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Myocardial Infarction and Negative ECG

Myocardial Infarction may be present without any specific changes in ECG this is the case in LBBB but can also be seen in othercases.

ECG pattern in myocardial infarction:

•    subendocardial Ml

•    transmural Ml

•    LBBB

•    no specific changes

ECG in Suspected Ischemic Heart Disease

Specific signs of ischemic heart disease:

• Ischemia/infarction?

In case of infarction:

•    Subendocardial/transmural?

•    Location and extension?

II, III AVF

Mirror image V-i -V₃ l,AVL,V₄-V₆ V₃-V₄ Vi-V₃

InferoposteriorMI

AnteriorMI

Interior Ml PosteriorMI c Lateral Ml Apical Ml < Septal Ml

/

Differential Diagnosis
ST-segment depression J	J r.
'^U\r-T Ischemia (subendocardial ischemia)	Cohn effect (digitalis)
ST-segment elevation
J\	A-a.
Acute myocardial infarction (transmural ischemia)	Pericarditis
CoronaryT-wave	JA
Subendocardial infarction	Hyperkalemia

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