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QJM Advance Access originally published online on February 22, 2006
QJM 2006 99(4):219-230; doi:10.1093/qjmed/hcl025
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Reviews

ECG diagnosis of acute ischaemia and infarction: past, present and future

N. Herring and D.J. Paterson

From the Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK

Address correspondence to Dr N. Herring, Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT. email: neilherring@doctors.org.uk

The first 150 words of the full text of this article appear below.


   Introduction
 
A century has passed since Einthoven published his description of the human electrocardiogram (ECG), recorded using a string galvanometer. The basic principles of this technique have remained unchanged, and it has revolutionized the diagnosis and management of cardiac pathology. At present, its sensitivity in diagnosing life-threatening myocardial infarction and ischaemia is inferior to that of biochemical markers. However, the ECG monitors cardiac function in real time, while biochemical assays can delay the diagnosis of acute myocardial infarction (AMI) and treatments that need to be delivered promptly. We review the historical development of the ECG and its limitations as a diagnostic tool for AMI, and highlight recent research into higher-resolution technologies for real-time cardiac monitoring, and how they may impact on chest pain management. Many distinguished scientists and clinicians have devoted their life's work to the use and understanding of the technique. This short review will merely highlight some of the . . . [Full Text of this Article]


   Development of the ECG
 

   ECG changes during myocardial ischaemia and infarction
 

   Assessing the sensitivity of the ECG to detect myocardial ischaemia
 
ECG changes during provoked ischaemia
Autopsy-proven infarction and ECG changes
Angiography and ECG changes
Troponins and ECG changes
The impact of diagnostic criteria on sensitivity and specificity

   Implications for management of cardiac chest pain
 

   New technologies
 
Combining ECG information with clinical history
Computer measurement of ST changes and Q waves in the 12-lead ECG
Increasing the ability of the 12-lead ECG to detect transient ischaemia
Increasing the ability of the 12-lead ECG to detect AMI
Improving sensitivity and specificity by the addition of more recording leads

   Concluding comments
 

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