Abstract
In the past 15–20 years, increasing attention has been paid to the use of multi-lead bedside monitoring and telemetry patient monitoring. Since the advent of continuous ST monitoring in the mid 1980s became available, initially using 1–3 leads, later on the full 12 leads, either using actual 12 leads or using a derived 12-lead approach using vectorcardiography (X–Y–Z) or the EASI-lead system. The technology providing ST-segment monitoring was first introduced by Krucoff in the intervention lab setting. Krucoff described how ST-segment monitoring is used to identify the patient's ST fingerprint. This fingerprint comprises a unique pattern of ST depression or elevation for an individual patient. Continuous ST monitoring and more importantly, reviewing stored ST-segment information makes it possible to detect ischemic events over time. This makes it possible to review ST segments and gives both nurses and physicians online critical information. Although continuous ST-segment monitoring is now available in many patient monitoring systems, many physicians and nurses feel uncomfortable and are not confident enough to use ST-segment monitoring in daily practice. It is often unjustly compared with serial 12 lead ECGs. Continuous monitoring demands a different approach to the clinical data. How can continuous ST segment monitoring guide us to define a treatment, and predict outcome in our patient population at the emergency department, chest pain unit and coronary care unit? One study (248 patients) describes a direct relationship between ST-segment recovery of more than 50% recovery within 90 min vs. persisting ST elevations and the 1 year survival. (2% vs. 14% death in the first year). Another study (995 patients) shows a direct relationship between the number of ischemic burden and outcome. In patients with ischemic burden, 1.4% of the patient died and 5.7% were diagnosed with MI within 30 days vs. patients with more than five ischemic burdens 9.9% died and 19.7% were diagnosed with MI. These studies, as many others, have shown how important it is to monitor ST segment and to be able to document ST segment changes. ST segment monitoring also makes it possible to monitor how quickly patients respond to treatments. Approximately 80–90% of the detected ischemic events are clinically silent which prove that ST segment monitoring is more sensitive than patient's symptoms for detecting myocardial ischemia. Conclusions and recommendations: Continuous ST segment monitoring should be a part of anti-ischemic treatment, it must be started on admission, and it provides online information about the myocardial physiology. This makes it possible to respond to cardiac changes instantaneously.