The review of recent studies dealing with the diagnostic and prognostic significance of the ECG in acute coronary syndromes indicate that the ECG remains an important initial test in patients with AMI or other coronary syndromes. It is of interest, however, that while the ECG is of limited value in the differentiation between transmural and nontransmural myocardial infarction, the different ECG manifestations of acute coronary syndromes are helpful in the assessment of prognosis, severity of coronary artery disease, and degree of myocardial impairment. As suggested by Spodick the ECG is “trying to tell us something” about the nature of AMI. In patients with QMI, the ECG confirms the diagnosis, while in patients with NQMI, the diagnosis of myocardial infarction is less certain and has to be confirmed by non-ECG methods. In addition, the degree of coronary artery disease is usually less severe in patients with ST segment elevation than in those with ST segment depression. buy antibiotics online
The same probably also applies for unstable angina. Furthermore, the combination of ischemic chest pain and intraventricular conduction defect or left ventricular hypertrophy is highly suggestive of coronary artery disease, left ventricular impairment and higher risk for developing life-threatening complications, and therefore, these patients should be admitted into the coronary care unit. A normal ECG in 10 to 20 percent of patients with documented myocardial infarction is an important limitation of the ECG. However, patients with AMI and normal ECG have good short-term prognosis and whether they can be managed in the intermediate care unit is not completely clear as is the indication for coronary reperfusion.