Fourth, patients with left ventricular hypertrophy and ischemic chest pain should be admitted into the coronary care unit because of higher likelihood of development of acute coronary syndromes and life-threatening complications.
Normal ECG or Nonspecific ST-T Wave Chances
Finally, in patients with ischemic chest pain, the initial ECG can show minor nonspecific ST-T wave changes or be normal. Among the possible causes of a normal initial ECG in AMI are delayed evolution of the ECG changes, lateral infarction due to occlusion of the left circumflex coronary artery, or small myocardial infarctions. buy prednisone
According to Brush et al and others, in patients with suspected AMI, the initial ECG is a good predictor of short-term prognosis and the need for acute interventions (drug therapy, temporary pacemaker or intraaortic balloon). As mentioned, patients with ischemic chest pain and normal ECG or nonspecific ST-T wave changes have a low incidence of AMI, serious complications, and mortality, and therefore, can be admitted into the step down unit. An important limitation of these studies was their retrospective character. Furthermore, the predictive value of the initial ECG was not confirmed by Young et al who showed that the incidence of life-threatening complications, need for interventions and mortality was similar and low regardless of the initial ECG. Similar results were also reported by Weingarten et al.
Another question is whether patients with suspected myocardial infarction and nonspecific repolarization abnormalities have the same prognosis as those with a completely normal ECG. Fesmire and co-workers suggested that patients with nonspecific ST-T wave changes or an abnormal but unchanged ECG have a slightly higher risk than those with completely normal ECG. According to Slater et al, there was no death in 107 patients with AMI and normal ECG and one death in 73 patients who had nonspecific ST-T wave changes.