The Role of the ECG in Diagnosis,Risk Estimation,and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document |
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| Authors: | Yochai Birnbaum MD Kjell Nikus MD Paul Kligfield MD Miguel Fiol MD Jose Antonio Barrabés MD Alessandro Sionis MD Olle Pahlm MD J Garcia Niebla RN Antonio Bayès de Luna MD |
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| Institution: | 1. The Section of Cardiology, The Department of Medicine, Baylor College of Medicine, , Houston, TX, USA;2. Heart Hospital, Tampere University Hospital and University of Tampere, , Finland;3. The New York‐Presbyterian Hospital–Weill Cornell Medical Center, , New York, NY;4. Coronary Care Unit, Palma's Institute of Health Research (IdISPa), Hospital Son Espases, , Palma de Mallorca, Spain;5. Cardiology Service, Vall d'Hebron University Hospital, VHIR, Autonomous University of Barcelona, , Barcelona, Spain;6. Intensive Cardiac Care Unit, Cardiology Department, Biomedical Research Institute Sant Pau (IIB Sant Pau), , Barcelona, Spain;7. Department of Clinical Sciences, Lund University and Sk?ne University Hospital, , Lund, Sweden;8. Regional Health Services of El Hierro, Valle del Golfo Health Center, , Canary Islands, Spain;9. The Catalan Institute for Cardiovascular Sciences, , Barcelona, Spain |
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| Abstract: | The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1–V3) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1–V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients. |
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| Keywords: | noninvasive techniques— electrocardiography Acute coronary syndrome ischemia ST elevation ST depression myocardial infarction |
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