The importance of serial EKG in acute myocardial infarction. A 52-year-old woman, smoker with chest pain.

Created by team@ekgdx.com on Dec. 29, 2023

Today's article is about the importance of serial electrocardiogram in acute myocardial infarction. By the way, I'm going to share an interesting case with you.

Let's start with the concept: Serial EKG is defined as the comparison of a newly made EKG with a previously made one, to look for possible changes. These changes are either used to detect new pathology or to verify the efficacy of a specific therapy or intervention.

Personal opinion: Any time I suspect acute MI without significant changes in the first EKG, I like to do “at least” a series of 3 EKG every 10-15 min. If a big vessel is involved (as in this case), you may see changes in that period of time (usually).

Let’s talk about this amazing case (see a similar case with associated LV thrombus here)

A 52-year-old woman, smoker with chest pain for one hour. She has a past medical history of hypertension and is compliant with her medication (losartan 50 mg daily). She is not overweight and works in a clothing store full time.

 

EKG #1 was performed in triage. What do you think?

 

10 min later, second EKG was performed. Nitroglycerin (sublingual) given with no pain release. Vital signs stable.

 

10 min later, third EKG was performed. Fentanyl (50 mcg) IV given with no pain release. The patient begins with signs of facial sweating. Vital signs remain stable.

 

Here the first EKG labeled with my concern.

 

Here the second EKG labeled. At this point, I had no doubts and very worried about the LAD. STEMI team was activated. Note the new changes.

 

Here the third EKG labeled. The changes are more evident.

 

Echocardiogram at bedside was performed after the second EKG. Note the regional wall motion abnormality. 35 min later, the blood pressure started to go down (BP 76/44) and the patient was rushed to cathlab. Click the image to open the video on Twitter.

 

An urgent left heart cath was performed and showed a total occlusion of LAD.

 

Successful PCI of the LAD. One stent was placed. Impella device was used due high-risk PCI.

 

Central illustration

 

Learning point

Performing EKG every 10-15 minutes (serial EKG) in patients with suspected acute MI can save many lives and avoid delays in appropriate management.

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Thanks for reading this teaching case.

Dr. Roig

The importance of serial EKG in acute myocardial infarction. A 52-year-old woman smoker with chest pain.