ECG Diagnosis and Classification of Acute Coronary Syndromes

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

Yochai Birnbaum¹  James Michael Wilson¹  Miquel Fiol³  Antonio Bayés de Luna⁴  Markku Eskola⁵  Kjell Nikus⁵ 

[1] The Section of Cardiology, Baylor College of Medicine;Texas Heart Institute, Saint Luke's Episcopal Hospital;Hospital Universitario Son Espases;Institute Català Ciències Cardiovasculars;Department of Cardiology, Heart Center, Tampere University Hospital and University of Tampere, Medical School

关键词: acute coronary syndrome;    electrocardiogram;    ST-segment elevation;    ST-segment depression;    risk stratification;    triage;    myocardial infarction;   

DOI  :  10.1111/anec.12130

来源: Wiley

【 摘 要 】

In acute coronary syndromes, the electrocardiogram (ECG) provides important information about the presence, extent, and severity of myocardial ischemia. At times, the changes are typical and clear. In other instances, changes are subtle and might be recognized only when ECG recording is repeated after changes in the severity of symptoms. ECG interpretation is an essential part of the initial evaluation of patients with symptoms suspected to be related to myocardial ischemia, along with focused history and physical examination. Patients with ST-segment elevation on their electrocardiogram and symptoms compatible with acute myocardial ischemia/infarction should be referred for emergent reperfusion therapy. However, it should be emphasized that a large number of patients may have ST-elevation without having acute ST-elevation acute coronary syndrome, while acute ongoing transmural ischemia due to an abrupt occlusion of an epicardial coronary artery may occur in patients with ST-elevation less than the thresholds defined by the guidelines. Up-sloping ST-segment depression with positive T waves is increasingly recognized as a sign of regional subendocardial ischemia associated with severe obstruction of the left anterior descending coronary artery. Widespread ST-segment depression, often associated with inverted T waves and ST-segment elevation in lead aVR during episodes of chest pain, may represent diffuse subendocardial ischemia caused by severe coronary artery disease. In case of hemodynamic compromise, urgent coronary angiography has been increasingly recommended for these patients.

【 授权许可】

Unknown