Clinical research consistently confirms the early detection of myocardial infarction is crucial in preserving viable myocardium. Occasionally the initial electrocardiogram may fail to show the typical diagnostic warnings leading to an erroneous diagnosis of “normal.” The overlooked MI can be avoided by recognizing the less-obvious signs of infarct, initiating continuous ST segment and the use of alternative leads when indicated.

This lecture begins with a brief review of the pathophysiology of acute coronary syndromes and the current AHA/ACC guidelines. Detailed discussion will outline subtle changes that may be seen during the earliest stages of infarction. Attendees will be provided with the principles of continuous ST segment monitoring as well as indications for using alternative leads for monitoring remote areas of the myocardium. Case studies will be included to facilitate critical thinking skills.