Analyzing Prominent T Waves and ST-segment Abnormalities in Acute Myocardial Infarction

Background: Hyperacute T waves and the non-concave appearance of the ST segment are early changes that may be seen on the electrocardiogram (ECG) in an acute myocardial infarction (AMI) patient. There are specific morphological changes in these ECG findings that can help distinguish them from other conditions with similar ECG patterns. The differential diagnosis of prominent T waves and ST-segment elevation is well known, however, certain tools to distinguish ECG patterns with various etiologies have been developed and proven useful to the emergency physician. Objectives: 1) To discuss and review the more common differential diagnosis of prominent T waves and how to identify the hyperacute T wave of AMI. 2) To review the distinction and determination of a concave and non-concave ST segment that may be initially overlooked. Case Report: A 42-year-old woman with minimal cardiac risk factors developed an ST-segment elevation myocardial infarction (STEMI) that illustrates the evolution of early and classic ECG changes associated with her infarct. Conclusions: The classic STEMI is ingrained in the emergency physician's mind, however, sometimes other lesser known and obvious ECG patterns can present early on in the evolution of disease, and these morphological patterns should be identified and treated accordingly.