Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation.

Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation. Scand Cardiovasc J. 2019 Dec 30;:1-8 Authors: Lindow T, Pahlm O, Khoshnood A, Nyman I, Manna D, Engblom H, Lassen AT, Ekelund U Abstract Objectives. Pericarditis, takotsubo cardiomyopathy and early repolarization syndrome (ERS) are well-known to mimic ST elevation myocardial infarction (STEMI). We aimed to study whether ECG findings of reciprocal ST depression, PR depression, ST-segment convexity or terminal QRS distortion can discriminate between ST elevation due to ischemia and non-ischemic conditions. Design. Eighty-five patients with STEMI and 94 patients with non-ischemic ST elevation were included. All patients had acute chest pain and at least 0.1 mV ST elevation. Presence of PR depression, ST-segment convexity, terminal QRS distortion or reciprocal ST depression was assessed in each ECG. Results. In anterior ST elevation, ST depression in lead II (≥0.025 mV) occurred in 40% of patients with STEMI but in none of the non-ischemic cases. In inferior ST elevation, ST depression in lead I (≥0.025 mV) was present in 83% of patients with STEMI but in none of the non-ischemic cases. Chest-lead PR depression was uncommon in STEMI (12%) compared to non-ischemic cases (38%; p 
Source: Scandinavian Cardiovascular Journal - Category: Cardiology Tags: Scand Cardiovasc J Source Type: research

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ECG changes in coronary artery disease (CAD) can be in any of the waves or segments. Diagnosis of acute myocardial infarction in the emergency room still relies mostly on the ECG, though other investigations are there to supplement. P wave abnormalities P wave being an atrial event, is not usually involved directly by CAD. But indirectly, there can be evidence of atrial enlargement if there is left ventricular dysfunction. Atrial arrhythmias are observed in atrial infarction. Abnormalities of PR segment PR segment contains the atrial repolarization wave (Ta) though it is not usually evident. PR segment depression can occu...
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