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Understanding the dynamic electrocardiographic changes that occur during ischemia

The main concepts and terminology that have been used to describe and explain the changes seen on the surface 12-lead electrocardiogram (ECG) were conceived many years ago. At those times, we lacked understanding of the pathophysiology of ischemia, and we did not have sophisticated imaging tools to test these hypotheses. In this respect, electrocardiography has had many similarities with alchemistry, as intelligent and knowledgeable scholars contemplated and generated hypotheses and concepts that were hard to prove or disprove. In the traditional electrocardiographic nomenclature, changes in the T waves reflect ischemia. ST elevation reflects "injury," whereas ST depression reflects ...

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