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We may lose a substantial amount of myocardium if we continue to wait for evolving changes that meet “STEMI” criteria.
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Note: although HATWs are a frequently observed “first sign” of OMI, these changes often persist during ongoing infarction (as is the case above) and their presence does not necessarily signify recent onset.
Dr najeeb lectures on ecg serial#
However, if there is uncertainty, serial ECGs should be performed as these changes generally precede classic STE findings or resolve if there is spontaneous reperfusion. In the right clinical scenario, we believe that HATWs alone are enough to guide a decision regarding reperfusion therapy. HATWs are wider and generally more symmetric than normal T-waves, and with evolving infarction the ST segment straightens and increases the AUC. In addition, the area under the curve (AUC) of the T wave appears more relevant than the overall height. This extends to the context of a low amplitude QRS complex, which should be followed by a relatively low voltage T wave. As is the case in bundle branch block with “appropriate discordance”, abnormal depolarisation should be followed by abnormal repolarisation. It is however recognised that the ratio of T wave amplitude to the preceding complex is of more significance than overall T wave size. “Small” HATW: Proportion and area matters more than heightĭespite long-standing recognition that hyperacute T waves (HATW) are usually the earliest ECG manifestation of occlusion myocardial infarction (OMI), there is still no formal, universal definition of what represents a HATW. In this case, serial ECGs were performed to look for dynamics changes: Here, an ST vector directed anterior and inferiorly is consistent with apical ischaemia, which generally occurs in the early phase of anterior MI, especially when the LAD is occluded after S1 but before D1.Īlthough not performed here, these authors would use bedside echo to look for associated anterior regional wall motion abnormalities to further confirm the diagnosis and guide cath lab activation. In the context of such a concerning history, these changes are highly suggestive of occlusion myocardial infarction secondary to a lesion of the left anterior descending artery (LAD). There is straightening of the ST segment in lead III, leading to widened T waves with an increased AUC