Use of the right-sided precordial lead V4R in the detection of intraoperative myocardial ischemia

Hert, S. G. De; Moens, Michel; Vermeyen, K. M.; Hageman, M. P.

doi:10.1016/1053-0770(93)90049-q

Cited by 14 publications

(1 citation statement)

References 35 publications

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“…4 Other, nonstandard ECG leads have been advocated for ischemia monitoring. 5 Visual detection of ST changes has been shown to not be reliable, so most modern monitoring systems have a means of automatically tracking ST segment changes and can be set up to alarm if ischemic changes are detected. 6 ST segment changes may prompt more extensive evaluation of the patient's cardiovascular system with hemodynamic monitors or echocardiography.…”

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confidence: 99%

How to Reliably Detect Ischemia in the Intensive Care Unit and Operating Room

Shanewise

2006

Semin Cardiothorac Vasc Anesth

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Detection of myocardial ischemia in the perioperative period is important because it allows for intervention that may prevent progression of ischemia to myocardial infarction. Perioperative ischemia is also an important predictor of adverse cardiovascular outcomes. Patients should first be stratified according to their risk of having cardiovascular disease by identifying major, intermediate, and minor predictors of adverse cardiovascular outcome. Electrocardiographic (ECG) monitoring for ischemia is inexpensive and noninvasive, but may not be applicable to all patients and is not perfectly sensitive or specific. Modern operating room monitors can automate ST segment monitoring and be set to alarm if changes occur. Increases in central venous pressure and pulmonary artery pressure can be caused by myocardial ischemia, but have been shown to be very insensitive compared to ECG. Also, detection of these hemodynamic changes requires insertion of invasive monitoring devices. Transesophageal echocardiography can be used to detect myocardial ischemia by identifying changes in regional wall motion. These transesophageal echocardiography changes occur sooner and more frequently than ECG changes, but require greater knowledge and skill to properly interpret.

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confidence: 99%