PMID: 9535494Apr 16, 1998Paper

Bedside diagnosis of myocardial ischemia with ST-segment monitoring technology: measurement issues for real-time clinical decision making and trial designs

Journal of Electrocardiology
B J DrewM M Pelter

Abstract

Monitoring of the ST segment is a valuable tool for guiding clinical decision making and evaluating anti-ischemia interventions in clinical trials; however, measurement issues hamper its diagnostic accuracy. This study reports the frequency and type of false positives and other measurement issues we have encountered during 12-lead ST-segment monitoring of patients in a cardiac care unit. Of 292 patients, 117 (40%) had one or more false positive events during an average of 41 hours of ST-segment monitoring, for a total of 506 false positive events. The 506 false positive events included 167 (36%) due to body positional change; 132 (26%) due to sudden increase in QRS complex/ST-segment voltage; 96 (19%) due to transient arrhythmia or pacing; 80 (16%) due to heart rate change in steeply sloped ST-segment contours; 26 (5%) due to a noisy signal; and 5 (1%) due to lead misplacement. It is concluded that many conditions in addition to myocardial ischemia can cause transient ST-segment deviation in patients with unstable coronary syndromes. Accurate ST-segment monitoring requires expertise in electrocardiogram interpretation, an understanding of the patient's clinical situation, and knowledge of the functions and limitations of the ST...Continue Reading

Citations

Aug 9, 2002·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Tomas JernbergLars Wallentin
Mar 14, 2007·European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology·Kaat SiebensChristiaan Vrints
Jan 31, 2002·Anesthesiology·Martin J London
Mar 3, 2010·American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses·Kristin E SandauKaren Doran
Dec 3, 2016·Critical Care Nurse
Jun 5, 2007·The Journal of Cardiovascular Nursing·Kimberly E StephensMichele M Pelter
Jun 8, 2015·Dimensions of Critical Care Nursing : DCCN·John R BlakemanKathy J Booker

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