Chest pain electrocardiogram

Jump to navigation Jump to search

Chest pain Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chest pain from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Chest Pain in Pregnancy

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chest pain electrocardiogram On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chest pain electrocardiogram

CDC on Chest pain electrocardiogram

Chest pain electrocardiogram in the news

Blogs on Chest pain electrocardiogram

to Hospitals Treating Chest pain electrocardiogram

Risk calculators and risk factors for Chest pain electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

The key findings to look for on EKG is ST elevation which is characteristic of myocardial infarction. Diffuse ST elevation may point to the diagnosis of pericarditis. Serial EKG's should be obtain to evaluate for continued or progression of myocardial injury over time.

Electrocardiogram

  • An electrocardiogram is usually required for initial evaluation of chest pain.
  • It is very useful for the diagnosis of several etiologies of chest pain such as:

Acute coronary syndrome

Shown below is an EKG demonstrating clear ST elevation in the right precordial leads depicting STEMI. A coronary angiography revealed a proximal right coronary artery occlusion. [8]

[9]
[9]


For more EKG examples of ST elevation myocardial infarction click here

Pericarditis

  • ECG findings in patients with pericarditis may mirror that seen in acute myocardial infarction and carrying changes may be seen as the disease progresses.
  • Findings on ECG suggestive of pericarditis at different levels include: [10]
  • Stage I: ST elevation in all leads; PTa depression (depression between the end of the P wave and the beginning of the QRS complex)
  • Stage II: Pseudonormalization (transition)
  • Stage III: Inverted T waves
  • Stage IV: Normalization
[11]
[11]

Acute aortic dissection


References

  1. Slater DK, Hlatky MA, Mark DB, Harrell FE, Pryor DB, Califf RM (October 1987). "Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings". Am. J. Cardiol. 60 (10): 766–70. doi:10.1016/0002-9149(87)91020-4. PMID 3661390.
  2. Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ (May 1985). "Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction". N. Engl. J. Med. 312 (18): 1137–41. doi:10.1056/NEJM198505023121801. PMID 3920520.
  3. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L (January 1985). "Acute chest pain in the emergency room. Identification and examination of low-risk patients". Arch. Intern. Med. 145 (1): 65–9. PMID 3970650.
  4. O'Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; de Lemos, James A.; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A.; Granger, Christopher B.; Krumholz, Harlan M.; Linderbaum, Jane A.; Morrow, David A.; Newby, L. Kristin; Ornato, Joseph P.; Ou, Narith; Radford, Martha J.; Tamis-Holland, Jacqueline E.; Tommaso, Carl L.; Tracy, Cynthia M.; Woo, Y. Joseph; Zhao, David X. (2013). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction". Journal of the American College of Cardiology. 61 (4): e78–e140. doi:10.1016/j.jacc.2012.11.019. ISSN 0735-1097.
  5. Somers MP, Brady WJ, Perron AD, Mattu A (2002). "The prominant T wave: electrocardiographic differential diagnosis". Am J Emerg Med. 20 (3): 243–51. PMID 11992348. Unknown parameter |month= ignored (help)
  6. Smith SW, Whitwam W. "Acute Coronary Syndromes." Emerg Med Clin N Am 2006; 24(1): 53-89. PMID 16308113
  7. "The clinical value of the ECG in noncardiac conditions." Chest 2004; 125(4): 1561-76. PMID 15078775
  8. "ST elevation myocardial infarction electrocardiogram - wikidoc".
  9. http://en.ecgpedia.org/wiki/Main_Page
  10. "Pericarditis electrocardiogram - wikidoc".
  11. http://en.ecgpedia.org/wiki/Main_Page
  12. 12.0 12.1 "Aortic dissection electrocardiogram - wikidoc".
  13. Evangelista, Arturo; Isselbacher, Eric M.; Bossone, Eduardo; Gleason, Thomas G.; Eusanio, Marco Di; Sechtem, Udo; Ehrlich, Marek P.; Trimarchi, Santi; Braverman, Alan C.; Myrmel, Truls; Harris, Kevin M.; Hutchinson, Stuart; O’Gara, Patrick; Suzuki, Toru; Nienaber, Christoph A.; Eagle, Kim A. (2018). "Insights From the International Registry of Acute Aortic Dissection". Circulation. 137 (17): 1846–1860. doi:10.1161/CIRCULATIONAHA.117.031264. ISSN 0009-7322.
  14. Hirata, Kazuhito; Wake, Minoru; Kyushima, Masahiro; Takahashi, Takanori; Nakazato, Jun; Mototake, Hidemitsu; Tengan, Toshiho; Yasumoto, Hiroshi; Henzan, Eisei; Maeshiro, Masao; Asato, Hiroaki (2010). "Electrocardiographic changes in patients with type A acute aortic dissection". Journal of Cardiology. 56 (2): 147–153. doi:10.1016/j.jjcc.2010.03.007. ISSN 0914-5087.