Accuracy of the Electrocardiographic Criteria for Predicting the Right or Left Circumflex Coronary Artery as the Culprit Coronary Artery in Acute Inferior Myocardial Infarction

PURPOSE: New electrocardiographic criteria to predict the culprit coronary artery in acute inferior myocardial infarction have been developed. We tested the effectiveness of these criteria by verifying their diagnostic accuracy. METHODS: The seven electrocardiographic criteria are STsegment depressions (1) in leads I > 0.5 mm, (2) in aVL > 1 mm, and (3) in V6 under the isoelectric line; higher ST-segment elevations (4) in lead III than in lead II, (5) in V1 than in V6, (6) in the sum of V(1 + 2 + 3) > or = V(4 + 5 + 6); and (7) ST-segment elevation > 1 mm in V1, and were analyzed by comparing the ST-segment deviation with the location of the infarcted coronary artery in 43 patients with acute inferior myocardial infarction. RESULTS: The culprit coronary artery consisted of the right coronary artery in 72.1% of the cases, the left circumflex artery in 23.3% of the cases, and the left anterior descending artery in 4.6% of the cases. There was a significant correlation between the criteria and the culprit coronary artery, except for two criteria, ST-segment depression in lead I > 0.5 mm and elevation in lead V1 > 1 mm (p=0.00 to 0.02). Criteria such as ST-segment depressions in lead aVL > 1 mm and V6 under the isoelectric line and a higher ST-segment elevation in the sum of V(1 + 2 + 3) > or = V(4 + 5 + 6) had relatively high specificities (80%, 100%), but a low sensitivities (51.6%, 67.7%). Criteria such as higher ST-segment elevations in lead III than in II and in V1 than in V6 had not only high sensitivities (80.6%, 100%) and specificities (70%, 90%) but also relatively high diagnostic accuracies (95.1%, 82.9%). CONCLUSION: Higher ST-segment elevations in lead III than in II and in V1 than in V6 are sensitive & specific criteria for correctly predicting the culprit coronary artery in acute inferior myocardial infarction.

Tooth Injuries in the Emergency Department

PURPOSE: Tooth injuries are common complaints presenting at emergency departments, so emergency physicians (EP) should play an important role in the initial care of dental trauma. However, there has been little interest in and research on this subject. Examining the various clinical factors helpful for the emergency physician's care of tooth injuries, we attempted to acquire basic data for establishing treatment guideline. METHODS: A retrospective analysis was done by reviewing the dental charts of 214 patients who presented to the emergency departments of one secondary hospital and one tertiary hospital following tooth injuries during a 1-year period (Oct. 2000-Sept. 2001). The following variables were extracted and examined: age, mechanism of injury, number and location of injured teeth, radiograph performance, diagnosis, type of treatment. RESULTS: With the 1992-WHO classification, 9 types of tooth injuries were found (multiple response): in adults, concussion (23.5% of cases), subluxation (16.7%), pulp-exposed crown fracture (16.7%), avulsion (10.8%), and non-pulpexposed crown fracture(15.7%); in children, subluxation (20.2%), luxation (17.2%), avulsion (17.2%), and concussion (11.1%), Seven types of treatment were performed based on single most difficult treatment recorded per patient: 91 conservative cares (42.5% of cases), 9 pulp cappings (4.2%), 49 splints (22.9%), 7 replantations (3.3%), 17 pulpectomies (7.9%), 30 extractions (14.0%), and 10 others. CONCLUSION: Considering that the most prevalent treatments were splints and conservative cares, we think emergency medicine could play a wide role in the initial management of tooth injuries and suggest a further co-study with a dentist.