Modified Selvester QRS Score in Predicting Successful ST Segment Resolution in Patients with Acute Myocardial Infarction receiving Fibrinolytic Therapy with Streptokinase

Ramya, K (2013) Modified Selvester QRS Score in Predicting Successful ST Segment Resolution in Patients with Acute Myocardial Infarction receiving Fibrinolytic Therapy with Streptokinase. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Coronary artery disease, the number one killer in the world, is a disease of the heart where the coronary arteries are either partially occluded resulting in myocardial ischemia, or totally occluded resulting in myocardial infarction (MI). MI could be a minor event, perhaps not even recognized, or it may be a major attack with results varying from acute pain, hemodynamic deterioration to sudden death. The early detection of an infarction greatly improves the patients’ chances of survival and return to health and is therefore very important. The real incidence of acute myocardial infarction is difficult to judge because of varied reporting pattern. Moreover increased incidence of diabetes and obesity, stemming from global shift to western diet and lifestyle will increase consequent coronary artery disease in the near future. Death due to silent ischaemia is common especially in diabetics and elderly and it’s the common cause of sudden death outside the hospital The mortality rate of patients with presumed myocardial infarction or acute coronary syndrome in the first month is ~50% and of these deaths about half occur within the first 2 hrs. For the first six months after infarction, the risk of developing sudden death is still high, but this risk falls after this period. Anterior infarction carries a grave prognosis if accompanied by conduction disturbances. All the major complications worsen the prognosis. Age above 70 years, hypertension, diabetes and heavy cigarette smoking worsen the outlook further. Patients requiring cardiopulmonary resuscitation during the course of the illness run a higher risk of fatal arrhythmias in the first few years after discharge from hospital. Evidence is that atleast a small proportion of cardiac myocytes compensate to make up for the lost cells, on long term follow up. The high initial mortality of MI has decreased with the advent of coronary care unit, fibrinolytic therapy and catheter based reperfusion. Although primary percutaneous coronary intervention (PCI) has been shown to decrease mortality, a significant number of patients with acute MI are not eligible for this as they cannot reach hospitals within the required time window. As the elderly constitute an increasing proportion of those presenting with acute MI having high mortality, but is not eligible for fibrinolytic therapy, MI may continue to remain the leading cause of death over the next several decades. Myocardial infarction may be revealed by any of the following - clinical symptoms and signs, biochemical markers, imaging or pathological characteristics, but the most important initial clinical test for diagnosis of MI remains electrocardiography. The relative ease of use, low cost and particularly the non-invasiveness and speed makes it an excellent tool for a patient with suspicion of MI. AIMS AND OBJECTIVES: To estimate whether Selvester QRS scoring would reliably predict resolution of ST segment in patients with first acute ST segment elevation myocardial infarction receiving fibrinolytic therapy with the drug streptokinase. MATERIALS AND METHODS: The study was conducted on 62 patients admitted in the intensive coronary care unit of Government Rajaji Hospital, Madurai. Approval from the hospital ethical committee was obtained. STUDY DESIGN: The study was a cohort study conducted for a period of one year from March 2012 to August 2012. Inclusion criteria: • Patients with first acute STEMI in the age group of 30-80 years presenting within 24 hours from symptom onset, eligible for reperfusion therapy (presenting within 12 hours of symptom onset or presenting thereafter with persistent symptoms) were included in the study. • The diagnosis of STEMI was based on ECG findings of ST segment elevation >1mm in atleast two contiguous leads in a patient presenting with typical history of angina and with elevated CPK MB. Exclusion criteria: 1. Patients with bundle branch block, paced rhythm, left fascicular block. 2. Ecg signs of ventricular hypertrophy. 3. Patients with cardiogenic shock. Blood samples were collected for estimation of CPK MB, fasting lipid profile, complete hemogram, blood sugar, blood urea and creatinine. CONCLUSION: 1. It was found that as age advances non resolution of ST segment is higher and also the QRS scores are high. 2. ST segment non resolution and QRS scores were high in diabetics. 3. Sex, smoking, alcohol had no effect on ST segment resolution and QRS score. 4. Although hypertension had no effect on the ST segment resolution, hypertensives (without LVH) had a higher QRS score. 5. The type of MI and dyslipidemia did not correlate well with ST segment resolution and QRS score. 6. Patients with congestive heart failure and low ejection fraction were significantly associated with non resolution of ST segment and high QRS score. 7. There was a statistically significant negative correlation between QRS score and ∑STR. Thus the Modified Selvester QRS score can reliably estimate the resolution of ST segment in patients with acute STEMI receiving fibrinolytic therapy. Using the cut-off mark of > 4, the QRS scoring system can estimate ST segment non resolution with a high sensitivity and an acceptable specificity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Modified Selvester QRS Score ; Predicting Successful ST Segment Resolution ; Acute Myocardial Infarction ; Fibrinolytic Therapy ; Streptokinase.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 20 Mar 2018 03:27
Last Modified: 20 Mar 2018 16:39

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