Article Text

PDF

First ECG in chest pain
  1. Doug Speake,
  2. Polly Terry
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

    Statistics from Altmetric.com

    Report by Doug Speake, Medical Student Search checked by Polly Terry Specialist Registrar

    Clinical scenario

    A 55 year old man with cardiac sounding chest pain presents to the emergency department. The first ECG is normal. Just before you discharge him you stop to wonder what the sensitivity of the initial 12 lead ECG is in predicting acute myocardial infarction.

    Three part question

    In [patients presenting to the ED with cardiac-sounding chest pain] what is the [sensitivity] of the [initial 12 lead ECG]?

    Search strategy

    Medline 1966–09/00 using the OVID interface. [(exp myocardial infarction OR myocardial infarction.mp OR AMI.mp OR MI.mp) AND (exp electrocardiography OR electrocardiogram.mp OR ECG.mp OR EKG.mp) AND (initial.mp OR first.mp OR single.mp or premier.mp)] AND maximally sensitive diagnostic study filter LIMIT to human AND english.

    Search outcome

    Altogether 543 papers found of which 533 were irrelevant or of insufficient quality for inclusion. The remaining 10 papers are shown in table 4.

    Table 4

    Comments

    At presentation history, clinical findings and ECG are all that are available to aid clinicians in the diagnosis of AMI. These studies have shown that the first ECG is between 13–69% sensitive for AMI.

    Clinical bottom line

    The first ECG is not sensitive enough to rule out AMI in the emergency department.

    Report by Doug Speake, Medical Student Search checked by Polly Terry Specialist Registrar

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.