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The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document

Birnbaum, Yochai; Nikus, Kjell; Kligfield, Paul; Fiol, Miguel; Antonio Barrabes, Jose; Sionis, Alessandro; Pahlm, Olle LU ; Garcia Niebla, J. and Bayes de Luna, Antonio (2014) In Annals of Noninvasive Electrocardiology 19(5). p.412-425
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 V-1-V-3) 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... (More)
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 V-1-V-3) 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 V-1-V-3 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
noninvasive techniqueselectrocardiography, Acute coronary syndrome, ischemia, ST elevation, ST depression, myocardial infarction
in
Annals of Noninvasive Electrocardiology
volume
19
issue
5
pages
412 - 425
publisher
Wiley-Blackwell
external identifiers
  • wos:000342753800002
  • scopus:84907815571
ISSN
1082-720X
DOI
10.1111/anec.12196
language
English
LU publication?
yes
id
46086b59-d22a-4863-a373-ae47a2a5723c (old id 4803560)
date added to LUP
2014-12-01 07:34:59
date last changed
2017-10-29 03:00:20
@article{46086b59-d22a-4863-a373-ae47a2a5723c,
  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 V-1-V-3) 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 V-1-V-3 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.},
  author       = {Birnbaum, Yochai and Nikus, Kjell and Kligfield, Paul and Fiol, Miguel and Antonio Barrabes, Jose and Sionis, Alessandro and Pahlm, Olle and Garcia Niebla, J. and Bayes de Luna, Antonio},
  issn         = {1082-720X},
  keyword      = {noninvasive techniqueselectrocardiography,Acute coronary syndrome,ischemia,ST elevation,ST depression,myocardial infarction},
  language     = {eng},
  number       = {5},
  pages        = {412--425},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document},
  url          = {http://dx.doi.org/10.1111/anec.12196},
  volume       = {19},
  year         = {2014},
}