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Prevalence of secondary ST-T wave electrocardiographic abnormalities confounding the diagnosis of acute myocardial ischemia in patients presenting to the emergency department with a chief complaint of chest pain

Rivero, Diana (2017) Prevalence of secondary ST-T wave electrocardiographic abnormalities confounding the diagnosis of acute myocardial ischemia in patients presenting to the emergency department with a chief complaint of chest pain. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Chest pain in patients presenting to the emergency department (ED) has a plethora of etiologies and electrocardiographic (ECG) manifestations. Admission to the hospital from the ED with chest pain will likely place the patient on a telemetry monitored unit for continued cardiac monitoring, specifically monitoring the ST-segment that can detect ischemia. The current guideline for in-hospital cardiac monitoring lists a few exclusions to ST-segment ischemia monitoring such as bundle-branch blocks, ventricular rhythms, and coarse atrial fibrillation or flutter (Drew et al., 2004). These conditions alter the ST-segment for reasons unrelated to acute myocardial ischemia, triggering ST-segment monitor alarms that can lead to alarm fatigue, misdiagnosis, or inappropriate treatment. The purpose of this study is to determine the prevalence and clinical significance of these non-ischemic ECG abnormalities that alter the ST-segment and affect the healthcare professionals’ accurate assessment of myocardial ischemia in patients that present to the ED with a chief complaint of chest pain. This study includes a secondary analysis of the ongoing Electrocardiographic Methods for Prompt Identification of Coronary Events (EMPIRE) study data set, which aims to quantify ischemia-induced repolarization dispersion for early non-ST elevation myocardial infarction detection. The parent study has created a database of patients who arrive via ambulance to the ED with a chief complaint of chest pain (Al-Zaiti, Martin-Gill, Sejdic, Alrawashdeh, & Callaway, 2015). In this secondary analysis, the demographic, clinical, and ECG data from 750 consecutively enrolled patients were assessed for acute coronary syndrome risk factors and ECG abnormalities, including secondary repolarization changes that interfere with ST-segment monitoring. 75% of patients were admitted and 16% of patients overall had confounders for ST-segment monitoring. Significant relationships between ST-segment monitoring confounders and important clinical variables such as age, coronary artery disease risk factors, and length of stay were found. Determination of the prevalence of ECG abnormalities that affect the ST-segment would provide valuable information on the clinical utility of ST-segment monitoring in chest-pain populations.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Rivero, Dianadlr55@pitt.edudlr55
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorAl-Zaiti, Salahssa33@pitt.edu
Committee MemberSherwood, Paulaprs11@pitt.edu
Committee MemberRen, Dianxudir8@pitt.edu
Committee MemberDrew, Barbarabarbara.drew@ucsf.edu
Date: 25 April 2017
Date Type: Publication
Defense Date: 27 March 2017
Approval Date: 25 April 2017
Submission Date: 19 April 2017
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 39
Institution: University of Pittsburgh
Schools and Programs: University Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: ST-T wave electrocardiogram changes, secondary repolarization changes, chest pain in emergency department, acute myocardial ischemia, ST-segment ischemia monitoring, telemetry monitoring, ST-segment confounders
Date Deposited: 25 Apr 2017 19:53
Last Modified: 25 Apr 2018 05:15
URI: http://d-scholarship.pitt.edu/id/eprint/31505

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