ECG

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• if 2 ECGs done 30 min apart are normal chance of acute MI <10% and even if these patients have had a MI the prognosis is excellent
• V4R lead useful for diagnosing MI and should be obtained in all patients with suspected acute MI. ST elevation in V4R relatively sensitive and specific for RV infarction
• non-STEMI and unstable angina:
  • ST elevation or depression
  • T wave inversion
  • May be normal or show only transient changes, even during pain
• STEMI
  • ST elevation ≥2 mm in V1-V3 or ≥1 mm in other leads
  • ST depression consistent posterior MI
  • LBBB
  • established MI (old or recent): Q ≥0.03 s in V1-V6 or II, aVL, aVF

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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