Any trigger for notifying the health care provider depends on the patient, as well as the expectations for a given setting. Patients vary in their responses to arrhythmias. A consistent message is that any hemodynamically unstable patient should have continuous electrocardiographic (ECG) monitoring. Each unit should consider having preset default heart rate parameters to guide provider notification. These decisions are based on discussion with all stakeholders, including providers and nurses.

Consider why your patient may have an elevated cardiac troponin level and no chest pain. Does the patient have neuropathy and, therefore, may not sense angina? Is the patient unable to communicate because of impaired mental status, a language barrier, intubation, or sedation? If the answer to any of these questions is yes, your patient may benefit from continuous ST-segment monitoring. The current highest recommendation for continuous ST-segment monitoring is a IIa (ie,...

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