Case in Electrocardiography
How an ECG is performed, not necessarily how it is interpreted, can lead to problems. The emergency physician should be aware of such issues so he does not embark on an unnecessary diagnostic or treatment pathway.
A case in point: A 58-year-old woman with a history of sarcoidosis is sent to the ED after a visit to the preoperative testing suite. In preparation for elective abdominal surgery (repair and debridement of a chronic inguinal sinus tract), she had an ECG performed, which was deemed abnormal. (See Figure 1.) She was immediately sent to the ED for evaluation and urgent cardiology consultation.
The patient had no acute complaints, and she denied chest pain, dyspnea, diaphoresis, nausea, weakness, or unusual fatigue. Her medications included bronchodilators and cephalexin. Her vital signs and physical examination were normal. The computer interpretation at the top of her ECG read: “Normal sinus rhythm; possible anterior infarct; age indeterminate; abnormal ECG.” What is your interpretation, and are there any other considerations in this case? See p. 22.