Repolarization after the myocardial infarction (MI). Observations concerning 30 cases after MI and 30 cases with chronical multiple MI

Introduction: The considerable importance of repola-rization in acute myocardial infarction (AMI) is well-knowned. The repolarization with or without Q wave is still an EKG criteria of evaluation of cases for months and years. The medical literature notices that the ST modifications have lead to 17.7% deaths in the corona-rian acute syndrome and only to 5.8 deaths without this syndrome. After MI it was noticed mortality of 1.7% in patients with T wave inversion and of 14.4% in patients with denivelated ST. It is possible that ST denivelati-on reflects a left ventriculus anevrism. The J point and denivelated ST with at least 1 mm continues with hi-ghly symmetric T in patients with proximity occlusion of the left descending artery, and this is therapeutically valuable.

Methods: In 60 cases. 30 after one MI and 30 with chro-nic and multiple MI we have followed more frequent aspects of complications. After MI with Q wave, the inversed T wave indicates chronic MI with transmu-ral fibrosis,but positive T indicates non-transmural MI with viable myocardium. Some notice the microvolted alternance of the T wave and this is associated with sud-den death.The ratio Tpeak Tend/QT indicates differen-ces of repolarization between the epicardium and myo-cardium, and this is a predictive aspect for ventricular tachycardia / fibrillation. A giant T wave >1mV was described: „triangular QRS-ST-T wave form” in spre-ad STEMI by fusion QRS-ST-T and cardiogen shock. But in STEMI the dimension of MI decreases by the reduction of the necrotic tissue, by the diminishing of the inflammation, of the edem, of the hemorragy, with evolution toward scar of MI („infarct healing”).

Results: for some important complications. The rhy-thm disturbances of 51.6% from the total are more frequent in gr II chronic multiple MI, 60.3% vs. 40% in gr. I with MI; also without the normalization of the repolarization (w.n.r.) of 56.6%, was more frequent in gr II than in gr. I of 33.3%. The heart failure was of 56.6 from the total was bigger that 70% in gr. II with multi-ple MI, and only 43.3% in gr. with one MI; also in gr. II w.n.r it is bigger 66.6% vs. gr. I of 40%. The positive T wave in aVR is of 48.8% from the total. In rhythm dis-turbances, the positive T wave was great of 100% in gr. with multiple MI, vs 58.8% in gr. I with one MI. The w.n.r. cases were more in gr. II with chronical multiple MI of 72.2% vs. of 24.1% in gr. I with one AMI. In heart failure with positive T, in aVR of 38.5% from the total and relatively the same 53.8% in gr. II with multiple MI, vs. 47.5% in gr. I with one AMI.

Conclusions: The rhythm disturbances and the heart failure are more frequent in gr II with multiple MI by comparison to gr I with one AMI, probably altering larger areas by myocardial necrosis. The persistence and/or the lability of repolarization anomalies can be a significance indicator in the periodic control of the cases evolution. The positive T wave in aVR is an EKG sign which must be analyzed at every recording. In the presented cases, the multitude of the modifications and the big variability of ST and T wave did not afford a selection of subgroups pertinent to this theme, but one can say that in these cases of cardiac pathology, EKG remains a method which is accessible, full of surprises and without exhausted. The modern investigations is not excluded.

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)