Smalcelj Anton
University Department of Cardiovascular Diseases, Zagreb University Hospital Center and School of Medicine, University of Zagreb, Zagreb, Croatia.
Acta Med Croatica. 2009 Feb;63(1):9-14.
After a century of clinical use, electrocardiography (ECG) remains the basic method for the diagnosis of acute myocardial infarction. Its suboptimal sensitivity can be improved by additional recording leads and device adjustment with posterior wall inverse presentation for the detection of left ventricular posterior wall and right ventricle infarcts. The addition of some ST-depression criteria equivalent to those of ST elevation is discussed, with the aim of increasing the sensitivity without a substantial loss of specificity. ECG patterns concerning myocardial infarction evolution, localization and size estimates are reviewed. PIS and EMI patterns are discussed in respect to the modes of reperfusion therapy. ECG scoring systems are commented, considering risk stratification and the choice of reperfusion therapy. In conclusion, ECG is an old diagnostic tool that should be used for new tasks.
经过一个世纪的临床应用，心电图（ECG）仍然是诊断急性心肌梗死的基本方法。通过增加记录导联和调整设备以采用后壁反向显示来检测左心室后壁和右心室梗死，可以提高其欠佳的敏感性。文中讨论了增加一些与ST段抬高标准等效的ST段压低标准，目的是在不显著降低特异性的情况下提高敏感性。回顾了与心肌梗死演变、定位和大小估计相关的心电图模式。针对再灌注治疗模式讨论了PIS和EMI模式。对心电图评分系统进行了评论，同时考虑了风险分层和再灌注治疗的选择。总之，心电图是一种古老的诊断工具，应被用于新的任务。
