Chest pain: The importance of serial ECGs

Abstract

Chest pain: The importance of serial ECGsA 44-year-old man, previously well, presented to the emergency department with severe hypertension and a 4-hour history of typical angina-like chest pain with associated diaphoresis. He had dyslipidemia, a 5-pack-year history of smoking, and, likely, undiagnosed hypertension.On arrival, his blood pressure was 200/110 mm Hg, representing a hypertensive emergency. A clinical examination was unremarkable. A blood sample was sent for troponin analysis, and a nitroglycerin infusion was started.

Things We Do for No Reason™: Routine repeat electrocardiogram for low‐to‐intermediate risk chest pain

“…6 Repeat ECG acquisition in the presence of new symptoms or ongoing, severe chest pain can be performed quickly and has the potential to identify a developing STEMI without needing to wait for lab values to result. 7 With an initial normal or nondiagnostic ECG, hospitalists often repeat the ECG one or more times during the hospitalization. The 2010 American Heart Association guidelines on the management of low-risk patients with chest pain recommended repeating the ECG at 5-to 10-min intervals, although it did not specify the ideal duration of monitoring.…”

“…Another study from 2000 found that serial ECGs resulted in changes to therapy in 15% of high‐risk chest pain patients after an initial nondiagnostic evaluation 6 . Repeat ECG acquisition in the presence of new symptoms or ongoing, severe chest pain can be performed quickly and has the potential to identify a developing STEMI without needing to wait for lab values to result 7 …”