Updates on the Electrocardiogram in Acute Coronary Syndromes

Abstract

The electrocardiogram (ECG) is the initial test\rin patients with suspected ACS. The ECG is the defining\relement of ST-segment elevation myocardial infarction\r(STEMI). Its most important use is in the detection of\racute coronary obstruction, and it is the most important,\rcost-effective, and immediately available initial test in the\rdecision for emergency reperfusion therapy. There is a\rrecent interest in refining the sensitivity and specificity of\rthe ECG for coronary occlusion, and thus for identifying\rsubtle STEMI, as well as in recognizing pseudoinfarction\rpatterns and thus avoiding false positive cath lab\ractivations. Studies assessing the accuracy of cath lab\ractivation, the differentiation of precordial ST-segment\relevation due to normal variant from that of anterior\rSTEMI, the diagnosis of STEMI in the presence of left\rbundle branch block, the differentiation of benign inferior\rST-segment elevation from that of inferior STEMI, and\rthe importance of ST-segment elevation in lead aVR will\rbe discussed.