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Case report

The value of monitoring a second precordial lead for patients in a telemetry unit

By Barbara J. Drew, RN, PhD, FAAN

A 62-year-old with a history of stable angina pectoris is admitted to a telemetry unit because of recent episodes of acute shortness of breath and near syncope. The cardiologist thinks the symptoms may be due to an arrhythmia or episodes of acute myocardial ischemia. A previous cardiac catheterization showed stenotic lesions in the left anterior descending (LAD) coronary artery that were too diffused to treat with coronary angioplasty or stenting. The patient was considering coronary artery bypass surgery when his symptoms developed.

The goal of monitoring this patient is to document any arrhythmias or acute myocardial ischemia episodes and to correlate these ECG changes with his symptoms. Using this case example, the author makes the argument that there is a need for a telemetry system that enables monitoring of two precordial leads (e.g., V1 and V3) so that both goals of monitoring – arrhythmias and ischemia – can be achieved instead of just one or the other.

The author also recommends the optimal leads for cardiac monitoring for arrhythmia and ischemia monitoring under a variety of clinical scenarios.

Barbara J. Drew, RN, PhD, FAAN, is a Professor at the University of California San Francisco, where she teaches cardiovascular and critical care nursing in the master of science and doctoral programs and conducts research related to cardiac electrocardiology and cardiac monitoring.

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