Letters To The Editor

Acute myocardial infarction

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To the Editor: I truly enjoyed the review by Drs. Senter and Francis in the March issue of the Journal,1 and I marveled at the authors’ feat of encompassing so much essential information about the diagnose of acute myocardial infarction (MI) in so few pages!

Under the subheading “Electrocardiography: Necessary but not sufficient,” the authors clearly describe the vagaries in using standard 12-lead electrocardiography in the diagnosis of acute MI. Indeed, one is often unable to substantiate the diagnosis of acute MI using standard 12-lead electrocardiography, with occasionally devastating consequences (death, loss of cardiac muscle due to failure to implement thrombolysis or percutaneous coronary intervention). Troponin biomarkers, echocardiography, and frequent sequential recordings of standard 12-lead electrocardiography may provide additional aid, as the authors remark. However, quite frequently, even all the above do not suffice, and acute MI remains undiagnosed, or, if the correct diagnosis is made, we fail to subject some patients to the appropriate procedures for optimal management of their condition.

It is time to upgrade standard 12-lead electrocardiography! Many have proposed certain additional electrocardiographic leads, on extensive thoracic electrode arrays, which are cumbersome to use in an acute or emergency setting. Instead, I have recently proposed as the solution the “double electrocardiogram” for the diagnosis of acute MI in patients with suspected acute coronary syndromes and a nondiagnostic electrocardiographic result. The double electrocardiogram consists of supplementing the 12-lead electrocardiogram immediately by repeating it, with the V 1 to V 6 electrodes used to record leads V 3R, V 4R, V 7, V 8, and V 9 to the left of the spine, and V 9R to the right of the spine.

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