Unstable angina non ST elevation myocardial infarction electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Raviteja Guddeti, M.B.B.S. [3]

Overview

The EKG in patients with unstable angina can be variable. In some cases, no changes on EKG will be appreciated. In other cases, a resting EKG may show flipped or inverted T waves, ST segment depression, or non-specific ST-T changes. It is the first line of assessment in any patient suspected of having unstable angina.

Electrocardiogram in Unstable angina / NSTEMI

The resting electrocardiogram in the patient with unstable angina / non-ST elevation MI may show any of the following:

  • No changes
  • Non specific ST / T wave changes
  • Flipped or inverted T waves
  • ST depression as shown below. ST depression carries the poorest prognosis. Greater magnitudes of down sloping ST depression are associated with a high in-hospital, 30-day and 1-year mortality. 1 year MI or death rate in patients with new ST deviation (more than 1 mm from baseline) has been shown to be 11% compared to 6.8% in patients with isolated T-wave inversion.

Wellens' syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in patients with unstable angina. It is characterized by symmetrical, often deep >2mm, T wave inversions in the anterior precordial leads. A less common variant is biphasic T wave inversions in the same leads.[1]

EKG Examples

Shown below is an EKG from a patient with unstable angina. ST depression in V2, V3,V4 and V6 can be noted:

Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page


References

  1. Tandy, TK (1999). "Wellens' syndrome". Annals of Emergency Medicine. 33 (3): 347–351. doi:10.1016/S0196-0644(99)70373-2. PMID 10036351. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)

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