High‑risk electrocardiogram presentations in the acute coronary syndrome patient – Beyond ST‑segment elevation myocardial infarction
William J Brady
, Andrew E. Muck, James H Moak
Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
Keywords: Acute coronary syndrome, electrocardiography, high risk, myocardial infarction, ST‑segment, T‑wave
Abstract
This review considers high risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short and long term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short and long term adverse outcome, include lead aVR ST segment elevation and Wellens syndrome. The features of each presentation, highlighting the electrocardiographic abnormalities, are presented and discussed.
How to cite this article: Brady WJ, Muck AE, Moak JH. High-risk electrocardiogram presentations in the acute coronary syndrome patient – Beyond ST-segment elevation myocardial infarction. Turk J Emerg Med 2025;25:1-9.