ST-elevation and non-ST-elevation acute coronary syndromes: Should the guidelines be changed?

Gorgels, Anton P.M.

doi:10.1016/j.jelectrocard.2013.04.005

Cited by 38 publications

(26 citation statements)

References 17 publications

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“…Our results show that only a frontal plane ST-vector of 60°was significant in distinguishing patients with TC (p b 0.01) from all patients with acute anterior STEMI. Originally it was expected that distal LAD occlusions would also have an inferiorly directed ST-vector [11], making differentiation with TC difficult. The significant difference found could be due to the small number of patients with distal LAD occlusion (n = 10) included in this study.…”

Section: Discussionmentioning

confidence: 99%

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Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

Vervaat

Christensen

Smeijers

et al. 2015

Journal of Electrocardiology

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Section: Discussionmentioning

confidence: 99%

“…(2) Frontal plane ST-vector; represents the direction and magnitude of the ST-segment deviation [11] and can be used to determine the specific occlusion site [12] -proximal LAD: approximately − 90° (Fig. 2 All measurements were done by a single observer (F.V.)…”

Section: Methodsmentioning

confidence: 99%

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

Vervaat

Christensen

Smeijers

et al. 2015

Journal of Electrocardiology

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“…(1) Transition from subendocardial ischemia (ST depression) to transmural ischemia (ST elevation) should have a phase of isoelectric ST. 52 We are not aware of such a description in patients, although it has been detected in an animal model. 53 Nevertheless, repeat ECGs several minutes later should probably show dynamic changes.…”

Section: (I) T-wave Inversion T-wave Inversion Withoutmentioning

confidence: 99%

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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“…Acute transmural myocardial ischemia is represented as ST-segment elevation on a standard 12-lead surface electrocardiogram (ECG) in leads with the positive pole facing the ST-vector [1][2][3]. In the acute phase of inferior wall ischemia ST-elevation is present in leads II, III and aVF.…”

Section: Introductionmentioning

confidence: 99%

“…If the lateral wall is involved there may be ST-elevation in V 5 -V 6 [2]. In addition, ST-depression, which can be STsegment elevation observed reversely, often occurs in leads V 1 -V 3 and aVR [3]. In the chronic phase, the infarcted area presents as a loss of R-waves and/or formation of Q-waves at the positive poles facing the affected tissue.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic prediction of lateral involvement in acute non-anterior wall myocardial infarction

Norda

Weg

Vos

et al. 2015

Journal of Electrocardiology

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ST-elevation and non-ST-elevation acute coronary syndromes: Should the guidelines be changed?

Cited by 38 publications

References 17 publications

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

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

Electrocardiographic prediction of lateral involvement in acute non-anterior wall myocardial infarction

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