Understanding ECG in Myocardial Infarction (MI)

Introduction

An electrocardiogram (ECG) is a crucial tool for diagnosing myocardial infarction (MI), commonly known as a heart attack. MI occurs when blood flow to a part of the heart is blocked, leading to tissue damage or death.

Key ECG Changes in Myocardial Infarction

1. ST-Segment Elevation Myocardial Infarction (STEMI)

  • ST-Segment Elevation: Indicates complete blockage of a coronary artery and requires urgent intervention.
  • Pathological Q Waves: Develop later, signaling permanent myocardial damage.
  • Hyperacute T Waves: Often the earliest sign, preceding ST-elevation.

2. Non-ST-Segment Elevation Myocardial Infarction (NSTEMI)

  • ST-Segment Depression: Suggests partial blockage and ischemia.
  • T-Wave Inversion: Signals myocardial ischemia or reperfusion.
  • No Pathological Q Waves: Unlike STEMI.

The Importance of ECG Timing

  • First 10 minutes: Every patient with suspected MI should receive an immediate ECG.
  • Serial ECGs: Changes evolve over time; repeated ECGs help in diagnosis.
  • Comparison with Previous ECGs: Essential for accurate interpretation.

Additional Diagnostic Tools

  • Blood Tests (Troponins): Confirms myocardial damage.
  • Echocardiography: Evaluates heart function and identifies complications.
  • Coronary Angiography: Determines the extent of blockage.

Conclusion

Recognizing ECG changes in MI promptly saves lives. If you experience symptoms like chest pain, shortness of breath, or dizziness, seek medical help immediately.

Source recommendations

1. American Heart Association Guidelines on ECG and Myocardial Infarction

  1. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-coronary-artery-disease/get-with-the-guidelines-cad-rural-recognition
  2. https://www.ahajournals.org/doi/10.1161/01.cir.94.9.2341
  3. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg
  4. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  5. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6

2. European Society of Cardiology Guidelines on Acute Coronary Syndromes

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
  2. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
  3. https://pubmed.ncbi.nlm.nih.gov/37622654/
  4. https://academic.oup.com/eurheartj/article/42/14/1289/5898842
  5. https://pubmed.ncbi.nlm.nih.gov/32860058/

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