AVR in myocardial infarction

Introduction: In later times, the aVR lead was not analyzed perseverently. In the late 20 years, the modifications of EKG in aVR, in the acute coronarian syndrom are more and more studied. The positivation of T wave and the modifications of the ST segment in aVR offers scientific informations of real use in the evaluation of myocardial infarction (MI). The prezence of the Q wave in aVR was also not sufficiently studied. In the last years, the medical literature offers interesting studies regarding the proeminent Q wave with time lapse > 20 milisec. in negative aVR in the acute myocardial infarction (AMI).

Methods: In 65 cases (an EKG collection) with AMI and 27 with multiple old an new, and recidive (MMI) we have analysed in aVR the T wave, the ST segment and the proeminent Q wave. The results have been co-related with cardial arythmias, the cardial insufficiency, the distorsion of the QRS complex and the deaths. The cases are between 19 and 82 years, with average 50.1; in AMI 51.9 and in MMI 42.2; 48 males and 17 females.

Results: In the integral group, the positive T wave in aVR was present in 26 cases (40%), in AMI 18 cases (42.1%) and in 17 (60.7%) in MMI. The ST segment is overelevated in 36 cases (55.5%), 21 (55.5%) in AMI and 15 (55.5%) in MMI. The proeminent Q wave in negative aVR was prezent in 52 cases (80%), 34 in AMI (86.6%) and 19 in MMI (70.3%). The arrythmias were present in 41 cases (63.2%), 10 with concomitent atrial and ventricular arrythmias, 18 (27.1%) with AMI and 23 (35.2%) with MMI; 22 (32.2%) were with positivated T wave, 12 (31.5%) in AMI and 10 (33.3%) in MMI. The ST segment is overelevated in 36 cases (55%) 21 with AMI (55.3%) and 16 (59.2%) in MMI, the proeminent Q wave in aVR in 13 cases with AMI (32.8%) and 10 (35%) in MMI. The cardial insufficiency was present in 35 de cases (56.1%) in the integral group, 18 with AMI (45.1%) and 20 (83.2%) in MMI, with positivated T wave, 12 (31.8%) with AMI and 16 with MMI (51.7%), ST overelevated in aVR in 26 cases (36.7%) and 14 in MMI (51.7%), proeminent Q wave in aVR in AMI 14 cases (34.1%) and 13 (48.7%) in MMI. The deaths were 16 in the integral group (25.5%); 3 in AMI (7.8%) and only one with positivated T wave and another one with overelevated ST in aVR; in AMI 9 positivated T (37.2%) and 7 (25.2%) cu overelevated ST; the relation with the proeminent Q wave in aVR: in AMI 3 deaths with Q wave in aVR; in MMI 11 deaths (40.7%) with proeminent Q wave in aVR.

Conclusions: We should note some modifications in aVR in myocardial infarction. The positivated T wave in aVR is more frequent in MMI; the values of overelevation of the ST segment are relatively the same in AMI and MMI; the proeminent Q wave is more frequent in AMI; the arrythmias have relatively the same values in AMI and in MMI; the cardial insufficiencies are more frequent in MMI; the cardial insufficiencies are more frequent in IMA with positivated T wave, as in the cases with overelevated ST; the deaths are more frequent in IMM with positivated T, with overelevated ST and proeminent Q wave in aVR. The presence of the QRS distorsion with modifications of the T wave, of the ST segment and of the Q wave in aVR is not significantly different in AMI in comparison to MMI.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)