STEMI-Äquivalente im EKG – eine fallbasierte Darstellung

 

 Buy Article Permissions and Reprints

Abstract

The 12-lead resting ECG remains an indispensable diagnostic tool in patients with acute chest pain. This is particularly important as the identification of ST-segment elevations leads to the diagnosis of ST-segment elevation myocardial infarction (STEMI) and subsequent, immediate coronary reperfusion (usually via primary PCI). However, correct interpretation of the 12-lead ECG in patients with acute chest pain remains challenging. Apart from “classical” ST-segment elevations there are several “equivalents” in the ECG pointing towards an acute coronary occlusion. Among these, hyperacute T-waves, subtle ST-segment elevations, ST-segment elevation in leads aVR/V₁ with concomitant ST-segment depression in ≥ 8 other leads and high R-peak with positive T-waves combined with horizontal ST-segment depression in leads V₁/V₂ can be found. This article provides a case-based presentation of STEMI equivalents on the ECG in order to improve correct ECG interpretation and prognosis of such patients.

• Literatur

• 1 Klawki R. Deutscher Herzbericht 2017. 2018. In: Deutsche Herzstiftung, Hrsg. Frankfurt am Main
  Google Scholar
• 2 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (02) 119-177 . doi:10.1093/eurheartj/ehx393
  CrossrefPubMedGoogle Scholar
• 3 Haude M, Rupprecht HJ, Schuster S. et al. Akutes Koronarsyndrom mit ST‑Strecken-Hebung. Herz 2019; 44 (01) 16-21 . doi:10.1007/s00059-018-4775-2
  CrossrefPubMedGoogle Scholar
• 4 Scholz KH, Maier SKG, Maier LS. et al. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J 2018; 39 (13) 1065-1074 . doi:10.1093/eurheartj/ehy004
  CrossrefPubMedGoogle Scholar
• 5 Macfarlane PW. The influence of age and sex on the electrocardiogram. Adv Exp Med Biol 2018; 1065: 93-106 . doi:10.1007/978-3-319-77932-4_6
  PubMedGoogle Scholar
• 6 Eberli F. Erstickungs-T oder etwas anderes?. info@herz+gefäß 2017; 2017 (01) 36-37
  PubMedGoogle Scholar
• 7 de Winter RW, Adams R, Verouden NJW. et al. Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion, case reports of STEMI equivalence. J Electrocardiol 2016; 49 (01) 76-80 . doi:10.1016/j.jelectrocard.2015.10.005
  CrossrefPubMedGoogle Scholar
• 8 Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J 2003; 79 (935) 490-504 . doi:10.1136/pmj.79.935.490
  CrossrefPubMedGoogle Scholar
• 9 Hillinger P, Strebel I, Abächerli R. et al. Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction. Int J Cardiol 2019; 292: 1-12 . doi:10.1016/j.ijcard.2019.04.041
  CrossrefPubMedGoogle Scholar
• 10 Taglieri N, Saia F, Alessi L. et al. Diagnostic performance of standard electrocardiogram for prediction of infarct related artery and site of coronary occlusion in unselected STEMI patients undergoing primary percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care 2014; 3 (04) 326-339 . doi:10.1177/2048872614530665
  CrossrefPubMedGoogle Scholar
• 11 Sgarbossa EB, Pinski SL, Gates KB. et al. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of Ventricular paced rhythm. Am J Cardiol 1996; 77 (05) 423-424 . doi:10.1016/S0002-9149(97)89377-0
  CrossrefPubMedGoogle Scholar
• 12 Meyers HP, Limkakeng AT, Jaffa EJ. et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J 2015; 170 (06) 1255-1264 . doi:10.1016/j.ahj.2015.09.005
  CrossrefPubMedGoogle Scholar
• 13 Knotts RJ, Wilson JM, Kim E. et al. Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease?. J Electrocardiol 2013; 46 (03) 240-248 . doi:10.1016/j.jelectrocard.2012.12.016
  CrossrefPubMedGoogle Scholar
• 14 Xu WW, Lu L, Jin MJ, de Winter RJ. Electrocardiogram pattern – an unusual ST-segment elevation myocardial infarction equivalent pattern. JAMA Intern Med 2019; DOI: 10.1001/jamainternmed.2019.4127.
  CrossrefPubMedGoogle Scholar
• 15 de Winter RJ, Verouden NJW, Wellens HJJ. et al. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008; 359 (19) 2071-2073 . doi:10.1056/NEJMc0804737
  CrossrefPubMedGoogle Scholar
• 16 Miranda DF, Lobo AS, Walsh B. et al. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Can J Cardiol 2018; 34 (02) 132-145 . doi:10.1016/j.cjca.2017.11.011
  CrossrefPubMedGoogle Scholar
• 17 de Zwaan C, Bär FWHM, Wellens HJJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982; 103 (04) 730-736 . doi:10.1016/0002-8703(82)90480-X
  CrossrefPubMedGoogle Scholar
• 18 Grautoff S. Wellens-Syndrom kann auf hochgradige RIVA-Stenose bei einem Linksschenkelblockhinweisen. Herzschrittmacherther Elektrophysiol 2017; 28 (01) 57-59 . doi:10.1007/s00399-017-0489-z
  PubMedGoogle Scholar
• 19 Wei M, Sanchez DR, Rokos I. Nondiagnostic ST elevations with chest pain: the subtle STEMI. JAMA Intern Med 2017; 177 (04) 577-578 . doi:10.1001/jamainternmed.2016.9396
  CrossrefPubMedGoogle Scholar