Key result
Early and subtle ECG features, including T-wave inversion in lead aVL and hyperacute T-waves, identified acute coronary syndrome in five patients who subsequently progressed to frank ST-segment elevation myocardial infarction.
Why the study?
Interpreting 12-lead ECGs for ischemia is challenging, and identifying subtle or early features of ACS is essential to prevent significant mortality and morbidity.
Case Report (n=5)
Recognition of subtle early ECG signs of ischemia can facilitate early diagnosis of impending STEMI in emergency department patients with chest pain.
May prompt ECG vigilance in ED chest pain; hypothesis-generating case series requiring prospective validation before practice change.
Chest pain is one of the most common presenting complaints in the emergency department. Interpreting a 12-lead electrocardiography (ECG) for evidence of ischemia is always challenging. Frank ECG changes such as ST-segment elevation and ST-segment depression can be easily identified by emergency physicians. However, identifying subtle or early features of ACS in the 12-lead ECG is essential in preventing significant mortality and morbidity from ACS. In the following case series, we describe five of the subtle/early ECG changes of ACS, namely (1) T-wave inversion in lead aVL; (2) terminal QRS distortion; (3) hyperacute T-waves; (4) negative U-waves in precordial leads; and (5) loss of precordial T-wave balance. In all these cases, the initial 12-lead ECG showed only subtle/early ECG changes which were followed up with serial ECGs which progressed to STEMI.
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A 2022 study conducted a case report in Acute Coronary Syndrome (n=5). Early/subtle ECG features of ACS was evaluated on Progression to STEMI. Early and subtle ECG features, including T-wave inversion in lead aVL and hyperacute T-waves, identified acute coronary syndrome in five patients who subsequently progressed to frank ST-segment elevation myocardial infarction.
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