You'll soon be using new 80-lead EKG to ID MIs
15% more patients are diagnosed
If a patient complains of chest pain, you probably suspect a myocardial infarction (MI) and obtain an immediate electrocardiogram (EKG). But it doesn't show any signs of a heart attack. What do you do next?
"The clinical concern is still there," says William Brady, MD, a professor in the Department of Emergency Medicine at University of Virginia Health System in Charlottesville. "It doesn't mean the patient is not having a heart attack. It could mean any number of things."
Currently, only a subset of patients with MIs is diagnosed on or soon after arrival to the ED, because of anatomic limitations of the standard 12-lead EKG, says Brady.
The 12-lead EKG looks at the heart from 12 perspectives. "So we are likely not imaging the entire heart as completely and fully as we should," says Brady. "The 12-lead [EKG] is a great tool, but it hasn't changed in over 50 years. It really hasn't kept pace with other advancements occurring in acute cardiac care."
The hospital's ED is implementing the 80-lead Prime ECG System (manufactured by Columbia, MD-based Heartscape Technologies), which can look at your patient's heart from 80 views instead of just 12. As a result, you may uncover a heart attack of the posterior wall that wasn't seen on the 12-lead EKG, says Brady.
Body surface mapping increases the rate of MI diagnosis in ED patients by up to 15%, according to a recent study.1 "It gives us the potential to improve our ability to detect a heart attack at an earlier point in time," says Brady, one of the study's authors. "This increased rate of diagnosis at an earlier time in the evaluation process allows for appropriate, time-sensitive therapy to be delivered more expeditiously."
This group of patients otherwise would be discharged with an MI, but with the Prime ECG, their treatment plan changes dramatically, he says. "This puts the person into a time-sensitive group where they need to go to the cath lab or receive a fibrolytic agent within minutes or a couple of hours," says Brady.
When can you expect to be using the 80-lead EKG in your ED? "You may see it as soon tomorrow in some EDs, and in other EDs it may be five to 10 years away," says Brady.
Reference
- Self WH, Mattu A, Martin M, et al. Body surface mapping in the ED evaluation of the patient with chest pain: Use of the 80-lead electrocardiogram system. Am J Emerg Med 2006; 24:87-112.
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