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The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Acute Coronary Syndrome and ECG Interpretation
Introduction
Acute Coronary Syndrome (ACS) is a term used to describe conditions caused by sudden reduced blood flow to the heart. These conditions include unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). The electrocardiogram (ECG) is a crucial tool for diagnosing and distinguishing between these types of ACS.
Key ECG Findings in ACS
1. STEMI (ST-Segment Elevation Myocardial Infarction)
- Defined by ST-segment elevation in at least two contiguous leads.
- Possible reciprocal ST depression in opposite leads.
- May show pathological Q waves later, indicating myocardial necrosis.
2. NSTEMI (Non-ST-Segment Elevation Myocardial Infarction)
- No ST-segment elevation but may have ST depression or T-wave inversion.
- Cardiac biomarkers (e.g., troponins) are elevated, confirming myocardial injury.
3. Unstable Angina (UA)
- Similar ECG changes as NSTEMI (ST depression or T-wave inversion) but with normal cardiac biomarkers.
- Indicates myocardial ischemia without infarction.
Importance of Early ECG Interpretation
- Initial ECG should be performed within 10 minutes of suspected ACS presentation.
- Serial ECGs may be needed if initial results are inconclusive but suspicion remains high.
- Additional leads (e.g., right-sided or posterior leads) should be considered in some cases (such as suspected right ventricular infarction).
Management Based on ECG Findings
- STEMI: Requires immediate reperfusion therapy, such as PCI (percutaneous coronary intervention) or fibrinolytic therapy if PCI is unavailable.
- NSTEMI/UA: Requires risk stratification and medical therapy such as dual antiplatelet therapy (DAPT), anticoagulation, and early invasive strategies if indicated.
Conclusion
ECG is a primary tool in ACS diagnosis and management, helping differentiate between life-threatening STEMI, NSTEMI, and unstable angina. Accurate and prompt ECG evaluation is essential for providing timely treatment and improving patient outcomes.
Source recommendations
1. American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
- https://pubmed.ncbi.nlm.nih.gov/15289388/
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation
- https://pubmed.ncbi.nlm.nih.gov/26320110/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://pubmed.ncbi.nlm.nih.gov/32860058/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/21873419/
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