Progression of EKG changes in Acute Coronary Syndrome (ACS)
Hyperacute T waves:
 • Broad-based and symmetrical, usually with increased amplitude and often associated with a depressed ST take off
ST depression and Twave changes:
 • New horizontal or down-sloping ST depression ≥ 0.05 mV in two contiguous leads 
 • and/or T inversion ≥ 0.1 mV in two contiguous leads with prominent R wave or R/S ratio >1
ST elevation:
 • New ST elevation at the J point in two contiguous leads with the cut points:
 • In leads other than V2 or V3: 0.1 mV
 • In leads V2-V3: 0.2 mV in men ≤ 40 years, 0.25 mV in men ≤ 40 years or ≥ 0.15 mV in women
T wave changes (flattening or inversions):
 • T wave flattening or inversions may be seen (T waves are normally inverted in aVR)
 • Inversion in precordial leads depends on age, ethnicity, and gender
Pathologic Q waves:
 • In leads V2-V3: Qwave ≥ 0.02 sec or QS complex in leads V2 and V3
 • In leads l, I, aVL, aVF, or V4-V6 in any two leads of a contiguous leading group:
 • Q wave ≥ 0.03 sec and ≥0.1 mV deep QS complex

Satya Patel, MD @SatyaPatelMD

#EKG #ACS #Progression #diagnosis #electrocardiogram #Acute #coronary #syndrome