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Precordial R-wave reappearance predicting infarct size and myocardial recovery after acute STEMI

Netherlands Heart Journal
Publication Date
DOI: 10.1007/s12471-011-0162-9
  • Case Report
  • Biology
  • Medicine


CASE REPORT Precordial R-wave reappearance predicting infarct size and myocardial recovery after acute STEMI M. T. Rijnierse & N. J. Verouden & R. J. de Winter Published online: 25 May 2011 # The Author(s) 2011. This article is published with open access at Introduction Pathological Q waves may appear on the 12-lead electro- cardiogram (ECG) during acute ST-segment elevation myocardial infarction (STEMI) and signify loss of electrical excitation. Anterior wall STEMI often results in loss of R waves in the precordial leads and subsequent appearance of pathological Q waves. Not infrequently, very early loss of R waves may be visible in patients presenting with anterior STEMI and occasionally, these R waves reappear in the first months following the index event. Despite reports in the literature [1–9], the prognostic significance of R-wave reappearance (RWR) in the setting of primary percutaneous coronary intervention (pPCI) remains uncertain. In this report we present two patients with anterior STEMI who underwent uncomplicated pPCI. The follow-up ECGs were indicative of the amount of myocardial recovery after the acute event as shown by cardiovascular magnetic resonance (CMR) imaging. Case report Case 1 A 75-year-old man with no prior history of cardiac disease was admitted to our coronary care unit because of acute chest pain with radiation to the left arm accompanied by vegetative symptoms for 3 h. Smoking was the patient’s only risk factor for coronary artery disease. The ECG on admission showed ST-segment elevation in leads aVL and V1–V4 with loss of R waves in leads V1–V3 indicating anterior wall STEMI (Fig. 1a). Emergency coronary angiography revealed an occlusion of the left anterior descending (LAD) artery immediately distal to the origin of the first diagonal branch. Uncom- plicated PCI with stenting resulted in restoration of TIMI 3-graded flow approximately 4 h after symptom onset. Peak CK-MB level was 148 μg/l. Post-procedural ECG showed >50% ST-segm

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