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Abstract
The National Service Framework for Coronary Heart Disease provides guidance on important aspects of therapy that may make a substantial difference to patient care (Department of Health (DoH), 2001). It highlights the need to identify and fast-track patients with an acute coronary syndrome so that thrombolysis or appropriate interventional care can take place as soon as possible, to optimize myocardial salvage and reduce door-to-needle time (DoH, 2001; Castle, 2002). It is therefore extremely important that nurses in acute clinical areas are able to record and interpret 12-lead electrocardiograms so that the treatment modality can be initiated as soon as possible, leading to better clinical outcomes for this patient group. Although nurses work within a healthcare team, it is often the nurse who initially assesses, implements and coordinates care for patients with chest pain, be it in the emergency department, cardiac unit, general ward setting or general practice.
Nurses are encouraged to develop evidence-based holistic care in line with service developments, where patient assessment is the key to determining which intervention or treatment may be required (Docherty, 2001a; Department of Health (DoH), 2002).
Acute coronary syndrome is a relatively new term for a group of conditions presenting with chest pain and related symptoms (Castle, 2002). This group includes:
* Full wall (transmural) myocardial infarction (MI) - now termed ST elevation MI (STEMI)
* Partial wall (subendocardial or non-Q wave) MI - now termed non-ST segment elevation MI (NSTEMI)
* High-risk unstable angina
* Chest pain patients who may benefit from early 12-lead electrocardiogram (ECG) interpretation to assist with diagnosis and ensuing management (Castle, 2002; Hughes, 2003).
The DoH has recently recommended that healthcare practitioners should review job roles, responsibilities and the infrastructure of the organization in which they work. The aim is to ensure that the health service is staffed by flexible professionals working in a way that benefits patient care, and may even exceed patient expectations (DoH, 2002). The National Service Framework for Coronary Heart Disease has set key standards for health professionals to achieve. Standards 5, 6 and 7 (Table 1) relate directly to 12-lead ECG recording and interpretation.
This article, the first of a two-part series, describes and demonstrates some of the core aspects of 12-lead ECG recording and analysis as...