ΗΛΕΚΤΡΟΝΙΚΟ ΠΟΡΙΣΜΑ ΤΗΣ ΔΟΚΙΜΑΣΙΑΣ ΚΟΠΩΣΗΣ

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The NEW ENGLAND JOURNAL of MEDICINE. 2003;349:2128-35

ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction
Kyuhyun Wang, M.D., Richard W. Asinger, M.D., and Henry J.L. Marriott, M.D.




 


Electrocardiograms Showing Normal ST-Segment Elevation and Normal Variants.
Tracing 1 shows normal ST-segment elevation. Approximately 90 percent of healthy young men have ST-segment elevation of 1 to 3 mm in one or more precordial leads. The ST segment is concave. Tracing 2 shows the early-repolarization pattern, with a notch at the J point in V4. The ST segment is concave, and the T waves are relatively tall. Tracing 3 shows a normal variant that is characterized by terminal T-wave inversion. The QT interval tends to be short, and the ST segment is coved.










 

Electrocardiograms Showing ST-Segment Elevation in Various Conditions.
Tracing 1 is from a patient with left ventricular hypertrophy, and tracing 2 is from a patient with left bundle-branch block. Tracing 3, from a patient with acute pericarditis, is the only tracing with ST-segment elevation in both precordial leads and lead II and PR-segment depression. Tracing 4 shows a pseudoinfarction pattern in a patient with hyperkalemia. The T wave in V3 is tall, narrow, pointed, and tented. Tracing 5 is from a patient with acute anteroseptal infarction. The distinctive features of tracing 6, from a patient with acute anteroseptal infarction and right bundle-branch block, include the remaining R' wave and the distinct transition between the downstroke of R' and the beginning of the ST segment. Tracing 7, from a patient with the Brugada syndrome, shows rSR' and ST-segment elevation limited to V1 and V2. The ST segment begins from the top of the R' and is downsloping.

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Μora S, Cook N, Buring JE et al . Physical activity and reduced risk of cardiovascular events. Potential mediating mechanisms. Circulation 2007;116:2110-2118.    

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Chow CK,  Jolly S, Rao-Melacini P et al. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010;121:750-758.

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Patel NB, Balady GI. The rewards of good behaviour. (Editorial). Circulation 2010;121:733-735

Jouven X, Schwartz PJ, Escolano S, et al. Exercise heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population. European Heart Journal.  2009;30:1703-1710.

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Aλγόριθμος αρχικής πιθανότητας στεφανιαίας νόσου (pre-test probability)
          Τable of Diamond & Forrester. NEJM 1979;300:1350-58.

Hλικία (έτη)	Φύλο	Σύμπτωμα
		Τυπική στηθάγχη	Στηθαγχικού τύπου ενοχλήματα (Ατυπη στηθάγχη)	Μη στηθαγχικά ενοχλήματα	Ασυμπτωματικά άτομα
30-39	♂	10-90%	10-90%	>5% <10%	<5%
	♀	10-90%	<5%	<5%	<5%
40-49	♂	>90%	10-90%	10-90%	>5% <10%
	♀	10-90%	>5% <10%	<5%	<5%
50-59	♂	>90%	10-90%	10-90%	>5% <10%
	♀	10-90%	10-90%	>5% <10%	<5%
60-69	♂	>90%	10-90%	10-90%	>5% <10%
	♀	>90%	10-90%	10-90%	>5% <10%

Πιθανότητα: α) Πολύ χαμηλή: <5%. β) Χαμηλή: >5% <10% γ) Ενδιάμεση: 10-90%. Υψηλή: >90%

Gibbons RJ et al : ACC/AHA 2002 guideline update for exercise testing. Circulation 2002; 106:1883.  
                                                                                Διασκευή Κομοτηνή, Ιανουάριος 2009. ΘΚΚ.