Serial electrocardiography in the ER

Acute coronary syndrome is a fluctuating process usually caused by an unstable plaque which is in a dynamic state of clot formation and lysis. This, combined with variable artery spasm may cause total occlusion alternating with recanalization. Accordingly, the electrocardiogram may fluctuate frequently in the early period of ACS. The authors of a paper in the American Journal of Emergency Medicine make a case for serial electrocardiograms during the patient’s ER workup, sometimes at intervals as short as 5 minutes, to enhance the sensitivity of detection of ACS.