The ECG therefore remains the cornerstone in evaluating and managing patients with acute coronary syndrome and continues to provide very useful information that is not obtainable with other more expensive technologies. In this era of modern and expensive technology, the ECG remains the most important and least expensive modality in evaluating and managing patients suspected of having acute symptoms from coronary artery disease.O It is the most useful modality in identifying several complications of acute MI, including the various atrioventricular and intraventricular conduction abnormalities as well as the different bradycardias and tachycardias, which are frequent during hospitalization especially after the initial onset of symptoms. O It is the simplest and most useful tool in the diagnosis of right ventricular MI. Localizing the culprit vessel will also help in predicting potential complications that may inherently occur based on the geographic location of the MI.įigure 23.1: Electrocardiogram Changes of Acute Coronary Syndrome. Complete occlusion of the vessel lumen by a thrombus causes ST elevation whereas partial occlusion of the vessel lumen will result in ST depression, T-wave inversion, or other less-specific ST and T-wave abnormalities. O It can identify the culprit vessel, localize whether the lesion is proximal or distal, and therefore predicts the extent of jeopardized myocardium. O It provides useful information on whether or not reperfusion therapy has been successful. It therefore remains central to the decision making process in managing patients with acute coronary syndrome. It serves as the only basis for deciding whether or not the patient is a candidate for thrombolytic therapy or primary angioplasty. It is the most important tool in defining the onset of the coronary event and the urgency for immediate revascularization. O The ECG is the only modality capable of making a diagnosis of ST elevation MI. The ECG can provide the following useful information in patients with acute coronary syndrome:
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