Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 96

Figure 2.1 Phases of STEMI.

Phase 3 does not imply that MI has already been too prolonged to benefit from PCI; some patients with phase 3 morphology have had only a brief period of ischemia.

ST elevation may persist for days, weeks, or chronically >3 weeks in patients with a dyskinetic or aneurysmal myocardium. In this case, the age of the infarct is implied clinically. Let’s take the case of a patient who had chest discomfort several days previously and currently has HF without angina; if his ECG shows Q waves and ST elevation, his STEMI is likely >24 hours old and the persistent ST elevation likely reflects dyskinesia. An echocardiogram showing a dilated LV with a truly thin wall in diastole confirms this suspicion.

The inverted T waves may persist for days, weeks, months, or even years. Patients with LV dyskinesia and persistent ST-segment elevation may have chronic T-wave inversion as well.