© 2000 the Emergency Medicine Journal
ECG interpretation for the emergency department
Electrocardiographic abnormalities encountered in acute myocardial infarction
1 Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
2 Department of Accident and Emergency Medicine, Northern General Hospital, Sheffield
Correspondence to:
Dr William J Brady, Department of Emergency Medicine, Box 523–21, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA (e-mail: wb4z@hscmail.mcc.virgina.edu)
Accepted October 5, 1999
Introduction
The evaluation of patients with chest pain is a challenging area of accident and emergency (A&E) work. In the clinical assessment of such patients, interpretation of the electrocardiogram (ECG) is an essential adjunct to the history and examination. Approximately 20% of patients presenting with chest pain will have acute myocardial infarction (AMI), 35% angina/unstable angina, and 45% non-cardiac chest pain.1, 2 Reaching a rapid and accurate clinical diagnosis is of great importance, particularly as urgent reperfusion treatments such as thrombolytic agents and coronary angioplasty have been shown to improve prognosis in patients with AMI—if applied appropriately and early.
The electrocardiographic criteria identifying the group of patients likely to benefit from urgent reperfusion treatments are: (1) ST segment elevation in at least two anatomically contiguous leads and (2) new left bundle branch block (LBBB); further, ST segment depression in the right precordial leads (V1–V3), indicative of posterior AMI with posterior lead ST
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