THE ELECTROCARDIOGRAPHIC DIAGNOSIS OF ACUTE MYOCARDIAL ISCHEMIA
Authors: G B MYERS, F N TALMERS
Journal: Annals of Internal Medicine (1955)

Article1 August 1955THE ELECTROCARDIOGRAPHIC DIAGNOSIS OF ACUTE MYOCARDIAL ISCHEMIAGORDON B. MYERS, M.D., F.A.C.P., FREDERICK N. TALMERS, M.D.GORDON B. MYERS, M.D., F.A.C.P., FREDERICK N. TALMERS, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-43-2-361 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMyocardial ischemia may be referable to (1) primary reduction in oxygen delivery by the coronary tree; (2) primary increase in cardiac work so that an oxygen supply ordinarily sufficient at rest is no longer adequate; (3) combinations of (1) and (2). Severe prolonged ischemia results in left ventricular infarction, which is manifested by distinctive QRS alterations in leads facing the epicardial surface. These consist of (1) increase in the duration and amplitude of the Q wave at the expense of the succeeding R, provided the septal vector maintains its normal left-to-right direction, or (2) development of incomplete or complete left...Bibliography1. Hecht HH: Concepts of myocardial ischemia, Arch. Int. Med. 84: 711-729, 1949. CrossrefGoogle Scholar2. Master AM: The two-step exercise electrocardiogram: a test for coronary insufficiency, Ann. Int. Med. 32: 842-863, 1950. LinkGoogle Scholar3. PruittBarnesEssex RDARHE: Electrocardiographic changes associated with lesions in the deeper layers of the myocardium—an experimental study, Am. J. M. Sc. 210: 100-113, 1945. CrossrefGoogle Scholar4. Bayley RH: Electrocardiographic effects of injury at the endocardial surface of the left ventricle, Am. Heart J. 31: 677-684, 1946. CrossrefMedlineGoogle Scholar5. LevineFord HDRF: Subendocardial infarction: report of six cases and critical survey of the literature, Circulation 1: 246-263, 1950. CrossrefMedlineGoogle Scholar6. MyersSearsHiratzka GBCHT: Correlation of electrocardiographic and pathologic findings in ring-like subendocardial infarction of the left ventricle, Am. J. M. Sc. 222: 417-426, 1951. CrossrefMedlineGoogle Scholar7. PruittValencia RDF: The immediate electrocardiographic effects of circumscribed myocardial injuries: an experimental study, Am. Heart J. 35: 161-197, 1948. CrossrefMedlineGoogle Scholar8. WégriaSegersKeatingWard RMRPHP: Relationship between the reduction in coronary flow and the appearance of electrocardiographic changes, Am. Heart J. 38: 90-96, 1949. CrossrefMedlineGoogle Scholar9. RandlesFradkin FSNF: Electrocardiographic alterations resembling those produced by myocardial infarction observed during a spontaneous attack of angina pectoris, Ann. Int. Med. 28: 671-676, 1948. LinkGoogle Scholar10. MyersSearsHiratzka GBCHT: Correlation of electrocardiographic and pathologic findings in circumferential lamellar infarction of the left ventricle, Tr. A. Am. Physicians 64: 82-94, 1951. MedlineGoogle Scholar11. ScherfGoldhammer DS: Zur Frühdiagnose der Angina pectoris mit Hilfe des Electrokardiogramms, Ztschr. klin. Med. 124: 111-137, 1933. Google Scholar12. DietrichSchwiegk SH: Angina pectoris und Anoxie des Herzmuskels, Ztschr. klin. Med. 125: 195-242, 1933. Google Scholar13. RisemanWallerBrown JEJVMG: The electrocardiogram during attacks of angina pectoris; its characteristics and diagnostic significance, Am. Heart J. 19: 683-707, 1940. CrossrefGoogle Scholar14. LevyWilliamsBruennCarr RLNEHGHA: The "anoxemia test" in the diagnosis of coronary insufficiency, Am. Heart J. 21: 634-656, 1941. CrossrefGoogle Scholar15. Levy RL: Clinical aspects of coronary insufficiency, Am. J. Med. 4: 89-99, 1948. CrossrefMedlineGoogle Scholar16. WeintraubBishop HJLF: The anoxemia test for coronary insufficiency, Ann. Int. Med. 26: 741-763, 1947. LinkGoogle Scholar17. StewartCarr HJHA: The anoxemia test, Am. Heart J. 48: 293-320, 1954. CrossrefMedlineGoogle Scholar18. Bitzer EW: Observations on the effect of sudden changes in arterial tension in angina pectoris, Ann. Int. Med. 9: 1120-1128, 1936. LinkGoogle Scholar19. BermanMcGuire BJ: Electrocardiographic changes induced by cold application to various body sites in patients with angina pectoris—preliminary report, Am. J. M. Sc. 219: 82-85, 1950. CrossrefMedlineGoogle Scholar20. Ruskin A: Pitressin test of coronary insufficiency, Am. Heart J. 34: 569-579, 1947. CrossrefMedlineGoogle Scholar21. Biörck G: Ergotamine and apparent coronary insufficiency, Brit. Heart J. 9: 181-184, 1947. CrossrefMedlineGoogle Scholar22. Stein I: Observations on the action of ergonovine on the coronary circulation and its use in the diagnosis of coronary artery insufficiency, Am. Heart J. 37: 36-45, 1949. CrossrefMedlineGoogle Scholar23. MasterPordyKolkerBlumenthal AMLJMJ: The "two-step" exercise electrocardiogram in functional heart disturbances and in organic heart disease: the use of ergotamine tartrate, Circulation 1: 692-699, 1950. CrossrefGoogle Scholar24. MasterPordyChesky AMLK: Two-step exercise electrocardiogram, J. A. M. A. 151: 458-462, 1953. MedlineGoogle Scholar25. Missal ME: Exercise tests and the electrocardiograph in the study of angina pectoris, Ann. Int. Med. 11: 2018-2036, 1938. LinkGoogle Scholar26. LittmannRodman DMH: An exercise test for coronary insufficiency, Circulation 3: 875-880, 1951. CrossrefMedlineGoogle Scholar27. SimonsonMcKinlay ECA: The meal test in clinical electrocardiography, Circulation 1: 1006-1016, 1950. CrossrefGoogle Scholar28. BermanBraunsteinMcGuire BJRJ: The effect of meals on the electrocardiogram and the ballistocardiogram in patients with angina pectoris, Circulation 1: 1017-1025, 1950. CrossrefGoogle Scholar29. ScherfWeissberg DJ: Hypertonic glucose solution in angina pectoris, Am. Heart J. 18: 411-424, 1939. CrossrefGoogle Scholar30. Biörck G: Anoxemia and exercise tests in the diagnosis of coronary disease, Am. Heart J. 32: 689-696, 1946. CrossrefMedlineGoogle Scholar31. Scherf D: Fifteen years of electrocardiographic exercise test in coronary stenosis, New York State J. Med. 47: 2420-2424, 1947. MedlineGoogle Scholar32. Sjostrand T: The electrocardiographic work and hypoxemia tests, Scandinav. J. Clin. and Lab. Invest. 3: 1-5, 1951. CrossrefMedlineGoogle Scholar33. StorchMaster SAM: RS-T segment, T wave and heart rate after two step and 10 per cent anoxemia tests, J. A. M. A. 146: 1011-1016, 1951. CrossrefMedlineGoogle Scholar34. GrossmanWeinsteinKatz MWWLN: The use of the exercise test in the diagnosis of coronary insufficiency, Ann. Int. Med. 30: 387-397, 1949. LinkGoogle Scholar35. PattersonClarkLevy JETWRL: A comparison of electrocardiographic changes observed during the "anoxemia test" on normal persons and on patients with coronary sclerosis, Am. Heart J. 23: 837-846, 1942. CrossrefGoogle Scholar36. YuSoffer PNA: Studies of electrocardiographic changes during exercise (modified double two-step test), Circulation 6: 183-192, 1952. CrossrefMedlineGoogle Scholar37. GreeneGilbert CWNC: Studies on the responses of the circulation to low oxygen tension, Arch. Int. Med. 27: 517-557, 1921. CrossrefGoogle Scholar38. BierringLarsenNielsen EKE: Some cases of slow pulse associated with electrocardiographic changes in cardiac patients after maximal work on the Krogh ergometer, Am. Heart J. 11: 416-430, 1936. CrossrefGoogle Scholar39. UntermanDe Graff DAC: The effect of exercise on the electrocardiogram (Master "two-step" test) in the diagnosis of coronary insufficiency, Am. J. M. Sc. 215: 671-685, 1948. CrossrefMedlineGoogle Scholar40. YuBruceLovejoyMcDowell PNRALWME: Variations in electrocardiographic responses during exercise, Circulation 3: 368-376, 1951. CrossrefMedlineGoogle Scholar41. WoodMcGregorMagidsonWhittaker PMOW: The effort test in angina pectoris, Brit. Heart J. 12: 363-371, 1950. CrossrefMedlineGoogle Scholar42. ScherlisSandbergWenerMasterGrishman LAAJAMA: RS-T segment displacement in induced coronary insufficiency as studied with esophageal leads, Circulation 2: 598-603, 1950. CrossrefMedlineGoogle Scholar43. MasterGubnerDackJaffe AMRSHL: Differentiation of acute coronary insufficiency with myocardial infarction from coronary occlusion, Arch. Int. Med. 67: 647, 1941. CrossrefGoogle Scholar44. BurchellPruittBarnes HBRDAR: The stress and the electrocardiogram in the induced hypoxemia test for coronary insufficiency, Am. Heart J. 36: 373-389, 1948. CrossrefMedlineGoogle Scholar45. HechtAbildskovBolinFocht HHJARCFS: Observations on the human heart during induced hypoxia (the ischemia injury pattern), Am. J. Med. 4: 623, 1948. CrossrefMedlineGoogle Scholar46. BryantWood JMJE: Tobacco angina—an electrocardiographic study, Am. Heart J. 34: 20-34, 1947. CrossrefMedlineGoogle Scholar47. LevyBruennWilliams RLHGNE: The modifying action of certain drugs (aminophyllin, nitrites, digitalis) upon the effects of induced anoxemia in patients with coronary insufficiency, Am. Heart J. 19: 639-654, 1940. CrossrefGoogle Scholar48. RussekSmithBaumNaegeleRegan HIRHWSCFFD: Influence of saline, papaverine, nitroglycerin and ethyl alcohol on electrocardiographic response to standard exercise in coronary disease, Circulation 1: 700-705 (Apr.) (Pt. 2) 1950. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, Michigan*Presented as a Morning Lecture at the Thirty-fifth Annual Session of the American College of Physicians, Chicago, Illinois, April 8, 1954.From the Departments of Medicine of Wayne University College of Medicine and City of Detroit Receiving Hospital.†Supported in part by grants from the National Heart Institute and Michigan Heart Association.‡Public Health Research Fellow of the National Heart Institute. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byExaggerated atrial repolarization waves as a predictor of false positive exercise tests in an unselected populationIdentification of false positive exercise tests with use of electrocardiographic criteria: A possible role for atrial repolarization wavesCalcium antagonist drugs in chronic stable angina. 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Coronarinsuffizienz, Angina pectoris und HerzinfarktElectrocardiographic Response to Exercise in Patients with Mitral StenosisCharacteristics of True-Positive and False-Positive Results of Electrocardiographs Master Two-Step Exercise TestsEvaluation of cardiac function in relation to specific physical activities following recovery from acute myocardial infarctionThe T-a wave of the adult electrocardiogram: An expression of pulmonary emphysemaAllergic shock in humans: Report of two cases with electrocardiographic findings 1 August 1955Volume 43, Issue 2Page: 361-382KeywordsElectrocardiographyHeartHospital medicineInfarctionIschemiaOxygenPrevention, policy, and public healthTachycardia ePublished: 1 December 2008 Issue Published: 1 August 1955 PDF downloadLoading ...