الفهرس 
Acute Myocardial InfarctionOnly 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
When estimating the infarct area and reversible myocardial dysfunction of patients with a first ST- segment elevated myocardial infarction, the use of an initial ECG, a simple noninvasive method, can serve as a useful prognostic tool in addition to other invasive and noninvasive methods available.
The presence of terminal portion distortion of the QRS complex is a sign of a higher grade of left ventricular dysfunction, higher necrotic myocardium, and probably a worse prognosis. This result is important for predicting the condition of the patients and designing a treatment strategy after discharge.
Also, QRS interval distortion has been suggested as a marker of increased in-hospital mortality and long-term prognosis in patients who have acute myocardial infarction that is treated with thrombolytic therapy or short-term outcome after primary percutaneous coronary intervention. Also there is a strong association between QRS interval distortion and persistence of left ventricular dysfunction in patients who undergo primary percutaneous coronary intervention.
The current study included 53 patients who admitted to the coronary care unit at Ain Shams University hospital during the period from May to November 2010 with their first attack acute ST- segment elevated myocardial infarction.
Total CK, CK-MB fractions, pre-discharge Echocardiography and ECG were performed for all patients.
from the ECG we assessed that according to the presence of distortion of the terminal portion of the QRS complex patients were divided into two groups:
Group A: QRS distortion +Ve
Group B: QRS distortion –Ve
Distortion of the terminal portion of the QRS complex defined as (emergence of the J point at a level above the lower half of the R wave in leads with a qR configuration or disappearance of the S wave in leads with an Rs configuration (leads V1through V3).
QRS distortion in at least 2 adjacent leads was required.
The study group aged 53.4±9.6 years (range 37 – 72) years, 28.3 % were females.
Inhospital complications, Cardiac death was 15.1 %, Re-infarction was 13.2 %, Post infarction angina was 77.4 %, CHF was 34.0 %, Pulmonary edema was 17.0 %, Cardiogenic shock was 13.2 %, Primary ventricular tachycardia was 43.4 %, Secondary ventricular tachycardia was 24.5 %, Primary ventricular fibrillation was 13.2 %, Secondary ventricular fibrillation was 11.3 %, Atrial fibrillation was 54.7 %.
All complications were more frequent in group A as compared with group B, but this was statistically significant only in Cardiac death 27.6% in group A versus 0.0% in group B, (P=0.005), Re-infarction 24.1% in group A versus 0.0% in group B, (P=0.010), Cardiogenic shock 24.1% in group A versus 0.0% in group B, (P=0.010), and Secondary ventricular fibrillation 20.7% in group A versus 0.0% in group B, (P=0.018).