Electrocardiogram interpretation as a basis for thrombolysis

To assess the skills and opinions of different grades of doctors and cardiac-trained nurses in interpreting electrocardiographic changes when deciding upon administration of thrombolysis to patients with chest pain.

A questionnaire was distributed to staff in several local hospitals.

Participants were asked to assess 30 electrocardiograms (ECGs) and determine whether they would prescribe thrombolytic therapy on the basis of each one, assuming an associated typical history of acute myocardial infarction (AMI) and no contra-indications to treatment. They were asked to return the questionnaire anonymously, stating only their position.

Of the 88 questionnaires, 61 were returned by 15 senior nurses, 10 house officers, 12 senior house officers, 10 medical registrars, eight consultant physicians and six consultant cardiologists. When electrocardiograms showed unequivocal evidence of acute myocardial infarction, all consultant cardiologists gave the correct answer, but only 75.5% of house officers diagnosed AMI. Cardiologists were most in favour of thrombolysis when left bundle branch block was present. Cardiac-trained nurses showed good decision-making skills.

Staff involved in assessment of patients with chest pain should have specific training in electrocardiographic diagnosis of myocardial infarction in order to minimise in-hospital delay when thrombolysis is indicated. The management of patients with left bundle branch block remains uncertain; cardiologists are more likely to recommend thrombolytic therapy than any of the other participants in the study.