Table 5.

Recommendations for ECG

Indications:
1. Chest pain
2. Acute pain anywhere from jaw to umbilicus (beyond 20 years of age)
3. Atypical symptoms of STEMI
4. Unexplained acute breathlessness, hypotension and hemodynamic collapseo

Recommendations
1. A 12-lead ECG to be performed in all patients with suspected STEMI
2. Presentation to ECG diagnosis of STEMI – < 10 min
3. A low threshold for performance of ECG in patients likely to present with atypical symptoms
4. Continuous ECG monitoring should be started as soon as possible
5. Right precordial leads (V3R, V4R) must be recorded in patients with inferior wall MI
6. True posterior wall MI may be diagnosed as ST elevation (>1 mm) in additional lateral chest leads V7 – V9

Recommendations
1. Repeat ECG – 10 min, 30 min and as needed
2. Compare with previous ECGs for even subtle changes
3. Troponin I or T to guide therapy
4. Echocardiogram for regional wall motion abnormalities 2.
5. Emergency coronary angiography if high index of suspicion of STEMI
6. CT angiogram only if aortic dissection or pulmonary embolism to be ruled out