What are the criteria for using ECG in the workup of suspected myocardial infarction (MI, heart attack), and how often should it be performed?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

ECGs should be performed serially upon presentation to evaluate progression and assess changes with and without pain. 

Because the symptoms of acute MI can be subtle, an ECG should be performed on any patient who is older than age 45 years and is experiencing any form of thoracoabdominal discomfort, including new epigastric pain or nausea.

In younger patients, an ECG should be considered when suggestive symptoms are present or when risk factors exist for early coronary artery disease. Younger patients are disproportionately represented in missed cases. An ECG is a rapid, low-risk, relatively low-cost measure.


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