Atlante coronarico e ischemia 3D
Simulatore STEMI 3D: territori coronarici ed equivalenti OMI
Visualizza le ripercussioni bioelettriche e tissutali dell'occlusione coronarica acuta su un cuore 3D interattivo con derivazioni standard e accessorie.
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 Siti di occlusione coronarica (STEMI / Infarto transmurale)
Localizzazioni anatomiche sul tronco comune, discendente anteriore, circonflessa, coronaria destra e rami secondari.
Tronco Comune Sinistro (TCS / LMCA)
1 locationDiscendente Anteriore (IVA / LAD)
5 locationsInfarto anterosettale massivo (LAD molto prossimale, pre-S1/pre-D1)
Infarto anterosettale esteso (LAD prossimale, post-S1/pre-D1)
Infarto anteroapicale (LAD media, post-D1)
Infarto apicale localizzato (LAD distale, post-D2)
Infarto apico-inferiore (LAD ricorrente / wraparound)
Circonflessa (Cx / LCx)
2 locationsInfarto laterale e posterolaterale (LCx prossimale)
Infarto posterolaterale / posteriore (LCx distale)
Coronaria Destra (CD / RCA)
4 locationsInfarto inferiore con estensione al Ventricolo Destro (RCA prossimale)
Infarto inferiore isolato (RCA media)
Infarto inferiore basale / pre-crux (RCA distale)
Infarto posteriore / infero-settale (PDA prossimale)
Rami Coronarici (Diagonali, Marginali, PDA, PLB)
6 locationsInfarto laterale alto isolato (1° Ramo Diagonale / D1)
Infarto laterale medio (2° Ramo Diagonale / D2)
Infarto laterale puro (1ª Marginale Ottusa / OM1)
Infarto posterolaterale basso (2ª Marginale Ottusa / OM2)
Infarto isolato del Ventricolo Destro (Ramo Marginale Acuto / AM)
Infarto postero-basale (Ramo Posterolaterale / PLB)
Paradigma OMI
8 Fenotipi elettrocardiografici ed equivalenti OMI
Pattern ischemici ad alto rischio indicativi di occlusione coronarica acuta senza sopraslivellamento ST classico.
STEMI Classico (Transmurale)
Pattern di de Winter (Equivalente OMI)
Sindrome di Wellens Tipo A (T Bifasica)
Sindrome di Wellens Tipo B (T Invertita Profonda)
Pattern di Aslanger (OMI Inferiore con Malattia Multivaso)
Pattern Shark-Fin (Onda Triangolare / Lambda Gigante)
Criteri di Sgarbossa-Smith (Blocco di Branca Sinistra)
Criteri di Sgarbossa in Ritmo da Pacemaker
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).