The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document
Por:
Birnbaum, Y, Nikus, K, Kligfield, P, Fiol, M, Barrabes, JA, Sionis, A, Pahlm, O, Niebla, JG, de Luna, AB
Publicada:
1 sep 2014
Resumen:
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.
Filiaciones:
Birnbaum, Y:
Baylor Coll Med, Dept Med, Cardiol Sect, Houston, TX 77030 USA
Nikus, K:
Tampere Univ Hosp, Heart Hosp, Tampere, Finland
Univ Tampere, FIN-33101 Tampere, Finland
Kligfield, P:
New York Presbyterian Hosp, Weill Cornell Med Ctr, New York, NY USA
Fiol, M:
Hosp Son Espases, Palmas Inst Hlth Res IdISPa, Coronary Care Unit, Palma De Mallorca, Spain
Barrabes, JA:
Autonomous Univ Barcelona, VHIR, Vall dHebron Univ Hosp, Serv Cardiol, Barcelona, Spain
Sionis, A:
Biomed Res Inst St Pau IIB St Pau, Dept Cardiol, Intens CardiacCare Unit, Barcelona, Spain
Pahlm, O:
Lund Univ, Dept Clin Sci, Lund, Sweden
Skane Univ Hosp, Lund, Sweden
Niebla, JG:
Valle del Golfo Hlth Ctr, Reg Hlth Serv El Hierro, Islas Canarias, Canary Islands, Spain
de Luna, AB:
Catalan Inst Cardiovasc Sci, Barcelona, Spain
Green Published
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