Acute Anterior Wall Myocardial Infarction Presenting with Positive T Waves and Without ST Segment Shift

“…19.6 ). A small percentage of patients presenting with ongoing chest pain due to coronary artery occlusion present with only Grade 1 of ischemia (tall T waves without ST elevation) [ 37 ]. Continuous ECG recording showed that without reperfusion therapy, these patients may develop Q-wave MI in the subsequent days.…”

Section: Grade Of Ischemiamentioning

confidence: 99%

Acute Coronary Syndromes: Introduction and Pathophysiologic Classification

Nikus

Birnbaum

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Several different classifi cations of acute coronary syndromes (ACS) exist, and most of them are based on the electrocardiogram (ECG). Based on differences in pathophysiology, treatment, and outcome, ACS are classifi ed as ST-elevation myocardial infarction (STEMI), non-ST-elevation MI, and unstable angina. STEMI is the most urgent subtype of ACS, because it is believed to refl ect acute ongoing transmural myocardial ischemia caused by acute coronary occlusion. Based on changes in the different parts of the ECG, ACS patients may be classifi ed according to the extent of the ischemic process or myocardial injury, the acuteness of the disease process, and the severity of myocardial ischemia. In the majority of patients, ACS classifi cation is rather straightforward, but some controversial issues remain to be solved in the future. The role of different ACS subtypes regarding choice of medication also needs to be explored more in detail. This chapter reviews pathophysiological mechanisms explaining the different ECG patterns encountered in ACS; the different ECG manifestations are also presented by illustrative fi gures. Both established guidelines and ECG-based expert reports for the classifi cation of ACS are presented. Unresolved, controversial issues regarding ECG manifestations of ACS are discussed.

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“…5 Patients may present with tall positive T waves without ST deviation or with minimal ST deviation. 50 It has been suggested that persistent positive T waves without ST elevation can be caused by an occlusion of an artery with preexisting severe narrowing and well developed collateral circulation. 50 Some of these patients will develop abnormal Q waves without significant ST elevation (Fig.…”

Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

“…(3) Ischemia that results in tall T wave without ST deviation. 50 As there are wide variations in the absolute amplitude of the T waves, relative increase in the T waves that could be detected by continuous ECG recording that begins before ischemia, cannot be appreciated by a "snapshot" ECG. (4) Small myocardial segments that are not covered by any of the 12 standard ECG leads, and (5) preexisting ECG changes that "hide" possible ischemic changes, such as "pseudonormalization" of the T waves in patients with baseline negative T waves.…”

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 Anterior Wall Myocardial Infarction Presenting with Positive T Waves and Without ST Segment Shift

Cited by 36 publications

References 24 publications

Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report

Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report

Acute Coronary Syndromes: Introduction and Pathophysiologic Classification

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

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