Detecting Transient Myocardial Ischemia in the Context of Acute Coronary Syndrome in the Emergency Department Delta Map Analysis of Body Electrocardiographic Surface Mapping

Diagnosing regional myocardial ischemia (TRMI) remains a challenge in patients presenting with acute chest pain. It is well recognized that early definitive clinical diagnosis can be difficult. Tests including the 12-lead ECG and troponin levels improve diagnostic certainty, but many patients present to the emergency department with acute chest pain too early for a reliable troponin result and show no acute change in ECG. The 12-lead ECG, though undoubtedly useful, provides information only from a limited window of body surface electric activity. Thus it has well-described limitations in the diagnosis of (1) right ventricular and/or posterior infarction, (2) transient myocardial ischemia, and (3) patients with left bundle-branch block. Given the clear-cut evidence of outcome benefit for both aggressive early pharmacological and revascularization treatment in acute coronary syndromes, novel techniques for reliable detection of such patients are potentially of substantial clinical value. Body surface mapping (BSM) is an electrocardiographic technique that uses multiple anterior and posterior thoracic