Electrocardiogram in the diagnosis of myocardial ischemia and infarction
- Ary L Goldberger, MD
Ary L Goldberger, MD
- Section Editor — Electrocardiography
- Professor of Medicine
- Harvard Medical School
- Jordan M Prutkin, MD, MHS, FHRS
Jordan M Prutkin, MD, MHS, FHRS
- Associate Professor of Medicine, Division of Cardiology, Electrophysiology Section
- University of Washington
- Section Editors
- Freek Verheugt, MD, FACC, FESC
Freek Verheugt, MD, FACC, FESC
- Section Editor — Coronary Heart Disease
- Onze Lieve Vrouwe Gasthuis, Netherlands
- David M Mirvis, MD
David M Mirvis, MD
- Section Editor — Electrocardiography
- Professor of Medicine
- University of Tennessee College of Medicine
The electrocardiogram (ECG) is an essential diagnostic test for patients with possible or established myocardial ischemia or infarction. Abnormalities are manifest in the ST-segment, T wave, and QRS complex. However, the ECG may be normal or nonspecific in these patients.
In addition, findings thought typical of acute myocardial infarction (MI) due to atherosclerosis may occur in other conditions, such as myocarditis. (See "Clinical manifestations and diagnosis of myocarditis in adults" and "Clinical manifestations and diagnosis of stress (takotsubo) cardiomyopathy".)
The use of the ECG in patients with suspected or proven myocardial ischemia or MI will be reviewed here. Other relevant topics include:
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- ECG CRITERIA FOR MYOCARDIAL ISCHEMIA/INFARCT
- SIGNIFICANCE OF Q WAVES
- LOCATION OF ISCHEMIA OR INFARCTION
- Anterior, lateral, and apical MI
- Inferior and right ventricular MI
- Posterior wall MI
- Multiple regions
- IDENTIFICATION OF THE INFARCT-RELATED ARTERY
- Inferior MI on the ECG
- Anterior MI on the ECG
- Abnormal findings in lead aVR
- EXTENT OF THE INFARCT
- EVOLUTION OF THE ECG
- OTHER ECG MANIFESTATIONS OF ISCHEMIA
- LAD-T wave inversion pattern
- Pseudonormalization of T waves
- UNEXPECTED ABSENCE OF DIAGNOSTIC FINDINGS
- Absence of Q waves
- Left bundle branch block
- DIFFERENTIAL DIAGNOSIS OF ECG ABNORMALITIES
- Early repolarization
- ST-segment elevation or depression
- Abnormal T waves
- Q waves
- INFORMATION FOR PATIENTS