Mô hình điện tâm đồ thấy trong STE-ACS Rõ ràng là các mô hình điển hình điện tâm đồ là sự hiện diện của ST độ cao trong một số khách hàng tiềm năng chiếm ưu thế hơn ST trầm cảm thường thấy trong các dẫn khác. | Acute coronary syndrome ACS Electrocardiographic alterations ỉn presence of normal intraventricular conduction narrow QRS Diagnosis at the discharge Unstable angina aborted Ml Q wave infarction or equivalent Non-Q wave infarction Unstable angina troponin - Small infarction troponin Sometimes the initial ECG presents in V1-V4 deep and negative T wave that in the absence of quick and intensive treatment may evolve to STE ACS. Sometimes thanks to quick treatment in case of LAD occlusion the STE changes to deep negative T wave and troponin levels remain normal despite important ST elevation in the initial ECG. In ACS with ECG pattern of ST depression or negative T wave troponin levels allow to distinguish between unstable angina troponin - and non-Q-wave infarction troponin . Usually cases of short duration ECG changes particularly with negative T wave present more often negative troponin levels and correspond to unstable angina. According to ESC ACC guidelines in patients presenting chest pain or its equivalent suggestive of ACS with accompanying normal ECG troponin level is a key to decide whether to diagnose small Ml or unstable angina. Figure 71 Electrocardiographic alterations observed in patients with acute coronary syndromes presenting with narrow QRS. Observe the initial ECG presentation A ACS with new ST elevation B ACS without new ST elevation with its approximate incidence and final discharge diagnosis according to the evolution. Electrocardiographic pattern of ischaemia injury and necrosis 85 ECG patterns seen in STE-ACS Obviously the typical ECG pattern is the presence of ST elevation in some leads that predominate over the ST depression usually seen in other leads. However the following atypical ECG patterns may be seen in the course of the clinical syndrome of STE-ACS and in its presence the patients have to be considered as STE-MI Figure 72 . 1 Presence of ST depression in V1-V3 more evident than ST elevation in II III VF and or V5-V6 that is usually .
