Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic.

Abstract

Objective-To evaluate a clinic set up specifically to assess patients with recent onset chest pain, particularly those presenting with a normal resting electrocardiogram.Design-Retrospective review of case notes.Setting-Cardiac department of a tertiary referral cardiothoracic centre.Patients-250 consecutive patients with recent onset chest pain seen within 24 hours of general practitioner referral.Outcome measures-Clinical diagnosis and management.Results-40% of patients were seen within seven days of the onset of symptoms. Twenty seven per cent had non-cardiac symptoms and could be discharged while 60% were considered to have cardiac pain. Sixty six patients (26%) were admitted directly from the clinic and 48 of these underwent coronary angiography within three weeks. Seventy patients (28%) have so far undergone intervention (angioplasty or coronary artery surgery), 22 within one month of presentation. One hundred and nine patients (44%) presented with a normal resting electrocardiogram, 21 of whom were considered to have unstable angina. Forty one of these patients were investigated of whom 37 were found to have significant coronary disease and 26 have undergone intervention.Conclusions-This experience highlights the inadequacy of a routine electrocardiogram reporting service in patients with recent onset of chest pain. An alternative facility offering immediate and complete cardiac assessment produced patient benefit with early diagnosis and intervention. Investigation of these patients, however, accounted for 5% of cardiac catheterisation laboratory throughput; this was a significant additional and unscheduled workload.

Long-Term Cardiac Mortality in Patients Admitted with Noncoronary Chest Pain under Suspicion of Acute Myocardial Infarction

“…Arrhythmias, which accounted for one third of the patients, may have reflected coronary artery disease, but on the other hand the mor tality among patients with other diagnoses than arrhythmia was equally high (table 1). Some of the patients may of course have had more than one explanation for chest pain [9], Our results are in accordance with the recent study by Norell et al [19]. who found that patients with chest pain and normal ECG at rest very well might have severe coronary artery disease.…”

Value of the Resting Electrocardiogram in Assessing Patients with Recent Onset Chest Pain A Study in Tertiary Care Hospital, Dhaka Bangladesh

“…Norell et al 5 the mean duration of symptoms precipitating referral was 27 days (range 1-90 days). One hundred and eighty seven patients (75%) presented within-30 days of the onset of symptoms and 100 (40%) were assessed within seven days.…”

“…Autore et al 7 found that electrocardiogram provides a specific diagnosis only in 4.9% of patients with acute myocardial infarction. Norell et al 5 study reported that sixty nine patients (37.5%) were considered to have non-cardiac pain. In 317 cases (31.7%) the diagnosis was stable angina and 94 patient's symptoms were considered to represent unstable angina, despite a normal resting electrocardiogram in 21 patients.…”

“…Dougan et al 4 study found that the mean (SD) age of 53(13) years. Norell et al 5 study showed the mean age 58 years (range 25-84 years). Santos et al 6 study observed that the mean age was found 54.0 years (±18.5).…”

Cardiac service provision in the United Kingdom

“…They have superseded hospitalbased electrocardiogram (ECG) reporting which, although previously commonplace, represented less than ideal practice. 18 Unstable CAD is a frequent cause of hospital admission and while AMI might be well recognised, more subtle presentations may not be so easily appreciated. In addition to the history, other clinical features and resting ECG appearances, estimation of serum troponin (a sensitive indicator of myocardial damage) has allowed high-risk patients to be better identified, and in many ways has become the 'key to the cardiological door' .…”