ECG changes during myocardial ischemia are not limited to ST segment or T wave.


Other ECG changes which may be observed during myocardial ischemia

  Atrioventricular (AV) block

  Arrhythmias

  Prolongation of the QT interval

  Negative U waves

  Bundle branch block

  QRS alternance





ECG 1. The ECG above belongs to a patient with unstable angina pectoris.
Negative T waves are observed in leads C2-C5
while
negative U waves are seen in leads C2-C4. Additionally, the PR interval is above 200 msec (1st degree AV block).
Coronary angiography showed significant stenosis of the LAD and Circumflex (Cx) arteries.

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ECG 2a. Atrial fibrillation developing during acute anterior wall myocardial infarction.

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ECG 2b. Ten minutes later, the ECG of the same patient shows junctional (nodal) rhythm (QRS complexes without preceding P
waves
). Coronary angiography showed total occlusion of the LAD and significant (80%) stenosis of the intermedier artery; the
RCA and Cx arteries were normal.

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ECG 3. the ECG above is from a 45 years-old man awaiting coronary artery bypass graft surgery after acute anteriyor myocardial
infarction. QT interval prolongation is seen.

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