On Reporting Cases of Acute

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Abstract
ST-segment elevation in the electrocardiogram with development of Q waves in the presence of enzyme changes and chest pain have been thought to be adequate for the unequivocal diagnosis of transmural myocardial infarction. Unlikely, detection of nontransmural myocardial infarction (NMTI) is often difficult. A variety of ECG alterations, enzymatic criteria, and chest pain patterns have been used in the diagnosis of this type of infarct. Since ECG criteria used in the diagnosis of NMTI are not specific for this entity, enzymes, isoenzymes, and myocardial imaging should be used for differentiation of NMTI from other ischemic syndromes. Characterization of the entity of NMTI will improve by acquiring information on chest pain patterns, serial enzyme and isoenzyme changes, sequential ECG alterations, myocardial imaging profiles, and autopsy data from patients with myocardial necrosis and atypical ECG pictures. (Arch Intern Med138:138-141, 1978)