Use of the 24-lead "standard" electrocardiogram to identify the site of acute coronary occlusion. A review paper.
This review presents the added value for diagnosis of acute ischemia/infarction of considering ST elevation in the 12 inverted leads (-I, -II, -II, -aVR, etc) of the standard electrocardiogram in addition to ST elevation in 12 positive leads. A small number of studies have been published showing substantial increases in sensitivity at the "cost of" slight decreases in specificity. One recent study indicated that only 7 of the inverted leads should be considered, yielding a "19-lead electrocardiogram" encompassing the following leads (presented here in the logical sequences): -III, aVL, I, -aVR, II, aVF, III, -aVL, -I, aVR; and V1, V2, V3, V4, V5, V6, -V1, -V2, -V3. Studies have to be performed to establish the thresholds that should be applied to these leads for achievement of sensitivity/specificity.
Wagner
Galen S
GS
Duke University Medical Center, Durham, NC 27705, USA. wagne004@mc.duke.edu
Pahlm-Webb
Ulrika
U
Pahlm
Olle
O
D000208:Acute Disease; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000592:standards*; D023921:Coronary Stenosis / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000592:standards*; D004562:Electrocardiography / Q000295:instrumentation* / Q000592:standards*; D004566:Electrodes; D006801:Humans; D012015:Reference Standards