Evolving ST elevation MI

Evolving ST T, QRS abnormalities in acute ST elevation MI, incomplete
Stage
ST-T
QRS
Comment
Duration
Ant
Inf
1
Hyperacute T wave .
• If occur, it is usually in the 1st half hour or less.
• Not commonly seen
• May simulating early repolarization, pericarditis, hyperkakemia
• May overlap with early stage 2
•If it occurs, it is of short duration. V4 .
1.5
Giant R wave (Tombstone) . • If occur, it is usually in the 1st half hour.
• Not commonly seen
• May overlap with early stage 2 •If it occurs, it is of short duration. V4 .
2
ST elevation • Begin to develope Q wave • Early stage 2 may overlap with stage 1.
• ST elevation may be concave, straight or convex.
• QT may prolong. . V3 III
3
• Decrease ST elevation
• T wave begins inversion • Q wave established • During stage 2 and 3, there may be time that ST has returned to baseline but T wave has not inverted. The pseudonormalization.
• Persistent ST elevation may suggest wall motion abnormality (LV aneurysm). . V2
V2 III
4
• ST elevation returns to baseline
• T wave inversion
• QT tends to prolong . T wave inversion has characteristic of Primary T wave inversion. T wave inversion may persist for days, weeks, months. V3 III
5
• ST T abnormality returns to normal or baseline. • Q wave may resolve in few cases • ECG may return to normal or baseline with very rapid reperfusion treatment, (Infarct aborted) . . .
The magnitude, extent and time course of the ST T change is highly variable
Immediate reperfusion therapy (thrombolysis, primary PCI) may effect the time coarse and magnitude of these changes significantly. (Most of the cases here received immediate reperfusion therapy)
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Stage	ST-T	QRS	Comment	Duration	Ant	Inf
1	Hyperacute T wave	.	• If occur, it is usually in the 1st half hour or less. • Not commonly seen • May simulating early repolarization, pericarditis, hyperkakemia • May overlap with early stage 2	•If it occurs, it is of short duration.	V4	.
1.5	Giant R wave (Tombstone)	.	• If occur, it is usually in the 1st half hour. • Not commonly seen • May overlap with early stage 2	•If it occurs, it is of short duration.	V4	.
2	ST elevation	• Begin to develope Q wave	• Early stage 2 may overlap with stage 1. • ST elevation may be concave, straight or convex. • QT may prolong.	.	V3	III
3	• Decrease ST elevation • T wave begins inversion	• Q wave established	• During stage 2 and 3, there may be time that ST has returned to baseline but T wave has not inverted. The pseudonormalization. • Persistent ST elevation may suggest wall motion abnormality (LV aneurysm).	.	V2 V2	III
4	• ST elevation returns to baseline • T wave inversion • QT tends to prolong	.	T wave inversion has characteristic of Primary T wave inversion.	T wave inversion may persist for days, weeks, months.	V3	III
5	• ST T abnormality returns to normal or baseline.	• Q wave may resolve in few cases	• ECG may return to normal or baseline with very rapid reperfusion treatment, (Infarct aborted)	.	.	.
The magnitude, extent and time course of the ST T change is highly variable
Immediate reperfusion therapy (thrombolysis, primary PCI) may effect the time coarse and magnitude of these changes significantly. (Most of the cases here received immediate reperfusion therapy)