急性冠心症候群 Acute Coronary Syndrome 心電圖診斷

心電圖診斷 ECG Diagnosis

STEMI ST段上升心肌梗塞

1. 以J point為基準，產生新的連續兩個lead ST波段 ≥0.1 mV(1小格), 例外在V2, V3這兩個lead, 40歲以上男性 ≥0.2 mV(2小格)，40歲以下男性 ≥0.25 mV(2.5小格), 女性不限年齡≥0.15 mV(1.5小格)。

2. 新的LBBB

NSTEMI 非ST段上升心肌梗塞

產生新的連續兩個水平的(horizontal)或下斜的(Down-sloping)lead ST depression ≥ 0.05mV(半小格)，並且或者連續兩個lead T波下降超過1mm(1小格)，合併有一個prominent R wave或R/S ration>1。

梗塞位置 Location

V1-V2 – Anteroseptal
V3-V4 – Anteroapical
V5-V6 – Anterolateral
I, aVL – Lateral
II, III, aVF – Inferior

右冠狀動脈阻塞 RCA occlusion
1. ST depression in lead I
2. ST elevation lead III>II
   Proximal: ST elevation 1mm with positive T wave
   Distal: ST isoelectric with positive T wave in V4R

左冠狀動脈迴旋枝阻塞 LCX occlusion
1. ST elevation in lead II>III
2. ST isoelectric or elevated in lead I
3. ST isoelectric or depressed with negative T wave in T4R

Extension to posterior wall
=> ST depression in precordial lead
Extension to lateral wall
=> ST elevation in lead I, aVL, V5, V6

Ref:

1. Fourth Universal Definition of Myocardial Infarction, 2018 ESC/ACCF/AHA/WHF Expert Consensus Document
2. ECG in emergency Decision Making 2006 2nd Edition

# STEMI and potiential Equivalents 看到這些也要當成可能是STEMI發生

Ref: Electrocardiographic Diagnosis of Life-Threatening STEMI Equivalents: When Every Minute Counts∗ https://www.jacc.org/doi/10.1016/j.jaccas.2019.10.030