Arrhythmias and Sudden Death in Athletes PDF
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THE ECG IN ACUTE MYOCARDIAL INFARCTION AND UNSTABLE ANGINA Developments in Cardiovascular Medicine 232. A. Bayés de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.): Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X 233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease. 2000. ISBN: 0-7923-7829-6 234. J. Candell-Riera, J. Castell-Conesa, S. Aguadé Bruiz (eds): Myocardium at Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3 235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing: New Conceptsfor the NewCentury. 2001. ISBN: 0-7923-7378-2 236. Douglas L. Mann (ed.): The Role of Inflammatory Mediators in the Failing Heart. 2001 ISBN: 0-7923-7381-2 237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac Contractile Force, Second Edition. 2001 ISBN: 0-7923-7157-7 238. Brian D. Hoit, Richard A. Walsh (eds.): Cardiovascular Physiology in the Genetically Engineered Mouse, Second Edition. 2001 ISBN 0-7923-7536-X 239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians 2001 ISBN 1-4020-0097-9 240. Stephen M. Factor, Maria A.Lamberti-Abadi, Jacobo Abadi (eds.): Handbook of Pathology and Pathophysiology ofCardiovascular Disease. 2001 ISBN0-7923-7542-4 241. Liong Bing Liem, Eugene Downar (eds): Progress in Catheter Ablation. 2001 ISBN 1-4020-0147-9 242. Pieter A. Doevendans, Stefan Kääb (eds): Cardiovascular Genomics: New PathophysiologicalConcepts. 2002 ISBN 1-4020-7022-5 243. Antonio Pacifico (ed.), Philip D. Henry, Gust H. Bardy, Martin Borggrefe, Francis E. Marchlinski, Andrea Natale, Bruce L. Wilkoff (assoc. eds): Implantable Defibrillator Therapy: A Clinical Guide. 2002 ISBN 1-4020-7143-4 244. Hein J.J. Wellens, Anton P.M. Gorgels, Pieter A. Doevendans (eds.): The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk Stratification. 2002 ISBN 1-4020-7214-7 Previous volumes are still available THE ECG IN ACUTE MYOCARDIAL INFARCTION AND UNSTABLE ANGINA Diagnosis and Risk Stratification by Hein J.J. Wellens Anton P.M. Gorgels Academic Hospital, Maastricht The Netherlands and Pieter A. Doevendans, MD Interuniversity Cardiology Institute of The Netherlands Utrecht, The Netherlands KLUWER ACADEMIC PUBLISHERS NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW eBookISBN: 0-306-48202-9 Print ISBN: 1-4020-7214-7 ©2002 Kluwer Academic Publishers NewYork, Boston, Dordrecht, London, Moscow Print ©2003 Kluwer Academic Publishers Dordrecht All rights reserved No part of this eBook maybe reproducedortransmitted inanyform or byanymeans,electronic, mechanical, recording, or otherwise,withoutwritten consent from the Publisher Createdin the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstoreat: http://ebooks.kluweronline.com CONTENTS Chapter 1 Introduction 1 Chapter 2 Determining the size of the area at risk, the severity of ischemia, and identifying the site of occlusion in the culprit coronary artery 5 A. The ST segment deviation score 9 B. The terminal QRS-ST segment pattern 11 C. Specific ECG patterns indicating the site of coronary artery occlusion: 13 I Infero-posterior myocardial infarction with or without right ventricular infarction 13 II Anterior wall myocardial infarction 24 Chapter 3 Conduction disturbances in acute myocardial infarction 43 A. The sino-atrial region 45 B. The AV nodal conduction system 49 C. The sub-AV nodal conduction system 53 Chapter 4 Myocardial infarction in the presence of abnormal ventricular activation 65 A. Left bundle branch block 68 B. Paced ventricular rhythm 76 C. Pre-excitation 79 Chapter 5 Arrhythmias in acute myocardial infarction: Incidence and prognostic significance 85 A. Supraventricular arrhythmias 87 B. Ventricular arrhythmias 91 Chapter 6 The electrocardiographic signs of reperfusion 99 Chapter 7 The electrocardiogram in unstable angina 117 Recognition of multivessel and left main disease Recognition of critical narrowing of the left anterior descending coronary artery Index 127 ERRATA The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk Stratification by: Hein J.J. Wellens, Anton P.M. Gorgels and PieterA. Doevendans ISBN: 1-4020-7214-7 The publisher regrets that due to a publishingerror, the incorrect series number appears on the series page and the back cover. The correct series number is DICM245. The corrected series page appears below. Kluwer Academic Publishers Developments in Cardiovascular Medicine 232. A. Bayés de Luna, F. Furlanello, B.J. Maron and D.P. Zipes (eds.): Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X 233. J-C. Tardif and M.G. Bourassa (eds): Antioxidants and Cardiovascular Disease. 2000. ISBN: 0-7923-7829-6 234. J. Candell-Riera, J. Castell-Conesa, S. Aguadé Bruiz (eds): Myocardium at Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3 235. M.H. Ellestad and E. Amsterdam (eds): Exercise Testing: New Conceptsfor the New Century. 2001. ISBN: 0-7923-7378-2 236. Douglas L. Mann (ed.): The Role ofInflammatory Mediators in the Failing Heart. 2001 ISBN:0-7923-7381-2 237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac Contractile Force,SecondEdition. 2001 ISBN: 0-7923-7157-7 238. BrianD. Hoit,RichardA.Walsh(eds.): CardiovascularPhysiologyinthe Genetically EngineeredMouse, Second Edition. 2001 ISBN 0-7923-7536-X 239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians 2001 ISBN 1-4020-0097-9 240. Stephen M. Factor, Maria A.Lamberti-Abadi, Jacobo Abadi (eds.): Handbook of Pathology and Pathophysiology of Cardiovascular Disease. 2001 ISBN 0-7923-7542-4 241. Liong Bing Liem, Eugene Downar(eds): Progress in Catheter Ablation. 2001 ISBN 1-4020-0147-9 242. Pieter A. Doevendans, Stefan Kääb (eds): Cardiovascular Genomics: New Pathophysiological Concepts. 2002 ISBN 1-4020-7022-5 243. Daan Kromhout, Alessandro Menotti, Henry Blackburn (eds.): Prevention ofCoronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study. 2002 ISBN 1-4020-7123-X 244. Antonio Pacifico (ed.), Philip D. Henry, Gust H. Bardy, Martin Borggrefe, Francis E. Marchlinski, Andrea Natale, Bruce L. Wilkoff (assoc. eds): Implantable Defibrillator Therapy: A Clinical Guide. 2002 ISBN 1-4020-7143-4 245. Hein J.J. Wellens, AntonP.M. Gorgels, Pieter A. Doevendans (eds.): The ECG in Acute Myocardial Infarction and Unstable Angina: Diagnosis and Risk Stratification. 2002 ISBN 1-4020-7214-7 Previous volumes are still available Authors Pieter A. Doevendans, M.D. Associate Professor of Cardiology, Department of Cardiology Academic Hospital Maastricht University of Maastricht, the Netherlands Anton P. Gorgels, M.D. Associate Professor of Cardiology Department of Cardiology Academic Hospital Maastricht University of Maastricht, the Netherlands Hein J.J.Wellens, M.D. Professor of Cardiology Medical Director of the Interuniversity Cardiology Institute of the Netherlands (ICIN) Utrecht, the Netherlands Acknowledgements Over the years the cardiologists, residents, fellows and nursing staff, working at the Department of Cardiology of the Academic Hospital of Maastricht, have carefully collected the electrocardiograms published in this book. We are very much indebted to them for their enthusiasm and willingness to donate those pearls to us! To have the electrocardiograms perfectly reproduced we had the good fortune to have Adrie van den Dool working for us. She and the medical photography group of the hospital did a perfect job, demonstrating again their ability to make beautiful illustrations. Excellent secretarial assistance was provided by Birgit van den Burg, Miriam Habex, Vivianne Schellings and Willemijn Gagliardi. We greatly appreciated their pleasant, never complaining way of helping us again and again! Manja Helmers played an important role in the final phase by expertly producing the layout of the manuscript. Hein J.J. Wellens Anton P.M. Gorgels Pieter A. Doevendans
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