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| 2. |
- Birnbaum, Yochai, et al.
(författare)
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Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report
- 2012
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 45:5, s. 463-475
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Tidskriftsartikel (refereegranskat)abstract
- Acute coronary syndromes (ACS) with narrow QRS are divided into 2 groups: ST-elevation ACS that requires emergency percutaneous coronary intervention, and non-ST elevation ACS. The classification of ACS into these 2 groups is not always straightforward. In this document, we discuss several electrocardiogram patterns of acute ischemia that are often misinterpreted. We suggest that any new recommendations or guidelines from the Scientific Societies should acknowledge these aspects of electrocardiogram interpretation by including appropriate diagnostic criteria that should prove helpful for the optimal management of patients with ACS. (C) 2012 Elsevier Inc. All rights reserved.
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| 3. |
- Birnbaum, Yochai, et al.
(författare)
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The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document
- 2014
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 19:5, s. 412-425
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Forskningsöversikt (refereegranskat)abstract
- 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.
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| 4. |
- Lindow, Thomas, et al.
(författare)
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A patient with non-ST-segment elevation acute coronary syndrome : Is it possible to predict the culprit coronary artery?
- 2016
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736. ; 49:4, s. 614-619
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Tidskriftsartikel (refereegranskat)abstract
- In acute coronary syndromes without ST-segment elevation (NSTE-ACS), identification of the culprit artery is, most often, not possible. In this case report, we elaborate on the likelihood of different culprit arteries in a patient with NSTE-ACS. While her symptoms were progressing, typical ECG findings of ischemia in the left coronary territories were diminishing. Instead, dynamic T-wave changes in the inferior leads were present and were most likely postischemic and "reischemic." Although the culprit artery could not be identified with certainty by means of these subtle changes, they correlated well with the findings on angiography and the ECG recorded afterward. This case report demonstrates the importance of analyzing ECG and its temporal changes in conjunction with evolving symptoms.
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| 5. |
- Lindow, Thomas, et al.
(författare)
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Akut ocklusion av cirkumflexa kransartären svår att upptäcka : Viktigt att titta i »döda vinkeln« på EKG
- 2017
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Ingår i: Läkartidningen. - 0023-7205. ; 114:41
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Acute coronary artery occlusion should be treated with urgent revascularization. ECG is important in the triage of patients with acute coronary syndrome. ST deviation depends on the relation between the location of the transmural ischemia and the positive poles of the 12 ECG leads. In acute occlusion of the left circumflex artery, ST elevation in two contiguous leads is not always present. Instead, isolated ST depression in leads V1–V3 may be present and represents a »STEMI-equivalent« pattern. Detection of acute occlusion of the left circumflex artery may be improved either by including inverted leads or by recording from electrodes on the posterior thorax.
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| 6. |
- Nikus, Kjell, et al.
(författare)
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Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology
- 2010
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 43:2, s. 91-103
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Tidskriftsartikel (refereegranskat)abstract
- The electrocardiogram (ECG) remains the most immediately accessible and widely used diagnostic tool for guiding emergency treatment strategies. The ECG recorded during acute myocardial ischemia is of diagnostic, therapeutic, and prognostic significance. In patients with myocardial ischemia as a result of decreased blood supply, the initial 12-lead ECG typically shows (1) predominant ST-segment elevation (STE) as part of STE acute coronary syndrome (STE-ACS), or (2) no predominant STE, that is, non STE ACS (NSTE-ACS). Patients with predominant STE are classified as having either aborted myocardial infarction (MI) or ST-elevation MI (STEMI) based on the absence or presence of biomarkers of myocardial necrosis. The MI may be aborted either by spontaneous or therapeutic reperfusion of the ischemic myocardium before development of myocardial cell necrosis. NSTE-ACS patients are classified as having either unstable angina or NSTE-MI, based also on the absence or presence of biomarkers of mycardial necrosis. The information obtained from the 12-lead ECG at presentation should be complemented by repeated ECGs especially during symptoms indicative of ischemia and, if applicable, by comparing the findings with reference ECGs. Also, continuous ECG recording in a coronary care setting, including the comparison of ECGs with and without pain, adds to the information gained at patient presentation. In this article, mechanisms of ischemic ECG changes and the ECG patterns recorded in both STE-ACS and NSTE-ACS are described. ECG patterns of NSTE-ACS, which include ST depression, negative T wave, and even normal ECG, need to be better defined in future studies to correlate them with the severity and extent of ischemia and to explore to what extent they are explained by acute active ischemia or represent consequences of ischemia. One of the aims of this article is to propose a classification of the ECG patterns encountered in different clinical scenarios of ACS. How these patterns will aid in guiding the diagnostic and therapeutic process is discussed. (c) 2010 Elsevier Inc. All rights reserved.
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| 7. |
- Nikus, Kjell, et al.
(författare)
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Report of the third International Society for Holter and Noninvasive Electrocardiology working group on improved electrocardiographic criteria for acute and chronic ischemic heart disease-Lund, Sweden: June 2010
- 2011
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 44:1, s. 84-86
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Tidskriftsartikel (refereegranskat)abstract
- The third meeting of the International Society for Holter and Noninvasive Electrocardiology working group was convened in Lund, Sweden, in June 2010 to consider the key clinical challenge of developing electrocardiographic (ECG) criteria for identification of the global subendocardial ischemia that results from subtotal occlusion of either the left main coronary artery or its equivalent. The participants considered the specific abnormalities typical of global subendocardial ischemia on the presenting ECG and outlined further studies to establish the optimal quantitative ECG criteria. Subgroups on Electrocardiology, Myocardial Imaging, and Coronary Intervention met separately to establish priorities on their topic and then joined together in a final session of the entire working group. The principles for a retrospective and then a prospective study were identified, and a writing group was formed. (C) 2011 Elsevier Inc. All rights reserved.
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