The majority of patients with ischemic chest pain and intraventricular conduction defect, with the exception of left anterior fascicular block, have advanced coronary artery disease, more impaired left ventricular function, and therefore, are of higher risk for life-threatening complications and should be monitored in the coronary care unit. Furthermore, the diagnosis of AMI has to be confirmed or excluded by non-ECG techniques. asthma inhalers
Left Ventricular Hypertrophy
The next ECG abnormality seen in patients with ischemic chest pain is left ventricular hypertrophy. The relationship between coronary artery disease, myocardial infarction, and ECG in left ventricular hypertrophy is the following. First, patients with left ventricular hypertrophy have a higher incidence of coronary artery disease. Second, the ECG has important limitations in the diagnosis of NQMI because of the similarities between ST-T wave changes due to left ventricular hypertrophy and myocardial infarction. According to Boden et al, in patients with left ventricular hypertrophy, the diagnosis of NQMI requires 2 mm instead of 1 mm ST segment depression and elevated CK-MB. Third, patients with left ventricular hypertrophy, particularly those with obstructive cardiomyopathy or aortic stenosis, can have ischemic chest pain and pathologic Q waves (pseudoinfarct) which have to be differentiated from AMI.