Myocardial ischemia and infarction

ECGs showing acute STEMI in two patients with severe chest pain. STEMI = ST elevation Myocardial Infarction.

STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management

STEMI (ST Elevation Acute Myocardial Infarction): Epidemiology, Diagnosis (ECG), Criteria & Management Acute STEMI (ST Elevation Myocardial Infarction) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology, definitions, criteria and management of patients with acute STEMI. Although ECG changes in acute STEMI have been discussed previously (refer to ECG…

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T-waves in ischemia: hyperacute, inverted (negative), Wellens sign & de Winters sign

T-wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T-wave was previously provided. Only aspects relevant to ischemia will be discussed here. The T-wave is notoriously difficult to judge, which is why a rather comprehensive discussion is warranted. The normal T-wave will be described first. Then, ischemic T-wave…

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Clinical application of ECG in chest pain & acute myocardial infarction

Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other symptoms which may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain.…

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Figure 1. Chest pain is the hallmark of myocardial ischemia. It signals that there is ongoing (acute) myocardial ischemia. Careful assessment of the symptoms is crucial to promptly establish a working diagnosis. Chest pain due to myocardial ischemia is rather characteristic, which means that the vast majority of patients with acute coronary syndromes can be treated before troponin test results have arrived. Hence, assessment of symptoms and ECG is sufficient to manage patients with chest pain.

Approach to patients with chest pain: differential diagnoses, management & ECG

Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. The cause (etiology) of chest pain varies according to age, sex, risk factors, type of symptoms etc. Chest pain is actually one of the most…

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ST segment depression in myocardial ischemia and differential diagnoses

ST segment depression due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment. Indeed, North American and European guidelines assert that the ST segment must be either downsloping or horizontal; otherwise ischemia is unlikely to be the cause of the ST segment depression. The horizontal…

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Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria

Left bundle branch block (LBBB) in acute myocardial infarction (AMI): clinical implications & Sgarbossa criteria On the contrary to right bundle branch block, left bundle branch block is always a pathological finding which affects cardiovascular and total mortality. Left bundle branch block is more common in individuals with structural and ischemic heart disease. Assessment of ischemia on ECG is…

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Coronary plaque with reudction of the lumen diameter. This plaque causes myocardial ischemia.

Myocardial ischemia and infarction: lack of oxygen or imbalance between supply/demand


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NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management

Non ST Elevation Acute Coronary Syndromes (NSTE-ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus of this chapter is the diagnosis and management of patients with Non ST Elevation Myocardial Infarction (NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE-ACS (Non ST Elevation Acute Coronary Syndromes). This chapter deals…

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ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit)

Using the ECG to localize myocardial infarction / infarction and determine the occluded coronary artery It is often important to be able to determine the localization of myocardial infarction and ischemia, as well as being able to determine which coronary artery that is iccluded, and where the occlusion may be located. As discussed below, this may facilitate diagnosis…

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Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction

Bradycardia and conduction defects, such as bundle branch block, fascicular block and AV block, are common in myocardial ischemia and infarction. These conditions may be seen as signs of ischemia, which is why one must be familiar with them. In order to completely understand the different complications related to ischemia/infarction in the conduction system, one…

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