At the present time, when confronted with the problem of chest pain that is considered to be cardiac in origin, the physician regards the electrocardiogram as the final test in deciding if acute myocardial infarction has occurred. Too often, when the clinical diagnosis is suspected, the early electrocardiograms may be interpreted as normal or, if abnormal, may lack the features usually considered diagnostic of recent myocardial injury. When this happens, the unsuspecting physician, reassured by the negative electrocardiographic report, may fail to obtain serial tracings or he may even begin to look elsewhere for a diagnosis.1 In this way the patient may be denied adequate therapy, including complete rest and anticoagulants for his heart attack.
In addition to the fact that early electrocardiograms may not show evidence of recent myocardial injury, certain additional difficulties arise in the electrocardiographic diagnosis of recent myocardial infarction. These include the fact that a
Krause S, Krause G. SERUM GLUTAMIC OXALACETIC AMINOPHERASE (TRANSAMINASE) DETERMINATIONS: VALUE IN THE DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN THE PRESENCE OF LEFT BUNDLE-BRANCH BLOCK. JAMA. 1956;161(2):144–147. doi:10.1001/jama.1956.62970020001006
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