Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed?

J. E. Hollander, M. Lozano, E. Goldstein, P. Gennis, W. Slater, P. Fairweather, H. C. Thode, E. John Gallagher

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: The evaluation of chest pain in young adults has changed with the recognition of cocaine-induced myocardial ischemia. The high frequency of abnormal electrocardiograms (56-84%) in the cocaine-user population is largely due to "normal" electrocardiographic variants (early repolarization). The authors sought to determine the frequency of these "normal" variants in a young population, and whether these findings can be confused with acute ischemia. METHODS: A prospective convenience sample of subjects aged 18 to 35 without known heart disease was interviewed and had 12-lead electrocardiographic tracings performed. An emergency physician (physician 1) and a cardiologist (physician 2) read the tracings while blinded to patient history, age, and race. When the physicians disagreed, another physician adjudicated the diagnosis. RESULTS: Four hundred fourteen subjects (127 black, 175 Hispanic, and 112 Caucasian) were enrolled. Overall, 154 tracings (37%) were normal, 245 (59%) were abnormal but nondiagnostic for ischemia, and 15 (4%) were consistent with ischemia. Frequencies of repolarization "abnormalities" as determined by physicians 1 and 2, respectively, were: blacks, 32%, 51%; Hispanics, 26%, 35%; Caucasians, 17%, 27%; chi-squared, p = 0.02 and 0.0004. Patients with ischemic electrocardiograms according to physician 1 had a high frequency of repolarization "abnormalities" according to physician 2, and vice versa (100%, 61%). Electrocardiographic criteria for thrombolytic use per physician 2 were present in 31 patients (7%): blacks, 9%; Hispanics, 10%; and Caucasians, 2%; chi-squared, p = 0.03.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
JournalAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine
Volume1
Issue number2
StatePublished - Mar 1994

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Young Adult
Electrocardiography
Physicians
Hispanic Americans
Ischemia
Cocaine
Chest Pain
Population
Myocardial Ischemia
Heart Diseases
Emergencies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Variations in the electrocardiograms of young adults : are revised criteria for thrombolysis needed? / Hollander, J. E.; Lozano, M.; Goldstein, E.; Gennis, P.; Slater, W.; Fairweather, P.; Thode, H. C.; Gallagher, E. John.

In: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Vol. 1, No. 2, 03.1994, p. 94-102.

Research output: Contribution to journalArticle

Hollander, J. E. ; Lozano, M. ; Goldstein, E. ; Gennis, P. ; Slater, W. ; Fairweather, P. ; Thode, H. C. ; Gallagher, E. John. / Variations in the electrocardiograms of young adults : are revised criteria for thrombolysis needed?. In: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1994 ; Vol. 1, No. 2. pp. 94-102.
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title = "Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed?",
abstract = "OBJECTIVE: The evaluation of chest pain in young adults has changed with the recognition of cocaine-induced myocardial ischemia. The high frequency of abnormal electrocardiograms (56-84{\%}) in the cocaine-user population is largely due to {"}normal{"} electrocardiographic variants (early repolarization). The authors sought to determine the frequency of these {"}normal{"} variants in a young population, and whether these findings can be confused with acute ischemia. METHODS: A prospective convenience sample of subjects aged 18 to 35 without known heart disease was interviewed and had 12-lead electrocardiographic tracings performed. An emergency physician (physician 1) and a cardiologist (physician 2) read the tracings while blinded to patient history, age, and race. When the physicians disagreed, another physician adjudicated the diagnosis. RESULTS: Four hundred fourteen subjects (127 black, 175 Hispanic, and 112 Caucasian) were enrolled. Overall, 154 tracings (37{\%}) were normal, 245 (59{\%}) were abnormal but nondiagnostic for ischemia, and 15 (4{\%}) were consistent with ischemia. Frequencies of repolarization {"}abnormalities{"} as determined by physicians 1 and 2, respectively, were: blacks, 32{\%}, 51{\%}; Hispanics, 26{\%}, 35{\%}; Caucasians, 17{\%}, 27{\%}; chi-squared, p = 0.02 and 0.0004. Patients with ischemic electrocardiograms according to physician 1 had a high frequency of repolarization {"}abnormalities{"} according to physician 2, and vice versa (100{\%}, 61{\%}). Electrocardiographic criteria for thrombolytic use per physician 2 were present in 31 patients (7{\%}): blacks, 9{\%}; Hispanics, 10{\%}; and Caucasians, 2{\%}; chi-squared, p = 0.03.",
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