination of a high sensitivity as well as specificity in the diagnosis of AMI. However, the time factor should be kept in mind, as positive results of CK—MB can only be expected during the first 30–50 hou

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00697.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00698.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

AbstractMyocardial scintigraphy with99mtechnetium‐pyrophosphate was performed in two selected groups of patients, consisting of 20 who had acute myocardial infarction (AMI) clinically and 18 who had no AMI clinically. The purpose was to estimate the value of this method in the detection or disproof of AMI compared with usual procedures (ECG and serum enzyme determination — GO‐transaminase and α1‐fraction of LDH).Each of the 20 patients with clinical AMI had positive scintigrams. There were no false‐negative findings. Out of 18 without AMI, 15 had negative scintigrams; in the other 3, scintigraphic findings were false‐positive.The prevalence of AMI among patients admitted to the cardiological department was 0.39. In this population of patients, the calculated predictive value of a positive scintigram was 0.80, whereas the predictive value of a negative was 1.0. In patients admitted to the coronary care unit, the prevalence of AMI was 0.51; the corresponding predictive values of a positive scintigram was 0.86 and of a negative 1.0.The identity between scintigraphic and electrocardiographic infarct localization was good. Infarct size estimated by scintigraphy was not significantly correlated to the maximum elevation of serum enzyme concentration.In patients suspected of having AMI, it is highly probable that a negative scintigram obtained from day 2 to day 6 after the onset of symptoms will rule out the presence of acute myocardia

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00699.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

AbstractThe ST segment elevation was measured hourly, via a single surface unipolar lead for 48 hours after admission, in 30 patients with acute myocardial infarction (AMI), admitted, on average, 2 hours after the onset of symptoms. In 14 patients with anterior AMI, the recordings were made through the precordial lead that initially showed the maximum ST elevation. In 16 patients with inferior AMI, the aV F lead was used. Twenty‐five control patients without AMI had the ST deviation measured hourly for 24 hours; 15 of them had the recording made via the Vs, aV F being used with the others. Our data for the reliability of the method showed that the variations in ST deviations in the control group were of the same magnitude as those observed with the measuring error of the method itself.The investigation showed that the spontaneous course of the hourly measured ST elevations in the early phase of AMI was marked by pronounced variability, and that this applied to both anterior and inferior infarctions. The intra‐individual patient variation of the ST elevation was significantly greater than in the control group of patients. The inter‐individual patient variation of the ST elevation with AMI was also significant. The ST elevation was correlated to heart rate, mean arterial blood pressure, heart rate multiplied by systolic blood pressure, and respiratory rate and it could be shown partly that there was a significant dispersion of the correlation coefficients within the separate correlation groups, and partly that the correlation coefficients were variable between the groups. It was also shown that nasal oxygen therapy and cardiac pain had no bearing on ST elevation. The variability of ST elevation was thus most often inexplicable and only rarely accounted for by alterations in the clinical status.It is generally accepted that ST segment elevation in the ECG is one of the characteistic features of acute myocardial infarction (AMI), but the electrophysiological basis of changes in the ST segment in myocardial ischaemia has not been completely clarified (1).In recent years, several investigations have been carried out where ST elevation has been used as a quantitative indicator of myocardial ischaemia. With multiple leads and epicardial and precordial mapping techniques, the sum of ST elevations has been used as an estimate of the extent of ischaemic injury after coronary occlusion in animals and after AMI in man (7, 8, 9, 12, 13). However, from the theoretical and experimental bases of ST segment deviation, it has been suggested that ST segment mapping is not a reliable measure of myocardial ischaemia (4, 5). Other investigators have pointed out the limitations of this method when used for the bedside estimate of ischaemic injury (11, 15).These studies suggest that there is a considerable variability of the ST deviation after AMI. Therefore, in an attempt to elucidate this problem, we have studied the ST elevation from hour to hour in a single surface lead for the first 2 days after admission of patients with AMI and have related the ST elevation to ST deviations measured hourly in patients without AMI. In addition, the ST elevations in patients with AMI have been related to heart rate, blood pressure, respiratory rate, retrosternal pain and oxygen treatment; clinical factors that can be associated with, or can influence, myocardial isch

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00700.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1979.tb00701.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY