3D Coronary & Ischemia Atlas
3D STEMI & OMI Simulator: Coronary Territories & Ischemic Phenotypes
Visualize the bioelectrical and tissue impact of acute coronary occlusion in an interactive 3D heart model with standard (12-lead) and accessory (V7-V9, V3R-V4R) leads.
Coronary tree modeling & myocardial perfusion
The MioAtlas coronary engine reconstructs the three-dimensional architecture of the 11 major arterial branches over the ventricular epicardium: left main (LMCA), left anterior descending (LAD) with D1 and D2 diagonals, circumflex (LCx) with OM1 and OM2 marginals, and right coronary artery (RCA) with acute marginal (AM), posterior descending (PDA), and posterolateral (PLB) branches.
Each stenosis or occlusion point (parameter ter=...) defines an ischemic myocardium-at-risk volume based on vessel location and coronary dominance. Transmural injury is mapped onto the standardized AHA/ACC 17-segment model (Cerqueira et al. 2002). Cellular injury currents during depolarization and repolarization yield ST-vector shifts recorded on the live 120 Hz ECG monitor.
OMI paradigm: beyond strict millimeter criteria
The simulator integrates 8 ECG phenotypes reflecting the modern Occlusion Myocardial Infarction (OMI) paradigm. This framework recognizes that many acute transmural or critical subtotal occlusions do not meet traditional millimeter ST elevation thresholds in contiguous leads.
Modeled patterns include De Winter hyperacute T-waves in critical proximal LAD stenosis, Wellens biphasic/inverted T-wave reperfusion patterns (Types A and B), Aslanger inferior infarction with multivessel disease, giant Shark-Fin triangular waves, and modified Sgarbossa-Smith criteria in LBBB and ventricular pacing.
Biophysical variables: evolutionary phases & coronary dominance
ECG manifestations change dynamically with ischemic duration and coronary anatomy. The engine allows interactive selection of infarction phases (ph=HIPERAGUDA, AGUDA, ESTABLECIDA, SUBAGUDA, or CRONICA), demonstrating the progression from hyperacute T-waves to pathological Q-wave necrosis (>30 ms) and T-wave inversion.
Dominance settings (dom=RIGHT, LEFT, CODOMINANT) redistribute vascular supply to the inferior and posterior LV, altering whether maximum ST elevation appears in lead III (right dominant) or lead II with inferolateral involvement (left dominant).
18 Coronary Occlusion Sites (STEMI / Transmural MI)
Anatomical sites across the left main, anterior descending, circumflex, right coronary artery, and diagonal/marginal branches.
Left Main Coronary Artery (LMCA)
1 locationLeft Anterior Descending (LAD)
5 locationsMassive anteroseptal infarction (very proximal LAD, pre-S1/pre-D1)
Extensive anteroseptal infarction (proximal LAD, post-S1/pre-D1)
Anteroapical infarction (mid LAD, post-D1)
Localized apical infarction (distal LAD, post-D2)
Apical-inferior infarction (recurrent / wraparound LAD)
Left Circumflex (LCx)
2 locationsLateral and posterolateral infarction (proximal LCx)
Posterolateral / posterior infarction (distal LCx)
Right Coronary Artery (RCA)
4 locationsInferior infarction with Right Ventricular extension (proximal RCA)
Isolated inferior infarction (mid RCA)
Basal inferior / pre-crux infarction (distal RCA)
Posterior / inferoseptal infarction (proximal PDA)
Coronary Branches (Diagonals, Marginals, PDA, PLB)
6 locationsIsolated high lateral infarction (1st Diagonal Branch / D1)
Mid lateral infarction (2nd Diagonal Branch / D2)
Pure lateral infarction (1st Obtuse Marginal / OM1)
Low posterolateral infarction (2nd Obtuse Marginal / OM2)
Isolated Right Ventricular infarction (Acute Marginal Branch / AM)
Posterobasal infarction (Posterolateral Branch / PLB)
OMI Paradigm
8 Electrocardiographic Phenotypes & OMI Equivalents
High-risk ischemic patterns reflecting active coronary occlusion or critical subtotal stenosis with distinctive bioelectrical signatures.
Classic STEMI (Transmural)
de Winter Pattern (OMI Equivalent)
Wellens Syndrome Type A (Biphasic T)
Wellens Syndrome Type B (Deep Inverted T)
Aslanger Pattern (Inferior OMI with Multivessel Disease)
Shark-Fin Pattern (Triangular Wave / Giant Lambda)
Sgarbossa-Smith Criteria (Left Bundle Branch Block)
Sgarbossa Criteria in Paced Rhythm
Hemodynamic and electrophysiological foundation
The 11-artery coronary model and myocardium-at-risk mapping build upon standardized American Heart Association anatomical classifications (Cerqueira et al. 2002; Austen et al. 1975). Culprit artery correlation and reciprocal leads follow European Society of Cardiology and American College of Cardiology consensus guidelines (Thygesen et al. 2018; Ibanez et al. 2018).