PMID- 24792903
OWN - NLM
STAT- MEDLINE
DCOM- 20151019
LR  - 20220331
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 47
IP  - 4
DP  - 2014 Jul-Aug
TI  - Difficult ECGs in STEMI: lessons learned from serial sampling of pre- and 
      in-hospital ECGs.
PG  - 448-58
LID - S0022-0736(14)00121-6 [pii]
LID - 10.1016/j.jelectrocard.2014.03.010 [doi]
AB  - Prehospital interpretation of electrocardiograms (ECGs) is crucial to ensure 
      early diagnosis and optimal treatment of patients with ST elevation myocardial 
      infarction (STEMI). Recognition of ST-segment elevations (STE) by qualified 
      personnel in the prehospital phase has successfully reduced the delay from the 
      first medical contact to reperfusion. A few other ECG patterns without true STE, 
      referred to as "STEMI equivalents", bear the same prognostic significance, 
      reflect imminent or ongoing transmural ischemia, but are less easily identified. 
      Hyperacute T waves, de Winter ST-T complex, Wellens' syndrome, and posterior 
      STEMI, as well as myocardial infarction in the presence of left bundle branch 
      block, paced rhythm or left ventricular hypertrophy, among others are diagnostic 
      challenges. This article reviews some critical examples of ischemic ECG patterns 
      that may be ephemeral, misinterpreted by medical staff or not identified by 
      automated ECG algorithms, and it emphasizes the importance of serial ECG 
      acquisition.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Ayer, Antoine
AU  - Ayer A
AD  - Department of cardiology, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, 
      Denmark. Electronic address: antoine.ayer@bluewin.ch.
FAU - Terkelsen, Christian Juhl
AU  - Terkelsen CJ
AD  - Department of cardiology, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, 
      Denmark.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20140330
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Arrhythmias, Cardiac/*diagnosis
MH  - Diagnosis, Differential
MH  - Diagnostic Errors/*prevention & control
MH  - Electrocardiography/*methods
MH  - Emergency Medical Services/*methods
MH  - *Hospitalization
MH  - Humans
MH  - Myocardial Ischemia/*diagnosis
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
OTO - NOTNLM
OT  - Electrocardiogram
OT  - In-hospital ECG
OT  - Prehospital ECG
OT  - STEMI
OT  - STEMI equivalent
OT  - serial ECGs
EDAT- 2014/05/06 06:00
MHDA- 2015/10/20 06:00
CRDT- 2014/05/06 06:00
PHST- 2014/01/17 00:00 [received]
PHST- 2014/05/06 06:00 [entrez]
PHST- 2014/05/06 06:00 [pubmed]
PHST- 2015/10/20 06:00 [medline]
AID - S0022-0736(14)00121-6 [pii]
AID - 10.1016/j.jelectrocard.2014.03.010 [doi]
PST - ppublish
SO  - J Electrocardiol. 2014 Jul-Aug;47(4):448-58. doi: 
      10.1016/j.jelectrocard.2014.03.010. Epub 2014 Mar 30.