In this course, we define the term ‘acute coronary syndrome’ and explain the role and limitations of the ECG in the diagnosis of this syndrome. We explain the difference in pathological processes underlying ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI). We describe the time-dependent sequence of changes in ECG abnormalities resulting from complete occlusion of a coronary artery. We explain the origin of Q waves in STEMI. We show you how to identify the likely site of complete coronary artery occlusion in an STEMI based on analysis of ECG findings. We test your ability to identify the ECG changes of acute coronary syndrome. A frontline worker must also appreciate that the ECG changes usually associated with ischemic heart disease have an extensive differential. Building on your understanding of the ECG changes described in the videos, we expand your knowledge of the differential diagnosis of ST segment elevation and ST segment depression on the ECG in the Essential Reading List.
Planner and Author: Dr John Seery MB PhD
Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
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de Blieck EC. ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation. Turk J Emerg Med. 2018;18(1):1-10.
Tewelde SZ et al. Pitfalls in Electrocardiographic Diagnosis of Acute Coronary syndrome in Low-Risk Chest Pain. West J Emerg Med. 2017; 18(4):601-6.
Brady WJ and Morris F. Electrocardiographic ST segment elevation in adults with chest pain. J Acad Emerg Med. 1999;16:433-9.
Wagner GS et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part VI: Acute Ischemia/Infarction: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council of Clinical Cardiology, the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology. Circulation. 2009;119(10):e262-e270.
Frankenfeld L. STEMI in Disguise. Taming the SRU:Emergency Medicine Tamed. 2019
Walsh L. Diagnostics: MI in Left Bundle Branch Block. Taming the SRU:Emergency Medicine Tamed. 2019
Di Diego JM and Antzelevitch C. Acute Myocardial Ischemia: Cellular Mechanisms underlying ST segment Elevation. J Electrocardiol. 2014;47(4):486-90.
Rossello X et al. New Electrocardiographic Criteria to Differentiate Acute Pericarditis and Myocardial Infarction. Am J Med. 2014;127:233-9.
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Acadoodle, Ltd designates this enduring material activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.