A single normal or non-diagnostic ECG does not exclude an evolving infarct. If pain continues, changes character or returns, repeat the tracing within 15 to 30 minutes, and compare it with the earlier one. Add posterior leads (V7 to V9) when there is ST depression in the anterior leads with a dominant R wave, because a posterior infarct can look like that.
Write the time of each ECG on the tracing, so the sequence is clear to whoever takes over.
- Repeat the ECG when pain persists, changes or recurs, and compare each tracing with the last
- Consider posterior leads (V7 to V9) when anterior ST depression is present
- Write the time on every tracing
- A normal first ECG and a normal first troponin do not close the question in ongoing pain
Why it matters
The first tracing is often the least informative one.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for cardiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free