The Electrocardiogram in Acute Myocardial Infarction
Ian P. Clements. 260 pp. New York, NY: Futura Publishing Company, Inc; 1998. $65.00. ISBN 0-87993-693-2.
As a cardiology fellow 2 decades ago, I was told by an otherwise highly prescient mentor that by century’s end, the ECG would end up in the archival display cases at the Smithsonian as an honored but outmoded bedside clinical test. Word of the demise of the 12-lead ECG, however, has proved premature. Indeed, at the close of the millennium, this inexpensive and versatile test has been reinvigorated, perhaps most importantly by the advent of thrombolysis and acute angioplasty in the treatment of myocardial infarction (MI). The success of these remarkable interventions relies on the accurate diagnosis of more subtle and atypical presentations of acute ischemia, as well as in the exclusion of its simulators, including acute pericarditis and normal variant “early repolarization.”
Dr Ian P. Clements has edited a useful but limited monograph on selected aspects of the ECG in acute MI. There are 16 chapters in all, about half of which deal with new or investigational extensions of ECG diagnoses in this area, including continuous multilead ST-segment monitoring, contemporary vectorcardiography, precordial ECG mapping, heart rate variability, single averaged ECG, QT dispersion analysis, high-frequency electrocardiography, and variance electrocardiography, as well as conventional heart rate variability analysis. At the all-but-certain risk of being as maladroit at forecasting as my beloved mentor, I will predict that few of these modalities will find a secure clinical niche in the next decade, with the notable exceptions of detection of repolarization alternans and assessment of complex heart rate dynamics.
Additional chapters deal with limitations in the 12-lead ECG, prognostic indicators, atypical ECG patterns, triage decisions based on acute ECG findings, and correlation of the 12-lead ECG with coronary artery anatomy and prognosis. The final chapter deals with ECG features of infarct-related regional pericarditis, calling attention to some important but not widely recognized findings.
Overall, the material covered is concisely presented. Proponents of electronic publication will note that most of the references are from 1996 or earlier, so that readers wishing for an update will have to do their own Medline search rather than awaiting serial CD-ROM–type updates provided by the authors. The selective nature of this volume is evidenced by topics that receive brief or no attention. The important differential diagnosis of ST-segment elevations is mentioned in passing, as is the pathophysiology of the injury current itself. There is no discussion of non–Q-wave versus Q-wave infarcts or of the increasingly important problem of recognizing acute MI in the presence of ventricular pacing. Arrhythmias associated with acute ischemia and reperfusion also fall outside the scope of this text. Tighter editing would have been helpful in interlacing the discussions by different authors in different chapters and avoiding overlapping or parallel discussions, such as those related to prognosis and infarct localization. Because of the saltatory sequencing of topics, as well as the lack of tutorial-type presentations, this volume likely will not be as appealing to cardiology trainees or practicing physicians as its title might lead them to believe.
- Copyright © 1999 by American Heart Association