Volume 98, Issue 5, Pages (November 1990)

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Presentation transcript:

Volume 98, Issue 5, Pages 1226-1232 (November 1990) Initial Electrocardiogram in Patients with Suspected Ischemic Chest Pain Paul Schweitzer, M.D. CHEST Volume 98, Issue 5, Pages 1226-1232 (November 1990) DOI: 10.1378/chest.98.5.1226 Copyright © 1990 The American College of Chest Physicians Terms and Conditions

FIGURE 1 Diffuse ST segment depression ranging from 0.5. to 4.0 nun in all except lead aVL and V1 and 1 mm ST segment elevation in lead aVR. This ECG was recorded during severe substernal chest pain in a patient with 90 percent proximal LAD and left circumflex coronary artery obstruction (left main equivalent). CHEST 1990 98, 1226-1232DOI: (10.1378/chest.98.5.1226) Copyright © 1990 The American College of Chest Physicians Terms and Conditions

FIGURE 2 Minimal ST segment elevation in lead V2–3 with symmetrical T wave inversion in V2–4 and less prominent T wave inversion in 1, aVL and V5–6. The inferior leads show nondiagnostic Q waves. This ECG was recorded 24 hours after an episode of rest pain. The coronary angiography showed 90 percent obstruction of the mid LAD. CHEST 1990 98, 1226-1232DOI: (10.1378/chest.98.5.1226) Copyright © 1990 The American College of Chest Physicians Terms and Conditions

FIGURE 3 Symmetrical T wave inversion between 1 and 6 mm in 1, aVL, V2–5 as well as Q waves in lead 2, 3, and aVF with ST segment elevation consistent with inferior myocardial infarction. The ECG changes in the inferior leads were present for the last two years. This ECG was recorded during chest pain in a patient with unstable angina who had a 90 percent proximal LAD obstruction. CHEST 1990 98, 1226-1232DOI: (10.1378/chest.98.5.1226) Copyright © 1990 The American College of Chest Physicians Terms and Conditions

FIGURE 4 Upper ECG shows acute extensive anterior myocardial infarction; center ECG, 14 months later left anterior fascicular block, abnormal Q waves in 1 and aVL and QS with persistent ST segment elevation in leads V3–6; and lower ECG after 2½ years a LBBB with Q waves in lead 1 and aVL, ST segment elevation in lead V1–4 and a notch on the ascending limb of the S wave in lead V4 suggestive of AMI (see text for details). CHEST 1990 98, 1226-1232DOI: (10.1378/chest.98.5.1226) Copyright © 1990 The American College of Chest Physicians Terms and Conditions