First ECG in chest pain
- Doug Speake,
- Polly Terry
- Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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.
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
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Zalenski R, Cooke D, Rydman R, et al. Assessing the diagnostic value of an ECG containing leads V4r, V8 and V9: the 15 lead ECG. Ann Emerg Med1993;22:786–93.
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Fesmire F. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients
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Kudenchuk P, Maynard C, Cobb L, et al. Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: the myocardial infarction triage and
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