Bedside electrocardiographic monitoring: state of the art for the 1990s.

Recent evidence indicates that misdiagnosis of cardiac arrhythmias is a common occurrence in critical care and telemetry units. The present article addresses the problem by reviewing electrocardiographic criteria for diagnosing the arrhythmias and ischemic conditions of major importance in the critically ill patient including wide QRS complex tachycardias, bundle branch blocks, and ST segment monitoring after thrombolytic therapy and balloon angioplasty. In addition, the advantages and disadvantages of various monitoring leads are discussed with recommendations regarding the most ideal leads for detecting these arrhythmias of interest. Finally, practical suggestions are offered for improving the quality of bedside electrocardiographic monitoring.