Use of the Initial Electrocardiogram During Acute Myocardial Infarction to Estimate the Extent of the Jeopardized Myocardium and Guide the Determination of Therapy

Abstract

During the initial assessment of a patient with suspected acute myocardial infarction (MI), few diagnostic tests are immediately available. A standard 12-lead electrocardiogram (ECG) remains the most useful method to assess the clinical situation and to guide the determination of therapy. The ECG is almost always immediately available at the site of patient presentation and is inexpensive and easy to perform. Although a normal ECG does not eliminate the possibility of an acute coronary event, the patient’s position along the spectrum from entirely normal to marked epicardial injury should guide the intensity of the acute intervention. Such information is particularly important in an era when limitation of infarct size has become an important goal of acute coronary care. Should a patient be managed “conservatively” with little or no effort aimed at size limitation, or managed “aggressively” with every effort exerted to optimize coronary blood flow? It is important for clinicians to understand the capability and limitation of the ECG as a diagnostic aid for the assessment of patients with suspected acute MI.