title: Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion, case reports of STEMI equivalence.
abstract: Timely reperfusion therapy by means of primary percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-segment elevation myocardial infarction. A significant number of patients with large acute myocardial infarction, caused by occlusion of an epicardial coronary artery, do not show ST-elevation on the electrocardiogram. Other ECG abnormalities may be present, the so called STEMI-equivalents. One such STEMI equivalent, junctional ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often in combination with slight ST-elevation in lead AVR, has been associated with proximal occlusion of the left anterior descending coronary artery. Recognition of this ECG pattern by ambulance staff, emergency physicians and interventional cardiologists envolved in STEMI networks, is important to ensure timely reperfusion therapy in these patients. In this paper we present three patients with typical symptoms of acute myocardial infarction and the ECG pattern with slight J-point depression combined with tall, symmetrical T-waves.
authors.affiliation: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ruben W
authors.initials: RW
authors.lastname: de Winter
authors.affiliation: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Adams
authors.affiliation: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Niels J W
authors.initials: NJ
authors.lastname: Verouden
authors.affiliation: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. Electronic address: r.j.dewinter@amc.uva.nl.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D023921:Coronary Stenosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*
keywords: 12-Lead electrocardiogram; Acute LAD artery occlusion; Acute myocardial infarction; Primary percutaneous coronary intervention; ST-segment