Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed?
Publication/Presentation Date
1-1-1994
Abstract
OBJECTIVE: The evaluation of chest pain in young adults has changed with the recognition of cocaine-induced myocardial ischemia. The high frequency of abnormal electrocardiograms (56-84%) in the cocaine-user population is largely due to "normal" electrocardiographic variants (early repolarization). The authors sought to determine the frequency of these "normal" variants in a young population, and whether these findings can be confused with acute ischemia.
METHODS: A prospective convenience sample of subjects aged 18 to 35 without known heart disease was interviewed and had 12-lead electrocardiographic tracings performed. An emergency physician (physician 1) and a cardiologist (physician 2) read the tracings while blinded to patient history, age, and race. When the physicians disagreed, another physician adjudicated the diagnosis.
RESULTS: Four hundred fourteen subjects (127 black, 175 Hispanic, and 112 Caucasian) were enrolled. Overall, 154 tracings (37%) were normal, 245 (59%) were abnormal but nondiagnostic for ischemia, and 15 (4%) were consistent with ischemia. Frequencies of repolarization "abnormalities" as determined by physicians 1 and 2, respectively, were: blacks, 32%, 51%; Hispanics, 26%, 35%; Caucasians, 17%, 27%; chi-squared, p = 0.02 and 0.0004. Patients with ischemic electrocardiograms according to physician 1 had a high frequency of repolarization "abnormalities" according to physician 2, and vice versa (100%, 61%). Electrocardiographic criteria for thrombolytic use per physician 2 were present in 31 patients (7%): blacks, 9%; Hispanics, 10%; and Caucasians, 2%; chi-squared, p = 0.03.
Volume
1
Issue
2
First Page
94
Last Page
102
ISSN
1069-6563
Published In/Presented At
Hollander, J. E., Lozano, M., Jr, Goldstein, E., Gennis, P., Slater, W., Fairweather, P., Thode, H. C., & Gallagher, E. J. (1994). Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed?. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1(2), 94–102. https://doi.org/10.1111/j.1553-2712.1994.tb02729.x
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
7621192
Department(s)
Administration and Leadership
Document Type
Article