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Continuous 12-lead electrocardiograph monitoring in the emergency department
1Department of Emergency Medicine, Erlanger Medical Center, University of Tennessee College of Medicine, Chattanooga Unit.
Insights
Continuous 12-lead ST monitoring in the emergency department identified acute myocardial infarction in patients with initially non-diagnostic ECGs. This technology enabled timely interventions, even without recurrent chest pain.
Area of Science:
- Cardiology
- Medical Devices
- Emergency Medicine
Background:
- Initial electrocardiograms (ECGs) in emergency departments are often non-diagnostic for acute myocardial infarction (AMI).
- Continuous ST segment monitoring has utility in outpatient ischemia diagnosis and post-procedure coronary occlusion detection.
Observation:
- Three patients with suspected AMI underwent real-time continuous 12-lead ST segment monitoring with frequent serial ECGs.
- Significant ECG changes were detected in all three patients during their emergency department evaluation.
- These changes occurred in the absence of recurrent chest pain.
Findings:
- Continuous 12-lead ECG monitoring revealed significant, actionable changes in all cases.
- The monitoring led to a change in emergency department therapy for these patients.
- This technology identified critical ischemia despite atypical or non-diagnostic initial ECGs.
Implications:
- Real-time continuous ST monitoring can identify patients with initially nondiagnostic or atypical ECGs who may benefit from early interventional therapy.
- This approach may improve the diagnosis and management of acute myocardial infarction in the emergency department.
- Continuous ECG monitoring offers a valuable tool for detecting silent ischemia during acute cardiac events.
Abstract:
Many patients presenting to the emergency department with suspected acute myocardial infarction have an initial electrocardiogram (ECG) non-diagnostic for acute injury or ischemia. Continuous ST segment monitoring devices have been used by physicians in the past to diagnose ischemia in the ambulatory outpatient population and to identify coronary occlusion in postthrombolytic and postsurgical patients. We report three patients with suspected acute myocardial infarction who underwent real-time continuous 12-lead ST segment monitoring with frequent serial ECGs on a microprocessor-controlled device during their initial emergency department evaluation. Continuous 12-lead ECG monitoring revealed significant changes on the ECG in all three cases presented, with a resultant change in emergency department therapy. Interestingly, all of these patients had significant ECG changes in the absence of recurrence of chest pain. We believe real-time continuous 12-lead ST segment monitoring with frequent serial ECGs can identify patients with an initially nondiagnostic or atypical ECG who may benefit from early interventional therapy.