What to look for on your patient's EKG
There are two distinct differences seen on an electrocardiogram (EKG) that can tell you whether your patient has an acute myocardial infarction (AMI) or pericarditis, says Dee Fontana, RN, MSN, ACNP-BC, ED nurse manager and nurse practitioner at University of Illinois Medical Center in Chicago.
In pericarditis, the ST elevations are usually less than 5 mmHg above baseline and are generalized; they occur across most of the leads on the ECG. With AMI, the ST-elevations are specific to the coronary artery that is blocked and causing the ischemia and subsequent infarct.
For example, if the patient is having an inferior wall MI, the ST-elevations would be in leads II, III, and AVF because those are the leads that reflect the blood supply provided by the right coronary artery, which feeds the inferior wall of the heart, says Fontana.
"In contrast, if that same patient presented with pericarditis, then all the leads would show ST-elevation, likely of a lesser degree in height but generally the elevations would be across the board," says Fontana. "The other difference is the shape of the ST-elevation, which is upwardly concave in pericarditis. This is a unique finding for this disease."
With pericarditis, the progression of the Q-wave conversion occurs after ST elevations have returned to the baseline, says Fontana, whereas with AMI, it might accompany ST-segment elevations.
Do this in addition to EKG
At Mission Hospitals in Asheville, NC, all chest pain patients get immediate EKGs at triage. "During this rapid time of assessment, a good storyline is needed," says Frank A. Luther Jr., RN, a nurse clinician in the hospital's ED. "And you need to get all of this, plus other history and supportive data, in about one minute. Chest pain is chest pain, and you work it up until proven otherwise."
You'll need to know the following pieces of information, says Luther:
- When did the pain start? Where is it, and does it go anywhere, such as the middle of the chest to the arm or straight to the back?
- Are there other supporting signs and symptoms, such as nausea or shortness of breath?
- Is there a history of recent illness, especially heart-related?
- Does the patient have fever and/or cough? "Often for pericarditis, you are looking for that slight history of fevers or chills, and sometimes cough for a few days leading up to the painful episodes," says Luther.
While the EKG is being done, the pericarditis needs to be treated and the inflammation relieved. "Anti-inflammatories are used. Aspirin is given for the blood aggregation and also helps with the anti-inflammatory effect," Luther says.
However, nonsteroidal anti-inflammatory drugs and aspirin are very aggravating to the stomach lining, especially in constant or higher doses. "Use coated aspirin when possible," says Luther. "Watch for nausea and check for increased GI [gastrointestinal] distress and history of ulcers, especially bleeding ones."
There are two distinct differences seen on an electrocardiogram (EKG) that can tell you whether your patient has an acute myocardial infarction (AMI) or pericarditis, says Dee Fontana, RN, MSN, ACNP-BC, ED nurse manager and nurse practitioner at University of Illinois Medical Center in Chicago.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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