ST-segment monitoring

Obtain serial troponin and CK MB as confirmatory results not needed before reperfusion therapy is initiated multilead continuous ST-segment monitoring... 

General treatment measures for all STE ACS and high- and intermediate-risk NSTE patients include admission to hospital, oxygen administration (if oxygen saturation is low, less than 90%), continuous multi-lead ST-segment monitoring for arrhythmias and ischemia, frequent measurement of vital signs, bed rest for 12 hours in hemodynamically stable patients, avoidance of Valsalva maneuver (prescribe stool softeners routinely), and pain relief (Fig. 5-3). 

Subramanian VB, Bowles MJ, Khnrmi NS, Davies AB, O Hara MJ, Raftery EB. Calcium antagonist withdrawal syndrome objective demonstration with frequency-modulated ambulatory ST-segment monitoring. BMJ (Clin Res Ed) 1983 286(6364) 520-1. 

The recording of ST-segment monitoring is very important to access changes during the follow-up with and without pain. 

Recurrent ST-segment elevation, especially with pain, detected with continuous multilead ST-segment monitoring (Akkerhuis et al., 2001). -According to the ST-segment elevation in the precordial or inferior leads and the presence of mirror patterns, the ECG allows for location of the coronary... 

Akkerhuis KM, Klootwijd PA, Lindeboom W et al. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events meta-analysis of three studies involving 995 patients. Eur Heart J 2001 22 1997. 

Cohn PR The value of continuous ST segment monitoring in patients with unstable angina. Eur Heart J 2001 22 1972. 

Perioperative beta-blockers There is a continuing debate about the administration of antihypertensive medications in the perioperative period. Particular focus has been directed at perioperative beta-blockers because they can reduce the incidence of perioperative cardiovascular adverse events. Randomized studies have shown that beta-adrenoceptor antagonists can reduce perioperative myocardial ischemia, as assessed by continuous ST-segment monitoring [4 ]. 

Landesberg, G., et al. Perioperative Myocardial Ischemia and Infarction Identification by Continuous 12-lead Electrocardiogram with Online ST Segment Monitoring, Anesthesiology 96(2) 264-70, February 2002. 

Formulate a monitoring plan for a patient with ST-segment elevation acute coronary syndrome receiving fibrinolytics, aspirin, unfractionated heparin, intravenous nitroglycerin, intravenous (3-blockers followed by oral P-blockers, an angiotensin-converting enzyme inhibitor, and a statin. 

Devise a pharmacotherapy treatment and monitoring plan for a patient with non-ST-segment elevation acute coronary syndrome given patient-specific data. 

Figure 12.2 During Holter monitoring in a patient with ischaemic heart disease, crises often silent with ST-segment elevation or depression may be recorded.

Dellborg M, Topol EJ, Swedberg K et al. Dynamic QRS complex and ST segment vectorcardiographic monitoring can identify vessel patency in patients with acute myocardial infarction treated with reperfusion therapy. Am Heart J 1991 122 943. 

The monitoring parameters for efficacy of nonpharmacologic and pharmacotherapy for both ST-segment-elevation and non-ST-segment-elevation ACS are similar ... 

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