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Successful intravenous thrombolytic therapy early in myocardial infraction has the potential to reduce patient mortality without the additional risk and cost of aggressive invasive therapy. Noninvasive detection of successful reperfusion using resolution of chest pain, ST-segment changes assessed on static electrocardiograms, arrhythmia evolution, early isoenzyme peaking or changes in ventricular perfusion or function has been hampered by poor sensitivity or specificity, or inability to provide timely information. A newly available portable programmable microprocessor-driven real-time 12-lead electrocardiographic monitor has been introduced that may address these limitations. A continuously updated precise digital record of ST-segment activity at the bedside provides valuable information both in monitoring patients during reperfusion therapy to determine the efficacy of such treatment and in the subsequent hours to signal threatened reocclusion. This report describes the salient features of the monitor and presents 4 distinct situations in which the monitor detected timely information regarding coronary patency after reperfusion.