Difficult ECGs in STEMI:

Ayer, Antoine; Terkelsen, Christian Juhl

doi:10.1016/j.jelectrocard.2014.03.010

Cited by 32 publications

(9 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The characteristic ECG patterns associated with Wellens’ syndrome can provide evidence for decision-making before severe MI develops. 4 , 6 – 8 Regarding the two cases described in the present report, the first case was more consistent with Wellens’ syndrome due to the severe LAD occlusion, however, only 50–60% LAD stenosis but 100% RCA occlusion was observed in the second case, which did not conform to the typical Wellens’ syndrome. This discrepancy suggests that Wellens’ syndrome has a wide spectrum of clinical manifestations, and although characteristic ECG identification of Wellens’ syndrome can provide diagnostic evidence, additional CAG is needed to make a definite diagnosis.…”

Section: Discussionsupporting

confidence: 63%

Two case reports of Wellens’ syndrome

et al. 2018

View full text Add to dashboard Cite

Wellens’ syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens’ syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi’an Jiaotong University with intermittent and laborious angina pectoris. Her first ECG on admission revealed T-wave inversion in leads V1–V3 and biphasic T-waves in V4. Case 2, an 85-year-old female, presented with dyspnoea and paroxysmal chest pain. Her admission ECG displayed asymmetrical T-wave inversion in leads V1–V3, I, and aVL, and depressed ST segments in leads V2–V5. In this patient, drug-eluting stents were placed on a LAD artery lesion and right coronary artery occlusion. The potential of ECGs to aid decision-making in severe myocardial infarction is straightforward, particularly in patients with characteristic ECGs, however, Wellens’ syndrome has a wide spectrum of clinical manifestations and the ECG patterns may manifest itself persistently over a period of weeks. Therefore, ECG parameters should be combined with coronary angiography to confirm the presence of lesions.

show abstract

Section: Discussionsupporting

confidence: 63%

Two case reports of Wellens’ syndrome

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Especially, clinically unstable and agitated patients may have impaired diagnostic performance of the acquired ECGs. Secondly and likely more importantly, electrocardiographic findings in ACS patients may show dynamic alterations over time and in some cases the exact timing of ECG acquisition may be of critical importance, especially in light of other prehospital therapeutic interventions such as aspirin, heparin and morphine (8,(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

“…As the institutional review board had required that trial conduction was not to impair or protract diagnostic or therapeutic algorithms, treating EPs and their teams probably waived repeated/parallel ECG acquisition of c12L-ECGs in case these had already been acquired. However, due to dynamic alterations in ACS patients over time, the exact timing of ECG acquisition may be of critical importance (8,(28)(29)(30). Future comparative studies will have to ensure correct electrode placement, synchrony and longitudinal diagnostic non-inferiority in this regard.…”

Section: Study Limitationsmentioning

confidence: 99%

Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

Spaich

Kern

Zelniker

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: This study explores the application of CardioSecur ® (CS-ECG), a hand-held 4-electrode/22-lead ECG-device, in comparison with conventional 12-lead electrocardiogram (c12L-ECG) in patients with acute chest pain in the prehospital emergency setting. Methods: CS-ECG systems were provided for two physician-staffed emergency ambulances and parallel recordings of c12L-ECG and CS-ECG were obtained from all patients with acute chest pain. Treating emergency physicians were asked to evaluate the CS-ECG system with a standardized questionnaire. Following study completion, acquired ECGs were analyzed separately by two independent cardiologists blinded to all other medical records. Results: Over a period of 20 months a total of 203 patients were included in our study. According to a standardized questionnaire, 79% of emergency medical professionals preferred application of CS-ECG, with 87% of teams judging CS-ECG to be beneficial for patients. Morover, 79% of physicians reported a reduction in time to definitive diagnosis with implementation of CS-ECG. The majority of professional users attested user-friendliness and feasibility of CS-ECG in terms of easy general handling (94%), application (93%), and placement of electrodes (98%). During prehospital triage, both c12L-ECG and CS-ECG correctly identified 31 (91%) patients with ST-elevation myocardial infarction (STEMI). Conclusion: In this first pilot study, implementation of the CardioSecur ®-ECG system in the prehospital emergency setting demonstrated feasibility and user-friendliness so that emergency teams generally preferred CS-ECG to c12L-ECG. Diagnostic yield of CS-ECG was similar to c12L-ECG recordings.

show abstract

“…23–26 This recommendation is based on the premise that longer delays are associated with worse outcomes, and ST-segment pattern recognition shortens the delay between the first medical contact and life-saving reperfusion therapies. 15,23,27 …”

Section: Ischemia Monitoring In the Emergency Departmentmentioning

confidence: 99%

“…27 Current guidelines specifically recommend the initial ECGs be repeated at 5- to 10-minute intervals if the initial ECG is not diagnostic but the patient remains symptomatic and a high clinical suspicion for ACS persists. 37 Prior studies suggest that serial ECG recordings enhance the diagnostic sensitivity for ACS as compared with abnormalities on a single tracing and offer the opportunity for clinicians to observe changes between tracings that may be more difficult to interpret individually, enabling detection of evolving changes of ischemia that, by nature, are dynamic and unpredictable.…”

Section: Ischemia Monitoring In the Emergency Departmentmentioning

confidence: 99%