Abstract
This review updates the clinician to the many typical, but also underappreciated and subtle, ECG signs of myocardial ischemia and infarction. This compilation explains the dynamic changes during severe myocardial ischemia (schematically, abnormal T-wave then ST-segment and QRS complex) and illustrates in detail the heterogeneity of the ECG representations. It emphasizes the importance of seeking any abnormality in the T-wave (amplitude or polarity not conforming to QRS, symmetry at the base), ST-segment (excessive elevation, minimal depression, or loss of appropriate discordance), but also within the QRS complex, to check whether the baseline ECG is normal or affected by frequent abnormalities (ventricular hypertrophy, bundle-branch block…).
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