12-leads ECG—executive summary
1. A 12-lead ECG must be performed on a patient with chest pain within 10’ after the FMC, and the results interpreted immediately by an expert.
2. Always perform V3R–4R in the case of inferior STEMI (to detect a possible lesion in the free wall of the right ventricle) and V7–V9 in the case of STEMI of the inferior and lateral wall, or of suspected posterior STEMI (to detect extension to the posterior myocardial tissue).
3. A quick comparison should be made with previous traces, if possible using electronic archives that will allow fast retrieval and consultation of previous ECGs. This comparison is indispensable for patients with bundle branch block, pacing or previous myocardial infarction.
4. For cases under observation in ED, continuous 12-lead ECG monitoring is recommended. Alternatively, serial 12-lead ECGs must be performed.
5. It is important that a 12-lead trace be taken in the event of a recurrence or worsening of symptoms.