Fesmire F M, Smith E E
Department of Emergency Medicine, Erlanger Medical Center, University of Tennessee College of Medicine, Chattanooga Unit.
Am J Emerg Med. 1993 Jan;11(1):54-60. doi: 10.1016/0735-6757(93)90061-f.
Many patients presenting to the emergency department with suspected acute myocardial infarction have an initial electrocardiogram (ECG) non-diagnostic for acute injury or ischemia. Continuous ST segment monitoring devices have been used by physicians in the past to diagnose ischemia in the ambulatory outpatient population and to identify coronary occlusion in postthrombolytic and postsurgical patients. We report three patients with suspected acute myocardial infarction who underwent real-time continuous 12-lead ST segment monitoring with frequent serial ECGs on a microprocessor-controlled device during their initial emergency department evaluation. Continuous 12-lead ECG monitoring revealed significant changes on the ECG in all three cases presented, with a resultant change in emergency department therapy. Interestingly, all of these patients had significant ECG changes in the absence of recurrence of chest pain. We believe real-time continuous 12-lead ST segment monitoring with frequent serial ECGs can identify patients with an initially nondiagnostic or atypical ECG who may benefit from early interventional therapy.
许多因疑似急性心肌梗死而到急诊科就诊的患者，其初始心电图（ECG）对急性损伤或缺血无诊断价值。过去，医生使用连续ST段监测设备来诊断门诊患者的缺血情况，并识别溶栓后和术后患者的冠状动脉闭塞。我们报告了3例疑似急性心肌梗死的患者，他们在急诊科初始评估期间，使用微处理器控制的设备进行了实时连续12导联ST段监测，并频繁进行系列心电图检查。连续12导联心电图监测显示，所有3例患者的心电图均有显著变化，从而导致急诊科治疗方案的改变。有趣的是，所有这些患者在无胸痛复发的情况下，心电图都有显著变化。我们认为，频繁进行系列心电图检查的实时连续12导联ST段监测，能够识别出那些初始心电图无诊断价值或不典型、但可能从早期介入治疗中获益的患者。
