ECGs: Read, reread, repeat. After reading an electrocardiogram, reread it and look for the five patterns of acute MI and for evidence of localized ischemia.
Perform delta enzyme analysis. One set of enzymes will be more likely to miss, rather than diagnose, an early acute MI.
Conduct an objective test. Develop a chest pain protocol that allows for an evidence-based approach to patient evaluation. Base the protocol on risk, ECG findings, age, and ability to run. Conduct one of the following: exercise tolerance test, nuclear study, echocardiography, or computed tomography.
Source: Dr. Slovis
ECG Mistakes Never to Make
▸ Failure to get an ECG in chest pain patients.
▸ Failure to get an ECG in older patients with signs of syncope, presyncope, weakness, vomiting, nausea, diaphoresis, or shortness of breath.
▸ Failure to look specifically for all acute MI-ischemic patterns.
▸ Failure to repeat the ECG, especially if it is abnormal or is from a high-risk patient.
▸ Failure to compare new ECGs with previous ones–ask to have them faxed from other hospitals.
Source: Dr. Slovis