الفهرس 
Patients and methodsOnly 14 pages are availabe for public view
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Abstract
To study the value of reciprocal ST segment depression during
early exercise ECG in patients presented with acute myocardial
infarction and received thrombolytic therapy. We studied 50 patients
who were subjected to the following:
1-Full history taking and thorough clinical examination.
2-12 lead Surface ECG.
3-Exercise ECG :
Exercise ECG was performed according to modified
Bruce protocol before or soon after discharge from the
hospital, a mean of ten (range 7-21) days after infarction. ST
depression induced by exercise was considered to be
reciprocal if accompanied by ST elevation in leads related to
another area of the heart -invariably the leads related to the
infarct, and to be isolated if occurring on its own.
4- Echocardiography:
Echocardiographic examination was done to all patients in all
possible views using M-mode, 2D and Doppler echocardiography
to assess left ventricular systolic and diastolic functions, to
evaluate wall motion abnormalities and to detect any cardiac
abnormality.
5-cardiac catheterization:
Coronary angiography was done to all patients within 2-4
weeks of discharge from hospital. Multiple projections of the
coronary arteries were recorded on CINE film and reviewed by
experienced observers to detect the number of coronary vessel
affection and the patency of the infarct related artery.
Statistical analysis of the results of this study revealed the following:
_ Chest pain during exercise was significantly higher in patients
with isolated ST segment depression and was lower in those
either with reciprocal or without ST segment depression.
_ Wall motion abnormalities was less in patients with reciprocal
ST depression, but without statistically significant difference.
_ Left ventricular Ejection Fraction was lower in patients with
reciprocal ST depression.
_ The reciprocal ST depression during exercise was significantly
associated with single vessel disease and with persistent
occlusion of the artery related to infarction.
_ There was no significant relation between age, sex,
hypertension, hypercholesterolemia or diabetes mellitus and the
occurrence of reciprocal ST depression during exercise.
We conclude that reciprocal ST segment depression that
occurred during early exercise stress testing in patients with acute
myocardial infarction who were treated by thrombolytic therapy
is most probably due to a passive electrical phenomenon and not
due to remote ischemia.
Finally we recommend the performance of this study in a
large number of patients using all possible new diagnostic
modalities and to extend the scale of the study to include patients
late after myocardial infarction.