Particular electrocardiographic phenotypes in acute coronary syndromes

Abstract

Despite continuous efforts in early recognition and timely management, acute coronary syndromes (ACS) continue to be the most common cause of death worldwide. The electrocardiogram (ECG) is the fastest, repeatable and most accesible instrument with diagnostic value, prognostic significance and therapeutic implications. Based on the ECG, ACS are divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation ACS (NSTEACS). Current guidelines recommend emergency reperfusion theraphy only in patients with STEMI. Conventional criteria for the diagnosis of STEMI exclude the patients with atypical ECG findings, correlated with an increased risk of transmural myocardial infarction and considered STEMI equivalents. These particular ECG phenotypes are: new or presumably new bundle branch block, ST segment elevation in aVR, isolated posterior myocardial infarction, de Winter T waves, Wellens syndrome and ischaemia induced Brugada phenocopy. Rapid risk stratification in patients with NSTEACS is crucial for adequate management. The particular ECG phenotypes discussed herein proove the need to redefine the signs of the present or iminent coronary artery occlusion, especially the left anterior descending (LAD) artery, because many patient may benefit from early invasive treatment instead of conservative pharmacological treatment.