Electrocardiographic diagnosis of acute myocardial infarction: Current concepts for the clinician.
BACKGROUND
Over the past 2 decades, the 12-lead electrocardiogram has attained special significance for the diagnosis and triage of patients with chest pain because timely detection of myocardial injury and a rapid assessment of myocardium at risk proved pivotal to implementing effective reperfusion therapies during acute myocardial infarction. However, this wealth of information could still be underutilized by clinicians who may restrict their diagnostic quest in patients with chest pain to the more classic electrocardiographic signs.


METHODS
The medical literature on electrocardiographic manifestations of acute myocardial infarction was extensively reviewed.


RESULTS
The widespread utilization of both coronary angiography and methods to determine myocardial function and metabolism in patients with acute myocardial infarction over the last 10 years has provided the means for rigorous comparisons with electrocardiographic information. We summarize these electrocardiographic signs and patterns in terms of their relevance to the clinician to help reduce the incidence of "nondiagnostic electrocardiograms" and improve timely decision-making.


CONCLUSIONS
The electrocardiogram continues to be an invaluable tool in the initial evaluation of patients with chest pain. The plethora of data currently available on electrocardiographic changes correlating with myocardial injury allows clinicians to make faster and better decisions than ever before.
Section of Cardiology, Rush Presbyterian-St. Luke's Medical Center, 1750 W. Harrison St., Chicago, IL 60612, USA. esgarbos@rush.edu
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EB
Sgarbossa
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Birnbaum
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Parrillo
D002037:Bundle-Branch Block / Q000175:diagnosis; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis