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. 1983 Sep 3;287(6393):634–637. doi: 10.1136/bmj.287.6393.634

"Reciprocal" depression of the ST segment in acute myocardial infarction.

K Jennings, D S Reid, D G Julian
PMCID: PMC1548805  PMID: 6411261

Abstract

In acute myocardial infarction depression of the ST segment in leads distant from those showing ST elevation has been considered to be "reciprocal" but might reflect local ischaemia. To examine this possibility 103 consecutive patients who underwent exercise testing early after myocardial infarction were reviewed. Treadmill exercise testing was performed a mean of 12 (range 5-30) days after infarction using a limited Naughton protocol. Thirty five (34%) of the patients had had reciprocal change, defined as greater than or equal to 1 mm ST depression in leads remote from the site of the infarct, within 48 hours of infarction. Twenty two (63%) of the 35 patients developed exercise induced ST depression in the leads previously showing reciprocal change. Coronary artery disease was assessed in 10 of these patients by arteriography and in four at necropsy: all but one had stenosis of greater than or equal to 50% in a coronary artery supplying the reciprocal territory in addition to the disease in the vessel to the infarct site. Of patients with reciprocal ST depression, 23.5% experienced nonfatal reinfarction, pulmonary oedema after discharge, or death compared with only 9.5% of patients without reciprocal ST depression. Eight (23.5%) patients with reciprocal depression had ventricular fibrillation while in hospital compared with only two (3%) patients without. Reciprocal ST depression in acute myocardial infarction may reflect ischaemia in territory distant from the site of infarction and is associated with a high risk of fatal arrhythmias and late morbidity.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Croft C. H., Woodward W., Nicod P., Corbett J. R., Lewis S. E., Willerson J. T., Rude R. E. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction. Am J Cardiol. 1982 Sep;50(3):428–436. doi: 10.1016/0002-9149(82)90306-x. [DOI] [PubMed] [Google Scholar]
  2. Dunn R. F., Kelly D. T., Sadick N., Uren R. Multivessel coronary artery spasm. Circulation. 1979 Aug;60(2):451–455. doi: 10.1161/01.cir.60.2.451. [DOI] [PubMed] [Google Scholar]
  3. Gelman J. S., Saltups A. Precordial ST segment depression in patients with inferior myocardial infarction: clinical implications. Br Heart J. 1982 Dec;48(6):560–565. doi: 10.1136/hrt.48.6.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Gibson R. S., Crampton R. S., Watson D. D., Taylor G. J., Carabello B. A., Holt N. D., Beller G. A. Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations. Circulation. 1982 Oct;66(4):732–741. doi: 10.1161/01.cir.66.4.732. [DOI] [PubMed] [Google Scholar]
  5. Goldberg H. L., Borer J. S., Jacobstein J. G., Kluger J., Scheidt S. S., Alonso D. R. Anterior S-T segment depression in acute inferior myocardial infarction: indicator of posterolateral infarction. Am J Cardiol. 1981 Dec;48(6):1009–1015. doi: 10.1016/0002-9149(81)90313-1. [DOI] [PubMed] [Google Scholar]
  6. Miller R. R., DeMaria A. N., Vismara L. A., Salel A. F., Maxwell K. S., Armsterdam E. A., Mason D. T. Chronic stable inferior myocardial infarction: unsuspected harbinger of high-risk proximal left coronary arterial obstruction amenable to surgical revascularization. Am J Cardiol. 1977 Jun;39(7):954–960. doi: 10.1016/s0002-9149(77)80207-5. [DOI] [PubMed] [Google Scholar]
  7. PRINZMETAL M., EKMEKCI A., TOYOSHIMA H., KWOCZYNSKI J. K. Angina pectoris. III. Demonstration of a chemical origin of ST deviation in classic angina pectoris, its variant form, early myocardial infarction, and some noncardiac conditions. Am J Cardiol. 1959 Mar;3(3):276–293. doi: 10.1016/0002-9149(59)90212-7. [DOI] [PubMed] [Google Scholar]
  8. Salcedo J. R., Baird M. G., Chambers R. J., Beanlands D. S. Significance of reciprocal S-T segment depression in anterior precordial leads in acute inferior myocardial infarction: concomitant left anterior descending coronary artery disease? Am J Cardiol. 1981 Dec;48(6):1003–1008. doi: 10.1016/0002-9149(81)90312-x. [DOI] [PubMed] [Google Scholar]
  9. Schuster E. H., Bulkley B. H. Ischemia at a distance after acute myocardial infarction: a cause of early postinfarction angina. Circulation. 1980 Sep;62(3):509–515. doi: 10.1161/01.cir.62.3.509. [DOI] [PubMed] [Google Scholar]
  10. Shah P. K., Pichler M., Berman D. S., Maddahi J., Peter T., Singh B. N., Swan H. J. Noninvasive identification of a high risk subset of patients with acute inferior myocardial infarction. Am J Cardiol. 1980 Dec 1;46(6):915–921. doi: 10.1016/0002-9149(80)90345-8. [DOI] [PubMed] [Google Scholar]

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