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European Heart Journal 1984 5(10):784-791;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Unreliability of conventional visual electrocardiographic monitoring for detection of transient ST segment changes in a coronary care unit

A. BIAGINI, A. L'ABBATE, R. TESTA, C. CARPEGGIANI, M. G. MAZZEI, C. MICHELASSI, A. BENASSI, A. RIVA, C. MARCHESI and A. MASERI

C.N.R. Clinical Physiology Institute and Istituto di Patologia Medica 1, University of Pisa Pisa, Italy

Received 11 April 1984; revised 22 June 1984; .

Address for reprints: A Biagni. MD, C.N.R. Clinical Physiology Institute. Via Savi. 8. 56100 Pisa, Italy.

Abstract

Visual monitoring at the central station of coronary care units (CCUs) may not adequately assess the presence and frequency of transient asymptomatic ST segment changes in patients with unstable angina. We have performed continuous 24-h electrocardiographic recordings over a total period of 50 days in 10 patients admitted to our CCU with frequent attacks of angina at rest. Over the corresponding period, at the central monitoring station (6 beds), the nursing-staff detected only 31 transient ischaemic episodes (27 with ST elevation, 4 with depression, 9 of which were asymptomatic). By contrast the retrospective analogue analysis of tapes identified 213 ischaemic episodes: 143 with ST elevation (≤0.2 mV) and 70 with ST depression (≤0.2 mV); usual CCU monitoring failed to report changes during 13 episodes (8 with ST elevation, 5 with depression) accompanied by anginal pain. When the tapes were played back in real time on a CCU monitoring scope, a cardiologist (who had the option of interrupting the play-back whenever tired) recognized 48% of the episodes when presented in groups of 4 and randomly positioned on the screen together with 2 other elelectrocardiographic tracings not related to the study; he recognized 92% of the episodes when only one ECG was presented on the screen.

Thus conventional visual monitoring in a CCU considerably underestimates the incidence of transient ischaemic ST segment changes, some of which were accompanied by pain. This low rate of detection is the result of the presentation on the central monitoring station of several ECGs and of fatigue.

Key Words: Asymptomatic ST changes • electrocardiographic monitoring in coronary care unit • unstable angina • Holter monitoring


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