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Multilead ST-segment monitoring in patients with acute coronary syndromes: A consensus statement for healthcare professionals

Publication ,  Journal Article
Drew, BJ; Krucoff, MW
Published in: American Journal of Critical Care
January 1, 1999

• BACKGROUND ST-segment monitoring is underused by healthcare professionals for patients with acute coronary syndromes treated in emergency departments and intensive care units. • OBJECTIVE To provide clinically practical consensus guidelines for optimal ST-segment monitoring. • METHODS A working group of key nurses and physicians met in Dallas, Tex, in November 1998. • RESULTS Consensus was reached on who should and should not have ST monitoring, goals and time frames for ST monitoring in various diagnostic categories, what electrocardiographic leads should be monitored, what equipment requirements are needed, what strategies improve accuracy and clinical usefulness of ST monitoring, and what knowledge and skills are required for safe and effective ST monitoring. • CONCLUSIONS Because changes in the ST segment can shift among various electrocardiographic leads in the same person over time owing to different ischemic mechanisms, 12-lead ST monitoring is recommended. Recommended monitoring times are as follows: myocardial infarction or unstable angina, 24 to 48 hours or until patient is event-free for 12 to 24 hours; chest pain prompting a visit to an emergency department, 8 to 12 hours; catheter-based interventions with less definitive interventional outcomes requiring monitoring in an intensive unit, 6 to 12 hours; and cardiac surgery or noncardiac surgery in patients with coronary disease or risk factors, 24 to 48 hours. An ST measurement point of J + 60 ms makes it unlikely that measurement will coincide with the upslope of the T wave, even in patients with sinus tachycardia. Accurate and consistent lead placement and careful electrode and skin preparation are imperative to improve the clinical usefulness of ST monitoring.

Duke Scholars

Published In

American Journal of Critical Care

DOI

ISSN

1062-3264

Publication Date

January 1, 1999

Volume

8

Issue

6

Start / End Page

372 / 388

Related Subject Headings

  • Nursing
  • 1110 Nursing
 

Citation

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Chicago
ICMJE
MLA
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Drew, B. J., & Krucoff, M. W. (1999). Multilead ST-segment monitoring in patients with acute coronary syndromes: A consensus statement for healthcare professionals. American Journal of Critical Care, 8(6), 372–388. https://doi.org/10.4037/ajcc1999.8.6.372
Drew, B. J., and M. W. Krucoff. “Multilead ST-segment monitoring in patients with acute coronary syndromes: A consensus statement for healthcare professionals.” American Journal of Critical Care 8, no. 6 (January 1, 1999): 372–88. https://doi.org/10.4037/ajcc1999.8.6.372.
Drew, B. J., and M. W. Krucoff. “Multilead ST-segment monitoring in patients with acute coronary syndromes: A consensus statement for healthcare professionals.” American Journal of Critical Care, vol. 8, no. 6, Jan. 1999, pp. 372–88. Scopus, doi:10.4037/ajcc1999.8.6.372.
Drew BJ, Krucoff MW. Multilead ST-segment monitoring in patients with acute coronary syndromes: A consensus statement for healthcare professionals. American Journal of Critical Care. 1999 Jan 1;8(6):372–388.

Published In

American Journal of Critical Care

DOI

ISSN

1062-3264

Publication Date

January 1, 1999

Volume

8

Issue

6

Start / End Page

372 / 388

Related Subject Headings

  • Nursing
  • 1110 Nursing