key: cord-1009592-1fwos0fi
authors: Pranata, Raymond; Tondas, Alexander Edo; Huang, Ian; Lim, Michael Anthonius; Siswanto, Bambang Budi; Meyer, Markus; Mitrovic, Veselin
title: Potential role of telemedicine in solving ST-segment elevation dilemmas in remote areas during the COVID-19 pandemic
date: 2020-06-06
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.06.012
sha: 11167a298d2128d41378cc325856068fa19be17b
doc_id: 1009592
cord_uid: 1fwos0fi

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identifiable culprit lesions and 0 out of 9 patients without culprit lesions. 10 Hence, echocardiography is a potential tool to rule out true STEMI; nevertheless, a larger sample size is needed and additional parameters may be required to increase its sensitivity.

Moreover, echocardiography seems to be a promising diagnostic noninvasive tool to detect coronary artery abnormalities, 12 especially in this era where Kawasaki-like disease in the pediatric population has been reported. 13 However, echocardiography is more difficult to operate and limited in availability compared to ECG so a possible solution may be remote echocardiography. A study in Brazil indicated that echocardiography with remote interpretation is feasible. The authors trained non-physicians to aid in performing echocardiography, which was then transmitted to the experts. The program has been shown to improve early diagnosis and referral. 14 To add a "layer" to tele-ECG and risk factorbased considerations, tele-echocardiography can be performed to increase the accuracy and distinguish whether patients are at a high probability of true STEMI, COVID-19 myocarditis, or cardiac injury to guide efficient treatment and patient transfer. The development of a more complex scoring system or artificial intelligence 15 

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