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American Journal of Critical Care. 2003;12: 9-16
Copyright © 2003 by the American Association of Critical-Care Nurses.
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CE Article

Factors to Consider When Analyzing 12-Lead Electrocardiograms for Evidence of Acute Myocardial Ischemia

By Mary G. Adams-Hamoda, RN, PhD, Mary A. Caldwell, RN, PhD, Nancy A. Stotts, RN, PhD and Barbara J. Drew, RN, PhD. From the University of California, San Francisco, Calif.

An important factor to consider when using findings on electrocardiograms for clinical decision making is that the waveforms are influenced by normal physiological and technical factors as well as by pathophysiological factors. Traditionally, the focus of bedside monitoring is detection of arrhythmia. However, continuous ST-segment monitoring for the detection of myocardial ischemia is now readily available. Many factors affect electrocardiographic waveforms and may interfere with diagnosis of myocardial ischemia based on electrocardiographic findings. Accordingly, a principal leadership role for clinical nurse specialists and nurse practitioners is to become knowledgeable about interpretation of 12-lead electrocardiograms and to share this knowledge with staff nurses who care for patients with acute coronary syndromes. The factors that alter electrocardiographic findings are reviewed, and the alterations that interfere with electrocardiogram-based diagnosis of myocardial ischemia are discussed.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  • Discuss physiological factors that can affect electrocardiogram (ECG) waveforms
  • Identify sources of pathophysiological influences on ECG waveforms
  • Describe technical effects that can occur on ECG waveforms




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S. Bresnahan and J.-A. Eastwood
Confounding T-Wave Inversion
Am. J. Crit. Care., March 1, 2007; 16(2): 137 - 140.
[Abstract] [Full Text] [PDF]


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