{"pk":10353,"title":"Pitfalls in Electrocardiographic Diagnosis of Acute Coronary Syndrome in Low-Risk Chest Pain","subtitle":null,"abstract":"Less than half of patients with a chest pain history indicative of acute coronary syndrome havea diagnostic electrocardiogram (ECG) on initial presentation to the emergency department. Thephysician must dissect the ECG for elusive, but perilous, characteristics that are often missed bymachine analysis. ST depression is interpreted and often suggestive of ischemia; however, whenexclusive to leads V1‒V3 with concomitant tall R waves and upright T waves, a posterior infarctionshould first and foremost be suspected. Likewise, diffuse ST depression with elevation in aVR shouldraise concern for left main- or triple-vessel disease and, as with the aforementioned, these ECGfindings are grounds for acute reperfusion therapy. Even in isolation, certain electrocardiographicfindings can suggest danger. Such is true of the lone T-wave inversion in aVL, known to precedean inferior myocardial infarction. Similarly, something as ordinary as an upright and tall T wave ora biphasic T wave can be the only marker of ischemia. ECG abnormalities, however subtle, shouldgive pause and merit careful inspection since misinterpretation occurs in 20-40% of misdiagnosedmyocardial infarctions.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency medicine, cardiology, low-risk chest pain"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8nq6n3dk","frozenauthors":[{"first_name":"Semhar","middle_name":"","last_name":"Tewelde","name_suffix":"","institution":"Other","department":"None"},{"first_name":"Amal","middle_name":"","last_name":"Mattu","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine,\nBaltimore, Maryland","department":"None"},{"first_name":"William","middle_name":"J.","last_name":"Brady, Jr.","name_suffix":"","institution":"University of Virginia School of Medicine, Department of Emergency Medicine,\nCharlottesville, Virginia","department":"None"}],"date_submitted":"2016-09-30T04:36:20Z","date_accepted":"2016-09-30T04:36:20Z","date_published":"2017-04-17T16:16:23Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10353/galley/5693/download/"}]}