The identification of acute coronary syndrome continues to challenge even experienced clinicians. Emergency physicians have the responsibility to identify, treat and admit those patients with true acute coronary syndrome to the appropriate units. This article described a case of acute coronary syndrome that developed in the observation ward, with discussion on some recent reviews of standard electrocardiogram analysis. It is very important to point out that controversy over the measurement of ST elevation exists which may adversely affect patient management.
Introduction The main feature of the male pattern in electrocardiograms (ECG) is ST-elevation at the J-point of >0.1 mV in at least one of the leads V1–4 with concave upward ST-segments. The prevalence of the male pattern in ECG of healthy male foreigners who were 16–58 years old (mostly Caucasians or Blacks) was high (85%). These ST-segment elevations may meet the ECG criteria for fibrinolytic therapy according to the present guidelines for the treatment of ST-elevation myocardial infarction (STEMI), thus resulting in potentially inappropriate management. Clinicians should be aware of this common phenomenon. As yet, the prevalence of the male pattern in healthy Chinese adult males has not been studied specifically. Materials and methods Standard 12-lead ECG from 202 apparently healthy Chinese adult males (aged 20–54) were collected and analysed. Results The prevalence of the male pattern was 95.5% in our 202 samples (p<0.05). Of these samples of male patterns, 97.4% might have met the ECG criteria for fibrinolytic therapy according to the guidelines of the American College of Cardiology and American Heart Association (2004); but if we followed the guidelines of the European Society of Cardiology (2003), only 21.8% met the criteria. Conclusions The prevalence of the male pattern in ECG of healthy Chinese adult males in Hong Kong is high. Clinicians should be more cautious while managing patients with possible acute coronary syndrome to avoid over-diagnosis of STEMI. It seems the European guidelines are safer to follow as regard to the prescription of fibrinolytics for STEMI, especially for junior doctors.
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