Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology

Nikus, Kjell; Pahlm, Olle; Wagner, Galen S.; Birnbaum, Yochai; Cinca, Juan; Clemmensen, Peter; Eskola, Markku; Fiol, Miguel; Goldwasser, Diego; Gorgels, Anton P.M.; Sclarovsky, Samuel; Stern, Shlomo; Wellens, Hein J.J.; Zaręba, Wojciech; Luna, Antoni Bayés de

doi:10.1016/j.jelectrocard.2009.07.009

Cited by 100 publications

(71 citation statements)

References 79 publications

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“…3B). 40 In fact ST elevation in aVR is the exact mirror-image pattern of ST depression in I + II, that is half-way between limb leads I and II, equivalent to a frontal plane axis of +30 degrees, where -aVR is calculated as (I + II)/2. Again, this pattern can also be seen in patients with many other conditions, including cardiomyopathy and LVH with secondary repolarization changes (Fig.…”

Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

“…We believe that emergent coronary angiography should be considered in patients with diffuse ST depression and ST elevation in aVR, especially if seen in a patient with ongoing symptoms or hemodynamic compromise and the ECG before the event was relatively normal. 32,40 (iv) Upsloping ST depression with tall positive T waves in the anterolateral leads. Traditionally, upsloping ST depression was not considered as ECG sign of ischemia, as it is commonly seen with increased heart rates (especially during stress tests).…”

Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

“…3A and C). 40,44 This issue is especially relevant for patients with NSTE-ACS. Many of these patients present after symptoms have resolved and the presenting ECG is therefore, relatively unremarkable.…”

Section: The Ecg In Patients After Resolution Of Symptomsmentioning

confidence: 99%

“…(3) Isolated T-wave inversion: In the ACS setting, T-wave inversion without concomitant ST depression is a sign of reperfusion of prior active ischemia, not of ongoing active ischemia itself. 37,40,56,57 This is to be distinguished from the isolated chronic localized T waves that may persist after resolution of an acute event.…”

Section: The Ecg In Patients After Resolution Of Symptomsmentioning

confidence: 99%

“…Thus, this pattern should be considered as a marker of a high risk, though the patient does not have active ongoing ischemia. 40,57 In other cases, T-wave inversion may be less prominent or biphasic T waves with inversion of the terminal portion of the T waves can be seen as a sign of reperfusion. Although there is no indication for emergent reperfusion therapy to prevent ongoing necrosis, this ECG evidence of reperfusion points toward the presence of a culprit coronary lesion that may progress and lead to reischemia/ reinfarction.…”

Section: The Ecg In Patients After Resolution Of Symptomsmentioning

confidence: 99%

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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

Nikus

Kligfield

et al. 2014

Noninvasive Electrocardiol

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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. Ann Noninvasive Electrocardiol 2014;19(5):412-425noninvasive techniques-electrocardiography; Acute coronary syndrome; ischemia; ST elevation; ST depression; myocardial infarctionThe electrical activity of the heart, as depicted by the surface electrocardiogram (ECG) is affected by ischemia, reperfusion and presence of necrosis or scar. Therefore, the ECG has remained the most widely utilized ancillary tool, along with focused history taking and physical examination,

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Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

Section: The Ecg In Patients After Resolution Of Symptomsmentioning

confidence: 99%