The electrocardiogram (ECG) findings in acute coronary syndrome should always be interpreted in the context
of the clinical findings and symptoms of the patient, when these data are available. It is important to acknowledge the dynamic
nature of ECG changes in acute coronary syndrome. The ECG pattern changes over time and may be different if
recorded when the patient is symptomatic or after symptoms have resolved. Temporal changes are most striking in cases
of ST-elevation myocardial infarction. With the emerging concept of acute reperfusion therapy, the concept STelevation/
non-ST elevation has replaced the traditional division into Q-wave/non-Q wave in the classification of acute
coronary syndrome in the acute phase.
Keypoints: In acute coronary syndrome, in addition to the traditional electrocardiographic risk markers, such as ST depression,
the 12-lead ECG contains additional, important diagnostic and prognostic information. Clinical guidelines need
to acknowledge certain high-risk ECG patterns to improve patient care.