Detecting Transient Myocardial Ischemia in the Context of Acute Coronary Syndrome in the Emergency Department

Abstract

Diagnosing regional myocardial ischemia (TRMI) remains a challenge in patients presenting with acute chest pain. It is well recognized that early definitive clinical diagnosis can be difficult. Tests including the 12-lead ECG and troponin levels improve diagnostic certainty, but many patients present to the emergency department with acute chest pain too early for a reliable troponin result and show no acute change in ECG. The 12-lead ECG, though undoubtedly useful, provides information only from a limited window of body surface electric activity. Thus it has well-described limitations in the diagnosis of (1) right ventricular and/or posterior infarction, (2) transient myocardial ischemia, and (3) patients with left bundle-branch block. Given the clear-cut evidence of outcome benefit for both aggressive early pharmacological and revascularization treatment in acute coronary syndromes, novel techniques for reliable detection of such patients are potentially of …