Erratum

Article Outline

• Myocardial Infarction
• Copyright

In the December 2005 issue, there was an error in the article “Managing the grandparent with chest pain: advice for emergency pediatricians” by Lynn Williams, BA, MBBCh, FRCS (Ed), FFAEM, and Martin Culshaw, MBChB, MRCP (UK), FFAEMy.

On p 223, under “Myocardial Infarction” the text erroneously reported 1 mm in 2 leads instead of 2 mm in 2 leads. The correct paragraph and Figure 1 are below.

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• Figure 1. 

  Anterior myocardial infarction. ST-segment elevation of greater than 2 mm in leads I, aVL, and V_1-4, with reciprocal changes in leads a and aVF.

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Myocardial Infarction 

This is a common cause of adult chest pain. One in 6 adult patients with chest pain has a myocardial infarction, and the risk is higher in elderly patients [2]. The emergency pediatrician does not need to be an expert in ECG interpretation to pursue this diagnosis. Up to 50% of patients with a myocardial infarction do not have diagnostic changes on the initial ECG; thus, distinguishing between a diagnosis of unstable angina and a myocardial infarction is difficult. Serial ECGs over several hours may show the evolution of ST-segment changes diagnostic of myocardial infarction. The presence of ST-segment changes, including ST elevation greater than 2 mm in 2 leads (Figure 1), mandates rapid transfer to an adult facility for early fibrinolytic therapy, ideally within 6 hours of the onset of pain. Similarly, left bundle-branch block (Figure 2) may be new and result from myocardial infarction.