A importância de um EGC normal em síndromes coronarianas agudas sem supradesnivelamento do segmento ST

Teixeira, Rogério; Lourenço, Carolina; António, Natália; Monteiro, Sílvia; Baptista, Rui; Jorge, Elisabete; Ferreira, Maria João; Monteiro, Pedro; Freitas, Mário; Providência, Luí­s A.

doi:10.1590/s0066-782x2010000100006

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Although hospital mortality in patients with ACS who had a normal ECG on admission is lower than in patients with ECG abnormalities, it has been shown that patients with MI and normal ECG on admission do not always have a favorable hospital course and that hospital mortality is as high as 5.7% ( 10 ). In previous studies, patients with a normal ECG were younger, had a lower Killip class on admission and a higher LVEF, while there were no significant differences in risk factors for cardiovascular disease, family history of CAD and previous treatments ( 11 ). In our study, patients with normal ECG were on average 60 years old, and in >90% of cases had preserved LVEF, while diabetes mellitus was present in a quarter of cases, which corresponds to the prevalence of diabetes in patients with ACS ( 12 ).…”

Section: Discussionmentioning

confidence: 88%

Characteristics of Patients With Acute Coronary Syndrome and Normal Electrocardiogram

Ljubojevic,

Neskovic,

Vranic

et al. 2024

Med Arch

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Background: Patients with acute coronary syndrome (ACS) and normal electrocardiogram (ECG) may have an increased risk of late diagnosis and complications of the disease. Objective: To study the demographic, angiographic and echocardiographic characteristics of patients hospitalized for ACS in whom the ECG was normal on admission to the hospital. Methods: This retrospective study included patients who were hospitalized for ACS without ST-elevation between 2015 and 2023 and who had coronary artery disease (CAD) confirmed by coronary angiography. By further inspection of the electronic databases, patients with ACS who had a normal ECG on admission were filtered out and analyzed separately. Results: Of the total 3137 patients with suspected ACS without ST-elevation, 129 patients (4.1%) were diagnosed as having ACS with a normal ECG. In three patients a non-atherosclerotic cause for the ACS was found. A significantly higher proportion of patients had single-vessel (54.3%) compared to two-vessel (29.5%) and three-vessel (14%) CAD. In addition to a normal ECG, 5.7% of patients with single-vessel CAD and 3.5% of patients with multi-vessel CAD had normal troponin levels and normal regional LV systolic function on echocardiography. Conclusion: Less than 5% of hospitalized patients with ACS without ST-elevation had a normal ECG on admission. The majority of these patients have single-vessel CAD. In about 5% of patients with single-vessel CAD, neither elevated troponin levels nor LV asynergy are detected.

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Section: Discussionmentioning

confidence: 88%

Characteristics of Patients With Acute Coronary Syndrome and Normal Electrocardiogram

Ljubojevic,

Neskovic,

Vranic

et al. 2024

Med Arch

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“…A study by Teixeira et al, further observed that 22% of patients with a normal ECG went on to develop an NSTEMI, which on a practical level forces the clinician to achieve a precise clinical and biochemical characterisation, considering that a normal ECG may not necessarily be a benign finding. We believe that ischemic changes are dynamic and can thus evade detection [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Frequency of Non-ST Segment Elevation Myocardial Infarction (NSTEMI) in Acute Coronary Syndrome With Normal Electrocardiogram (ECG): Insights From a Cardiology Hospital in Pakistan

Khan

Akhter

Munir

et al. 2020

Cureus

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Introduction Patients presenting to the emergency department with a non-ST segment elevation myocardial infarction (NSTEMI) frequently have unremarkable electrocardiography (ECG) reports, alluding to the unreliable nature of ECG in diagnosing NSTEMI. This study aims to assess the burden of NSTEMI in acute coronary syndrome (ACS) with unremarkable ECG, elucidating that in patients presenting with acute retrosternal chest pain, NSTEMI should not be excluded unless cardiac enzyme levels are assessed. Methods All patients who fulfilled the inclusion criteria in the Department of Cardiology, Tabba Heart Institute, Karachi were included. After obtaining informed written consent, a detailed history was taken. Clinical examination was consequently performed, and an ECG, along with the cardiac enzymes implicated in ACS, such as troponin I, was evaluated. The proportion of normal ECGs in the context of an NSTEMI was duly noted. Result A total of 215 patients with ACS presenting within 24 hours of the onset of symptoms, on a background of unremarkable ECG reports, were included. One hundred thirty-eight (64.2%) were males and 77 (35.8%) were females, with the mean age being 54.3 + 7.6 years. A confirmed diagnosis of NSTEMI was made in 49 (22.8%) of the total cases. Conclusion The frequency of patients presenting with an NSTEMI within 24 hours of the onset of symptoms, and having normal ECG findings, was strikingly high in patients presenting to the Tabba Heart Institute, Karachi, Pakistan. These findings were more common in males and in older patients.

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“…3 A eficácia do tratamento do IAM está relacionada ao tempo de instituição da terapia de reperfusão, ou seja, a recanalização arterial em tempo hábil poderá proporcionar inúmeros benefícios para o aumento da sobrevida. [4][5][6] Sobretudo, é a terapia mais importante no tratamento, sendo sua indicação associada à clínica e as alterações eletrocardiográficas. 7,8 A reperfusão pode ser realizada com agentes fibrinolíticos, com intervenções mecânicas (angioplastia primária) ou revascularização cirúrgica.…”

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“…14 Contudo, este exame deve ser realizado em até 10 minutos após a chegada do paciente ao hospital. 6,9,12 No entanto, o retardo desse atendimento torna impossível à terapêutica com trombolíticos. Os estudos mostram que o tratamento com trombolíticos iniciado na primeira hora é muito mais eficaz, com diminuição do risco de mortalidade, do que quando é iniciado após 6 a 12 horas do início do sintoma.…”

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Door-to-electrocardiogram time: attendance evaluation of patients with acute myocardial infarction

Palmeira

Machado

2011

Rev enferm UFPE on line.

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Objectives: to measure the time to perform the electrocardiogram after admittance of patient with thoracic pain; investigate the characteristics of exams and treatment rendered to patient diagnosed with acute myocardial infarction (AMI) with ST-segment elevation. Method: it is a descriptive and exploratory study. The data was extracted from attendance records of patients with thoracic pain at an emergency room, between June and August 2010. The project was approved by the Research Ethics Committee of the University of Paraiba Valley (Univap) (H16/2010). The sample to evaluate the electrocardiogram time was composed of 115 patients, and of these, only 18 presented AMI with ST-segment elevation. Results: the door-to-electrocardiogram time was more than 10 minutes for 95.8% of the patients with thoracic pain. The troponin exam presented an alteration on 83.3% and the Transluminal Coronary Angioplasty was performed on 72.2% of patients with AMI and ST-segment elevation. Conclusions: most patients underwent the electrocardiogram after 10 minutes. All patients diagnosed with AMI and ST-segment elevation underwent the myocardial necrosis marker exam and the prevailing treatment was primary angioplasty. Descriptors: myocardial Infarction; emergency medical services; nurses.RESUMO Objetivos: mensurar o tempo da realização do eletrocardiograma após admissão do paciente com dor torácica; investigar as características dos exames e o tratamento prestado ao paciente com diagnóstico de infarto agudo do miocárdio (IAM) com supradesnível de ST. Método: trata-se de um estudo descritivo e exploratório. Os dados foram extraídos das fichas de atendimento de pacientes com dor torácica em um pronto atendimento, entre junho a agosto de 2010. O projeto obteve aprovação do Comitê de Ética em Pesquisa da Univap (H16/2010). A amostra para avaliação do tempo eletrocardiograma foi composta por 115 pacientes e destes, apenas 18 apresentaram IAM com supradesnível de ST. Resultados: o tempo porta-eletrocardiograma foi maior que 10 minutos para 95,8% dos pacientes com dor torácica. O exame de troponina apresentou alteração em 83,3% e a Angioplastia Coronária Transluminal foi realizada em 72,2% dos pacientes com IAM e supradesnível de ST. Conclusões: a maioria dos pacientes realizou o eletrocardiograma com mais de 10 minutos. Todos os pacientes com diagnóstico de IAM e supradesnível de ST realizaram o exame de marcadores de necrose miocárdica e o tratamento predominante foi à angioplastia primária. Descritores: infarto do miocárdio; atendimento de emergência; enfermeiros.RESUMENObjetivos: mensurar el tiempo de la realización del electrocardiograma tras admisión del paciente con dolor torácica; investigar las características de los exámenes y el tratamiento prestado al paciente con diagnostico de infarto agudo de miocardio (IAM) con supradesnivel de ST. Método: tratase de un estudio descriptivo y exploratorio. Los dados fueron extraídos de las fichas de atendimiento de pacientes con dolor torácica en un Centro de salud, entre junio y agosto de 2010. El proyecto obtuvo aprobación del Comité de Ética en Pesquisa de la Univap (H16/2010). La muestra para evaluación del tiempo electrocardiograma fue compuesta por 115 pacientes y de estos, solamente 18 presentaron IAM con supradesnivel de ST. Resultados: el tiempo porta electrocardiograma fue mayor que 10 minutos para 95,8% de los pacientes con dolor torácica. La prueba de troponina ha presentado alteración en 83,3%, y la Angioplastia Coronaria Transluminal fue realizada en 72,2% de los pacientes con IAM y supradesnivel de ST. Conclusiones: la mayoría de los pacientes han realizado los electrocardiogramas con más de 10 minutos. Todos los pacientes con diagnostico de IAM y supradesnivel de ST han realizado el examen de marcadores de necrosis miocárdica y el tratamiento predominante fue la angioplastia primaria. Descriptores: infarto del miocardio; servicios médicos de urgencia; enfermeros.

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A importância de um EGC normal em síndromes coronarianas agudas sem supradesnivelamento do segmento ST

Abstract: Background: Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS).

Cited by 5 publications

References 14 publications

Characteristics of Patients With Acute Coronary Syndrome and Normal Electrocardiogram

Characteristics of Patients With Acute Coronary Syndrome and Normal Electrocardiogram

Frequency of Non-ST Segment Elevation Myocardial Infarction (NSTEMI) in Acute Coronary Syndrome With Normal Electrocardiogram (ECG): Insights From a Cardiology Hospital in Pakistan

Door-to-electrocardiogram time: attendance evaluation of patients with acute myocardial infarction

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