Electrocardiographic analysis of V1-V4 leads in infarction by proximal right coronary artery occlusion / Análisis electrocardiográfico de derivaciones V1-V4 en infarto por oclusión de la arteria coronaria derecha proximal

Abstract: Introduction: In some cases, ST segment elevation in right precordial leads in conjunction with inferior leads can be originated by an obstruction of the right coronary artery in its proximal portion, generating an inferior myocardial infarction which involves the right ventricle. Case presentation: We present the case of a 57-year-old male, which presents symptoms of acute coronary syndrome. The electrocardiogram shows subepicardial injury in anteroseptal leads (V1-V3) and elevation of ST segment in inferior leads (DIII, AVF). A coronariography is performed finding a complete obstruction of right coronary artery in the proximal portion, left coronary artery without lesions. Analysis: In right ventricular infarction or anteroseptal infarction, the ST segment vector always has a posterior- anterior direction in horizontal plane, the direction of this vector will produce an elevation of ST segment in leads V1 to V3 (even V4). Conclusion: It is necessary to do a correct analysis of the electrocardiogram for understanding the mentioned changes and to not assume that the electrocardiographic manifestations are a consequence of multivessel disease.(AU)

Resumen: Introducción: En algunos casos, la elevación del segmento ST en derivaciones precordiales derechas en conjunción con derivaciones inferiores, puede originarse por una obstrucción de la arteria coronaria derecha en su porción proximal, generando así un infarto de miocardio inferior que involucra al ventrículo derecho. Presentación del caso: Presentamos el caso de un paciente varón de 57 años, que presenta síntomas de síndrome coronario agudo, el electrocardiograma muestra lesión subepicárdica en derivaciones anteroseptales (V1-V3) y elevación del segmento ST en derivaciones inferiores (DIII, AVF). Una coronariografía se realiza encontrando una obstrucción completa de la arteria coronaria derecha en la porción proximal, arteria coronaria izquierda sin lesiones. Análisis: En el infarto ventricular derecho o infarto anteroseptal, el vector del segmento ST siempre tiene una dirección posterior-anterior en el plano horizontal, la dirección de este vector producirá una elevación del segmento ST en las derivaciones V1 a V3 (incluso V4). Conclusión: Es necesario hacer un análisis correcto del electrocardiograma para comprender los cambios mencionados y no asumir que las manifestaciones electrocardiográficas son consecuencia de la enfermedad multivaso.(AU)

Prevalencia y asociación de la calcificación valvular aórtica con factores de riesgo y aterosclerosis coronaria en población mexicana / Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population

Resumen: Objetivo: La prevalencia de calcificación valvular aórtica (CVA) tiene influencia importante de la etnia y se desconoce en población mexicana. Nuestro objetivo fue investigar la prevalencia de CVA y sus asociaciones con factores de riesgo cardiovascular y calcificación arterial coronaria (CAC). Método: En 1,267 sujetos (53% mujeres) sin enfermedad coronaria conocida y con edad de 35 a 75 años, la CVA y la CAC se evaluaron mediante tomografía computada multidetector, utilizando el método de Agatston. Los factores de riesgo cardiovascular se documentaron en todos los participantes. Las asociaciones de CVA con CAC y factores de riesgo se estimaron usando el análisis de regresión logística múltiple. Resultados: La prevalencia global de CVA y CAC fue del 19.89% y del 26.5%, respectivamente. Ambas condiciones aumentaron con la edad y se encontraron con mayor frecuencia en hombres (25.5 y 37.1%, respectivamente) que en mujeres (14.9 y 13%, respectivamente). La CVA se observó en únicamente el 8.5% de los sujetos sin CAC, mientras que en aquellos con CAC 1-99, 100-399 y > 400 unidades Agatston, las prevalencias fueron del 36.8, 56.8 y 84%, respectivamente. El análisis de regresión logística múltiple ajustado por edad, género, obesidad, inactividad física, hipertensión, dislipidemia y valores altos de insulina, mostró que la presencia de CAC (RM [IC95%]: 3.23 [2.26-4.60]), obesidad (1.94 [1.35-2.79]), género masculino (1.44 [1.01-2.05]) y edad (1.08 [1.03-1.10]), fueron predictores independientes y significativos de la CVA. Conclusiones: La prevalencia de CVA es alta y se asocia significativamente con factores de riesgo aterosclerótico y CAC en población mexicana.

Abstract: Objetive: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. Methods: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. Results: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects wit-hout CAC, while those with CAC 1-99, 100-399, and > 400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. Conclusion: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.

[Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population]. / Prevalencia y asociación de la calcificación valvular aórtica con factores de riesgo y aterosclerosis coronaria en población mexicana.

OBJETIVE: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. METHODS: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. RESULTS: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects without CAC, while those with CAC 1-99, 100-399, and >400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. CONCLUSION: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.