Letters

Patients from coronary care units should be given their electrocardiograms and carry them at all times

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7096.1764b (Published 14 June 1997) Cite this as: BMJ 1997;314:1764
  1. Sandeep Varma, Senior house officer in general medicinea,
  2. G Adrian Large, Senior house officer in general medicinea
  1. a Princess of Wales Hospital, Bridgend, Mid Glamorgan CP31 1RQ

    Editor—Our experience with patients admitted with acute chest pain leads us to propose that coronary care units should issue each patient with their electrocardiogram before discharge.

    Commonly, patients given thrombolysis are given a thrombolysis card to carry. Possession of an electrocardiogram recorded on the last day of the most recent admission would also be of enormous benefit on any readmission. Often an admitting physician is presented with a patient with prolonged chest pain, a history of ischaemic heart disease and previous myocardial infarction, and suspicious but equivocal electrocardiographic changes. At other times the history is atypical but an electrocardiogram is suggestive of infarction. Often deciding whether chest pains are due to unstable angina or infarction is difficult. Early thrombolysis is of unequivocal benefit in acute myocardial infarction but is not without its risks. A previous electrocardiogram is useful in deciding whether any aberrations such as left bundle branch block or persistent or borderline ST elevation are long standing or due to recent changes. In most emergency admissions previous notes are not available, thereby precluding an early conclusion. Comparison of an old electrocardiogram with a recent one can help to clinch the diagnosis and assist management decisions.

    We recommend that all patients admitted to coronary care units should be issued with and strongly urged to carry their electrocardiogram at all times. Judgments on their diagnosis will be reached sooner, they will be more likely to receive optimum treatment, and unnecessary administration of thrombolysis with its attendant risks will be avoided. As a spinoff, money will be saved.

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