All that you need to know to diagnose MI / ACS

Different ECG changes in MI

Dr. Sanoop Kumar Sherin Sabu,

Earliest change	Hyper acute T wave – very tall T wave
MOST SPECIFIC CHANGE	Grave stone sign- ST segment elevation
Evolving MI	Pardle sign- ST elevation with T wave inversion
Old MI	Pathological q wave- depth of q wave more than 25% of R wave
Atypical change to be considered as an MI	New onset LBBB ( Left bundle branch block)  - in simple terms-  wide QRS complex in V5 or V6

Hyper acute T wave

Grave stone sign- ST segment elevation

Pardle sign- ST elevation with T wave inversion

Walls affected in MI

Wall	ST Elevation	Reciprocal ST Depression	Artery
Inferior	Lead 2,3,  avF	1, av L	RCA
Lateral wall	Lead 1, avL V5, V6	2, 3, av F	Left Circumflex b/o LAD
Septum	V1. V2		LAD
Anterior wall	V3, v4
Right sided	V1 V2r V3r , V4r		Marginal b/o RCA
Posterior wall MI	V7,8,9	V1, v2, v3	Circumflex b/o RCA (SA and AV node blocks seen)

Definitions

	Stable angina	ACS- Acute Coronary Syndrome
		Unstable angina	NSTEMI	STEMI
Pain at rest	Absent	Present	Present	Present
ECG	Normal	ST depression or T wave inversion	ST depression or T wave inversion	ST elevation
Trop I	Normal	Normal	Elevated	Elevated

Prinzmetal’s  Angina/ Vasospastic angina/ Variant angina/ Stress induced angina-

·         Rest pain + , which is triggered by some stress or anxiety

·         ECG- ST elevation ( Most specific change), Rarely other changes.

·         Trop I negative

·         ECG changes disappears after reliving the stress episode or giving nitrates.

Reference:-

1. Harrison textbook of internal medicine

2. Google images

Dr. Sanoop Kumar Sherin Sabu,

sanoopkumarsherinsabu2007@gmail.com