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==Electrocardiogram==
==Electrocardiogram==
* [[Electrocardiogram]] is usually required for initial evaluation.
* [[Electrocardiogram]] is usually required for initial evaluation.
* [[ST elevation]] should require further urgent evaluation for reperfusion therapy.
*An electrocardiogram is very useful for the diagnosis of several etiologies of chest pain such as;
* Salient findings on ECG are:
====[[Acute coronary syndromes|Acute coronary syndrome]]====
** New ST elevation (>1 mm) or [[Q wave]]s on ECG (MI)
*A standard 12 lead ECG is recommended in all patients with chest pain within 10 minutes of presentation if acute coronary syndrome is suspected<ref name="pmid3661390">{{cite journal |vauthors=Slater DK, Hlatky MA, Mark DB, Harrell FE, Pryor DB, Califf RM |title=Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings |journal=Am. J. Cardiol. |volume=60 |issue=10 |pages=766–70 |date=October 1987 |pmid=3661390 |doi=10.1016/0002-9149(87)91020-4 |url=}}</ref><ref name="pmid3920520">{{cite journal |vauthors=Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ |title=Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction |journal=N. Engl. J. Med. |volume=312 |issue=18 |pages=1137–41 |date=May 1985 |pmid=3920520 |doi=10.1056/NEJM198505023121801 |url=}}</ref>.
** ST depression >1 mm or ischemic [[T wave]]s ([[unstable angina]])
*Findings on ECG suggestive of ACS include<ref name="pmid3970650">{{cite journal |vauthors=Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L |title=Acute chest pain in the emergency room. Identification and examination of low-risk patients |journal=Arch. Intern. Med. |volume=145 |issue=1 |pages=65–9 |date=January 1985 |pmid=3970650 |doi= |url=}}</ref><ref name="O'GaraKushner2013">{{cite journal|last1=O'Gara|first1=Patrick T.|last2=Kushner|first2=Frederick G.|last3=Ascheim|first3=Deborah D.|last4=Casey|first4=Donald E.|last5=Chung|first5=Mina K.|last6=de Lemos|first6=James A.|last7=Ettinger|first7=Steven M.|last8=Fang|first8=James C.|last9=Fesmire|first9=Francis M.|last10=Franklin|first10=Barry A.|last11=Granger|first11=Christopher B.|last12=Krumholz|first12=Harlan M.|last13=Linderbaum|first13=Jane A.|last14=Morrow|first14=David A.|last15=Newby|first15=L. Kristin|last16=Ornato|first16=Joseph P.|last17=Ou|first17=Narith|last18=Radford|first18=Martha J.|last19=Tamis-Holland|first19=Jacqueline E.|last20=Tommaso|first20=Carl L.|last21=Tracy|first21=Cynthia M.|last22=Woo|first22=Y. Joseph|last23=Zhao|first23=David X.|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=61|issue=4|year=2013|pages=e78–e140|issn=07351097|doi=10.1016/j.jacc.2012.11.019}}</ref>, [[ST elevation]], [[ST depression]] and a new [[left bundle branch block]] ([[LBBB]])
*It is important to note that a normal ECG does not rule out the presence of an acute myocardial infarction as ECG can show a hyper-acute [[T wave]]<ref name="pmid11992348">{{cite journal |author=Somers MP, Brady WJ, Perron AD, Mattu A |title=The prominant T wave: electrocardiographic differential diagnosis |journal=Am J Emerg Med |volume=20 |issue=3 |pages=243–51 |year=2002 |month=May |pmid=11992348 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735675702921935}}</ref><ref name="ACS_Clin_NA">Smith SW, Whitwam W. "Acute Coronary Syndromes." ''Emerg Med Clin N Am'' 2006; '''24(1)''': 53-89. PMID 16308113</ref> <ref name="ECG_Noncardiac">"The clinical value of the ECG in noncardiac conditions." ''Chest'' 2004; '''125(4)''': 1561-76. PMID 15078775</ref> as an early presentation.
*If an initial ECG is non-diagnostic and there is still a high clinical suspicion of an MI, a repeat ECG should be conducted.
*It is helpful to have precious ECGs of a patient to determine if findings observed are new.
 
Shown below is an EKG demonstrating clear [[ST elevation]] in the right [[precordial lead]]s depicting STEMI. A [[coronary angiography]] revealed a proximal right coronary artery occlusion<ref name="urlST elevation myocardial infarction electrocardiogram - wikidoc">{{cite web |url=https://www.wikidoc.org/index.php/ST_elevation_myocardial_infarction_electrocardiogram |title=ST elevation myocardial infarction electrocardiogram - wikidoc |format= |work= |accessdate=}}</ref>.
[[Image:STEMI 20 a.jpg|center|500px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
 
'''For more EKG examples of ST elevation myocardial infarction click [[ST elevation myocardial infarction EKG examples|here]]'''
 
====[[Pericarditis]]====
*ECG findings in patients with [[Pericarditis|pericarditi]]<nowiki/>s may mirror that seen in [[acute myocardial infarction]] and carrying changes may be seen as the disease progresses.
*Findings on ECG suggestive of pericarditis at different levels include<ref name="urlPericarditis electrocardiogram - wikidoc">{{cite web |url=https://www.wikidoc.org/index.php/Pericarditis_electrocardiogram |title=Pericarditis electrocardiogram - wikidoc |format= |work= |accessdate=}}</ref>,
*Stage I: ST elevation in all leads; PTa depression (depression between the end of the [[P wave]] and the beginning of the [[QRS]] complex)
*Stage II: Pseudonormalization (transition)
*Stage III: Inverted [[T waves]]
*Stage IV: Normalization
 
[[Image:Stadia pericarditis.png|center|500px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
 
==Overview==
==Overview==
There are no ECG findings associated with [disease name].
There are no ECG findings associated with [disease name].

Revision as of 14:29, 31 August 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

The key findings to look for on EKG is ST elevation which is characteristic of myocardial infarction. Diffuse ST elevation may point to the diagnosis of pericarditis. Serial EKG's should be obtain to evaluate for continued or progression of myocardial injury over time.

Electrocardiogram

  • Electrocardiogram is usually required for initial evaluation.
  • An electrocardiogram is very useful for the diagnosis of several etiologies of chest pain such as;

Acute coronary syndrome

  • A standard 12 lead ECG is recommended in all patients with chest pain within 10 minutes of presentation if acute coronary syndrome is suspected[1][2].
  • Findings on ECG suggestive of ACS include[3][4], ST elevation, ST depression and a new left bundle branch block (LBBB)
  • It is important to note that a normal ECG does not rule out the presence of an acute myocardial infarction as ECG can show a hyper-acute T wave[5][6] [7] as an early presentation.
  • If an initial ECG is non-diagnostic and there is still a high clinical suspicion of an MI, a repeat ECG should be conducted.
  • It is helpful to have precious ECGs of a patient to determine if findings observed are new.

Shown below is an EKG demonstrating clear ST elevation in the right precordial leads depicting STEMI. A coronary angiography revealed a proximal right coronary artery occlusion[8].

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

For more EKG examples of ST elevation myocardial infarction click here

Pericarditis

  • ECG findings in patients with pericarditis may mirror that seen in acute myocardial infarction and carrying changes may be seen as the disease progresses.
  • Findings on ECG suggestive of pericarditis at different levels include[9],
  • Stage I: ST elevation in all leads; PTa depression (depression between the end of the P wave and the beginning of the QRS complex)
  • Stage II: Pseudonormalization (transition)
  • Stage III: Inverted T waves
  • Stage IV: Normalization

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Overview

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include

  • [Finding 1]
  • [Finding 2]
  • [Finding 3]


References

  1. ↑ Slater DK, Hlatky MA, Mark DB, Harrell FE, Pryor DB, Califf RM (October 1987). "Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings". Am. J. Cardiol. 60 (10): 766–70. doi:10.1016/0002-9149(87)91020-4. PMID 3661390.
  2. ↑ Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ (May 1985). "Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction". N. Engl. J. Med. 312 (18): 1137–41. doi:10.1056/NEJM198505023121801. PMID 3920520.
  3. ↑ Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L (January 1985). "Acute chest pain in the emergency room. Identification and examination of low-risk patients". Arch. Intern. Med. 145 (1): 65–9. PMID 3970650.
  4. ↑ O'Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; de Lemos, James A.; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A.; Granger, Christopher B.; Krumholz, Harlan M.; Linderbaum, Jane A.; Morrow, David A.; Newby, L. Kristin; Ornato, Joseph P.; Ou, Narith; Radford, Martha J.; Tamis-Holland, Jacqueline E.; Tommaso, Carl L.; Tracy, Cynthia M.; Woo, Y. Joseph; Zhao, David X. (2013). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction". Journal of the American College of Cardiology. 61 (4): e78–e140. doi:10.1016/j.jacc.2012.11.019. ISSN 0735-1097.
  5. ↑ Somers MP, Brady WJ, Perron AD, Mattu A (2002). "The prominant T wave: electrocardiographic differential diagnosis". Am J Emerg Med. 20 (3): 243–51. PMID 11992348. Unknown parameter |month= ignored (help)
  6. ↑ Smith SW, Whitwam W. "Acute Coronary Syndromes." Emerg Med Clin N Am 2006; 24(1): 53-89. PMID 16308113
  7. ↑ "The clinical value of the ECG in noncardiac conditions." Chest 2004; 125(4): 1561-76. PMID 15078775
  8. ↑ "ST elevation myocardial infarction electrocardiogram - wikidoc".
  9. ↑ "Pericarditis electrocardiogram - wikidoc".
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