2 It seems clear that nonspecific ECG changes are not necessarily benign. Individuals with chest pain and nonspecific ECG changes also had higher rates of positive exercise stress tests and stent placement (though not statistically significant). Patients who presented to the emergency department with chest pain and had nonspecific changes on ECG (e.g., nonspecific ST segment, T-wave, or Q-wave findings) were ultimately transferred from the observation unit to the inpatient unit at higher rates than those without such ECG changes. NSST-T wave changes may be seen on a computer-generated ECG interpretation. To speak intelligibly about NSST-T wave changes with patients, first get a firm handle on what these changes may indicate or suggest. NSST-T WAVE CHANGES: PERHAPS NOT SO REASSURING While technically accurate, the latter approach will probably be ineffective because the clinician has used complex language that is unlikely to be clearly understood by most patients. Therefore, additional testing is necessary to assess for other possible problems.Ĭontrast this approach with telling a patient, “While your ECG showed no signs of acute MI, there is a myriad of other diagnostic possibilities, some more serious than others, that make additional work-up necessary to rule out medical conditions such as electrolyte abnormalities, cardiomyopathy, or pulmonary embolism.” In the case of an individual with NSST-T wave changes on ECG, although the diagnostic possibilities may be extensive, the provider should attempt to explain to the patient that the heart tracing did not show clear signs of serious heart damage (like a heart attack), but that the tracing was not normal either. It is the clinician’s obligation to explain important medical knowledge and information to the patient in terms the average layperson can reasonably be expected to understand. In addition, the clinician must be sensitive to the fact that most patients have little or no medical background, may have limited education, or may not speak English as a primary language. The goal should be to facilitate communication and improve patient comprehension.Ī clinician must effectively convey the essence or spirit of the medical concerns to his or her patients. One way to meet these challenges is to acknowledge that patients do not always hear the messages and information delivered by clinicians as intended.įor example, the clinician may tell a patient with NSST-T wave changes, “While your ECG was abnormal, there were no signs of acute MI.” The patient may interpret this message as, “I did not have a heart attack! Thank goodness I’m okay.” Better and more accurate communication is critical in this situation and can be provided by avoiding complicated or confusing medical jargon. Unfortunately, such diagnostic clarity and reassurance may prove more elusive in other patients whose ECG may be abnormal (i.e., NSST-T wave changes) but not classic or specific for such conditions as ischemia, infarction, or pericarditis.The challenge in such cases is twofold: (1) to determine the actual significance of the NSST-T wave changes in symptomatic patients and (2) to convey these concerns clearly and understandably to patients who might be from culturally and educationally diverse backgrounds.
Although obviously concerning, these positive ECG findings can be reassuring regarding clarity of diagnosis, necessary interventions, or the need for specialty consultations. For some patients, specific ECG abnormalities are present that indicate or strongly suggest ischemic heart disease or acute MI.
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