Abstract
The incidence of acute coronary syndrome (ACS) is rising globally. Electrocardiography is still one of the best diagnostic modalities for it. Although some of the ECG changes of ACS are well known among medical practitioners, there are a handful of ECG changes that do not get the recognition they deserve. Among these are localized ST-segment depressions in a vascular territory and altered precordial T-wave balance. The urgency of management varies among the various subtypes of ACS, especially in low resource settings. ST-segment depression localized to a vascular territory is a sign of ST-elevation myocardial infarction (MI) in the reciprocal lead which may not always be evident and hence, requires emergent reperfusion therapy. On the other hand, altered precordial T-wave balance (T1 > T6, T-wave in V1 > 1.5 mm and upright T-wave in V1) may be predictive of significant coronary artery disease (CAD).
Highlights
BackgroundIn patients with myocardial infarction (MI), the ST depression localized to a vascular territory in electrocardiography is a frequent, yet overlooked sign
ST-segment depression localized to a vascular territory is a sign of ST-elevation myocardial infarction (MI) in the reciprocal lead which may not always be evident and requires emergent reperfusion therapy
Localized ST depression in anterior precordial leads is widely recognized as a sign of posterior ST-elevation myocardial infarction (STEMI), the same is not true for localized ST depressions in other vascular territories
Summary
In patients with myocardial infarction (MI), the ST depression localized to a vascular territory in electrocardiography is a frequent, yet overlooked sign. The ST depression may be mistaken for non-ST elevation myocardial infarction (NSTEMI) or unstable angina. The loss of precordial T-wave balance is a valuable sign when it comes to a patient with chest pain. These signs should be observed as they are overlooked if not given due attention. The main aim of this article is to provide a detailed overview of the pathophysiology behind the occurrence of these signs and show how they can be useful in real-life scenarios
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