Limitations of Electrocardiography in the Diagnosis of Acute Myocardial Infarction: Comparison with Two-Dimensional Echocardiography

Abstract

In order to assess the sensitivity of the initial electrocardiogram (ECG) in diagnosing the first attack of acute myocardial infarction (AMI), we compared the findings on ECG and two-dimensional echocardiogram (2-D echo) in 74 patients with single vessel coronary artery disease. Group A consisted of 41 patients with infero-posterior AMI while group B consisted of 33 patients with antero-septal AMI. In group A, 12 patients showed normal ECGs, while 2-D echo failed to reveal abnormal left ventricular wall motion in only 2 patients. In those two patients, the quality of the echocardiogram was poor. In group B, only one patient showed a normal ECG, and all patients showed abnormal left ventricular wall motion on 2-D echo. We conclude that electrocardiography has limitations in diagnosing infero-posterior myocardial infarction especially during the acute phase, but 2-D echo is an additional useful diagnostic procedure. © 1995, The Japanese Society of Internal Medicine. All rights reserved.