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Obtaining an electrocardiogram (ECG) is the gold standard for initial diagnostics of atraumatic chest pain. To provide optimal patient care, the treating physician has to be proficient in recognizing early signs of myocardial ischemia. Information from the clinical assessment and typical ECG signs have to be recognized promptly in order to diagnose myocardial ischemia early.A selective literature search in international databases (PubMed, Cochrane Library, Google Scholar) was conducted; current, topic-specific websites and literature were also included and evaluated.Several subtle ECG abnormalities exist besides the typical ST-elevation myocardial infarction (STEMI) and well-known STEMI equivalents and may point to possible myocardial ischemia.To fully evaluate the ECG in patients with atraumatic chest pain, typical signs of ischemia like STEMI as well as subtle ECG signs should be recognized to allow early cardiac intervention.HINTERGRUND: Das Elektrokardiogramm (EKG) stellt den Goldstandard für die initiale Diagnostik des atraumatischen Thoraxschmerzes dar. Für eine optimale Versorgung des Patienten ist dabei eine umfassende Expertise des Behandlers im Erkennen von Frühzeichen einer Myokardischämie essenziell. Um frühzeitig eine Myokardischämie zu erkennen, müssen neben einer klinischen Beurteilung auch typische EKG-Veränderungen umgehend erkannt werden.Es wurde eine selektive Literaturrecherche in internationalen Datenbanken (PubMed [US National Library of Medicine, Bethesda, MD, USA], Cochrane Library [Wiley, Hoboken, NJ, USA], Google Scholar [Google, Mountain View, CA, USA]) sowie Auswertung und Durchsicht themenspezifischer Webseiten und Fachbüchern durchgeführt.Neben klassischen Kriterien des ST-Hebungs-Infarkts (STEMI) sowie von STEMI-Äquivalenten existieren weitere, subtilere EKG-Veränderungen, die auf eine Myokardischämie hinweisen können.Für eine adäquate Beurteilung des EKG im Zusammenhang mit atraumatischem Thoraxschmerz müssen neben klassischen Ischämiezeichen wie dem STEMI auch subtile Hinweise erkannt werden, um den Patienten schnellstmöglich einer notwendigen Koronarintervention zuzuführen.

We present a case of successful interventional laser-assisted extraction of an endovascularly trapped long-term implanted ventriculoatrial shunt in a patient with shunt-associated septicemia. This approach is based on modified techniques for explantation of pacemaker leads and might be considered an additional option for extraction of otherwise nonremovable trapped endovascular catheters in experienced centers.

A 9-year-old girl presented with systemic infection related to a Port-a-Cath system (PAC); therefore, the urgent removal of the PAC was indicated. However, the catheter was trapped and not extractable by conventional means. Using existing comprehensive experience in the removal of pacemaker and implantable cardioverter defibrillator leads, the entrapped PAC was successfully extracted by laser technique, thus avoiding open heart surgery.