High-risk electrocardiogram presentations in the acute coronary syndrome patient - Beyond ST-segment elevation
William J Brady1, Andrew E Muck1, James H Moak1
1Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
Abstract:
This review considers high-risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST-segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short-and long-term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T-wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High-risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short-and long-term adverse outcome, include lead aVR ST-segment elevation and Wellens syndrome. The features of each presentation, highlighting the electrocardiographic abnormalities, are presented and discussed.
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