[Acute coronary syndromes with simultaneous elevation of the ST segment in inferior and precordial leads].

OBJECTIVE

To describe the patients with ischemic chest pain and simultaneous ST-segment elevation in the inferior and right precordial leads. MATERIAL AND METHODS.

DESIGN

Series of cases.

CONTEXT

an adult, Intensive Care Service with 16 beds, with no hemodynamic service, for the management of coronary and polyvalent patients.

PATIENTS

we studied 10 patients with acute coronary syndrome who had: a) a ST-segment elevation > or = 1 mm in two or more contiguous leads in the inferior and right precordial leads, b) a resolution of the ST-segment elevation and/or the appearance of Q waves or decrease of the R wave amplitude after the disappearance of the angina and c) a coronary angiographic study.

RESULTS

There were 9 men and 1 woman, with an average age of 62.6 years. Two patients had a background of inferior myocardial infarction. Nine patients received thrombolytic treatment after 122.2 +/- 93.9 minutes of the pain onset. Leads III and V3 showed the greatest elevations of ST segment. Serum levels of creatine kinase were normal in 3 cases and significantly elevated (> 1700 U/L) in six. The ECG evolved to normality in 2 cases and it showed inferior Q waves in 5 patients, and negative T waves in 3 patients. Three patients had no complications, three cases had cardiac blocks and three patients had ventricular tachycardias. The coronary arteriography was normal in 2 patients; three patients showed a proximal stenosis in the right coronary artery and five patients had two or more stenotic coronary arteries. Three patients were diagnosed of unstable angina, one patient was diagnosed of transient apical cardiomyopathy, 4 patients had an acute inferior myocardial infarction with right ventricular extension and 2 patients had a myocardial infarction without anterior Q wave. All the patients survived.

CONCLUSIONS

Most of the patients with acute coronary syndrome associated with simultaneous SST elevation in inferior and right precordial leads had multivessel coronary disease and all patients with only one coronary vessel involved had right ventricular infarction secondary to severe proximal lesion of the right coronary artery.