Understanding the ECG. Part 9: Myocardial ischaemia and infarction (part B)

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Cardiac Nursing, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see 10.12968/bjca.2016.11.7.332 In this penultimate part of our ECG series, we return to STEMI to answer the following questions. Firstly, what are the differential diagnoses for ST elevation on the 12-lead ECG? Secondly, how can we detect STEMI affecting the right ventricle (RV) or posterior wall of the left ventricle (LV), given that they are poorly seen by the standard ECG leads (Garcia, 2015)? Thirdly, how does left bundle branch block (LBBB) affect the diagnosis of acute myocardial infarction? We also turn our attention to non-ST elevation MI (NSTEMI) and unstable angina, and evaluate the role of the ECG in the diagnosis and management of these conditions.