Objective To investigate the ECG atypical changes in acute myocardial infarction(AMI). Meth-ods 352 patients with AMI were selected sequentially and examined by electrocardiogram(ECG) ,Holter of 24h,my-ocardial enzymes testing and coronary angiography, and electrocardio-monitoring was performed at the same time. Data were analyzed by statistics. Results The incidence of ECG atypical changes in patients with AMI was 14. 5%. The ECG atypical changes including Q wavelet with the elevation value of ST segment, the delays of Q wave and the only changes of ST-T. Conclusion The above several kind of ECG performane are present in atypical AMI.