ECG changes could signal something other than a heart attack, nursing alumni team finds

Six nurse practitioners (NP) who run the cardiac care unit (CCU) at Rockyview General Hospital have teamed up on a research paper, recently published in the Journal for Nurse Practitioners, intended to inform clinical decision-making.  

Five of the six are University of Calgary alumni from the Faculty of Nursing, and all are excited about lifelong learning to improve their practice.

This paper looks at two situations in which patients presented with a concerning change on their electrocardiogram (ECG) test results, that are usually associated with blocked arteries and can lead to a heart attack — but in these cases was caused by something else.

“We wanted to dig into some complex situations in cardiology that health-care providers might come across,” says NP Jessica Jenkins, MN’17, MDip’16, who is first author of the paper and has more than a dozen publications under her belt. “When you see these ECG changes, you have to be cognizant that there are several potential causes.”

Recent revisions to the STEMI (ST-segment elevation myocardial infarction) Guidelines, put out by the American College of Cardiology and the American Heart Association, state that a VR ST segment elevation signals that patients are having a heart attack and should be sent directly to the cardiac catherization lab to have blockages removed from their arteries. But sometimes, the elevations are caused by things like critical illness, stroke, shock, sepsis, and respiratory failure.

Jenkins, who recently began working at the Peter Lougheed Centre, says she hopes the paper will help health-care providers make decisions in the clinic.

According to NP Nancy Clark, MN’03, who leads the Critical Care Unit at Rockyview Hospital, the paper was the first for several of the NPs involved in the publication, making it extra special for the team.

“I am proud of the commitment the team made to this process,” says Clark, explaining the team volunteered their time to write the paper. “It speaks to the complexity of the diagnostic process and that we gain valuable insight within our clinical practice.”

Both Jenkins and Clark have been involved in publishing several papers. For Jenkins, research is a priority.

“Participating in research as an NP helps to disseminate knowledge to other NPs and other specialties and helps me really grow in my practice,” she says, noting "Oftentimes, participating in research offers the opportunity to collaborate in a different way with colleagues, including physicians, and we learn a great deal from each other."

Jenkins is currently researching the integration of palliative and advance care planning for congenital heart patients, who are at risk of premature death.

Dr. Paul Fedak, MD, PhD, director of the Libin Cardiovascular Institute, is pleased with the team’s work. 

“The Libin Cardiovascular Institute is focused on collaboration and innovation, and we are proud of the commitment of the nurse practitioners in our cardiac units,” he says. “Their commitment to working together to further research and create positive changes for our patients is exemplary.”

NPs are graduate-prepared leaders who are integral members of an interdisciplinary health-care team. The diagnostic and prescriptive authority that NPs bring to the team supports the clinical needs of Albertans in both in-patient and out-patient settings. Leaders within their environments, they mentor and train their nurse colleagues and many, including this team, take part in academic research and training.  

The team at the Rockyview Hospital is the first NP-led cardiac unit in Alberta. The innovation provides consistent, 24-hour support for patients. 

NPs working in hospital cardiac units in Calgary are affiliated with the Faculty of Nursing and the Cumming School of Medicine’s Libin Cardiovascular Institute through the Department of Cardiac Sciences.