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Sir,—I hate to write a letter to the editor commenting on another letter to the editor, but I wish to comment not only on the remarks made by Hooghoudt and colleagues1 but also on the two original articles,2 ,3 which escaped my notice when first published.
Fax machines truly contribute to better patient care, not only in decisions regarding thrombolysis but also in other common clinical situations. On many occasions we see patients in the emergency department with chest pain and electrocardiographic abnormalities including Q waves and ST changes. But these changes could be “old”, representing previous myocardial infarction or ventricular aneurysm rather than something acute. In the absence of a previous ECG, the usual plan would be to admit the patient to the coronary care unit, put the patient on a monitor, repeat the electrocardiography at frequent intervals, and draw serial blood samples for myocardial enzyme determinations to rule out an acute myocardial infarction. However, if we could see the previous ECGs with the old Q waves and/or ST changes for comparison, all these unnecessary and costly tests could be avoided.
Another clinical situation where a knowledge of any previous ECG abnormality would be critical in decision making is atrial fibrillation. Patients with chronic atrial fibrillation and well controlled ventricular rate often do not experience any cardiac irregularity or palpitation. Thus, when such a patient is seen for the first time with complaint of palpitation and is found to be in atrial fibrillation, one assumes the atrial fibrillation to be acute in onset. The differentiation between acute and chronic atrial fibrillation is particularly important if one is thinking about cardioversion without preceding anticoagulation. This problem could be easily and promptly resolved if the patient’s previous ECG is made available for comparison. Therefore, the immediate availability of a previous ECG4-6 is extremely relevant, whether for consultation, comparison or confirmation, in most clinical situations. Fax machines can now accomplish this whether across town or around the world. They can really influence the way we practice medicine. As the Chinese saying goes, one picture is better than a thousand words. This is certainly true in the case of comparing ECGs.