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| 3. |
- Pahlm, Ulrika, et al.
(författare)
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Comparison of teaching the basic electrocardiographic concept of frontal plane QRS axis using the classical versus the orderly electrocardiogram limb lead displays
- 1997
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Ingår i: American Heart Journal. - 1097-6744. ; 134:6, s. 1014-1018
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Tidskriftsartikel (refereegranskat)abstract
- This study compares the effectiveness of teaching the calculation of frontal plane QRS axis with the use of the classical versus the orderly electrocardiographic limb lead display. Eighty-three students from two environments were randomized into two groups and were taught to determine frontal plane axis with one of the methods. The accuracy and time to determine the axis were tested on 10 electrocardiograms. In the United States the group using the classical display achieved 4.2 (+/-2.7) correct answers, whereas those using the orderly method achieved 6.8 (+/-3.0) (p = 0.0006). The classical group used 9.2 (+/-2.8) minutes to complete the test, whereas the orderly group needed 7.2 (+/-2.0) minutes (p = 0.015). The results achieved in Sweden were similar. The use of the orderly electrocardiographic limb lead display results in greater diagnostic accuracy in less time than the classical display when determining the frontal plane QRS axis.
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| 4. |
- Pahlm, Ulrika, et al.
(författare)
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The 24-lead ECG display for enhanced recognition of STEMI-equivalent patterns in the 12-lead ECG.
- 2014
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 47:4, s. 425-429
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Forskningsöversikt (refereegranskat)abstract
- In a patient with chest pain and suspected acute coronary syndrome, the electrocardiogram (ECG) is the only readily available diagnostic tool. It is important to maximize its usefulness to detect acute myocardial ischemia that may evolve to myocardial infarction unless the patient is treated expediently with reperfusion therapy. Since diagnostic guidelines have usually included only ST-elevation myocardial infarction (STEMI) as the entity that should be diagnosed and treated urgently, a patient with coronary occlusion represented on ECG as ST depression is likely not to be considered a candidate for receiving immediate coronary angiography and coronary intervention. ECG criteria for STEMI detection require that ST elevation meet predetermined millivolt thresholds and appear in at least two spatially contiguous ECG leads. The typical ECG reader recognizes only three contiguous pairs: aVL and I; II and aVF; aVF and III. However, viewing the "orderly sequenced" 12-lead ECG display, two more contiguous pairs become obvious in the frontal plane: +I and -aVR; -aVR and +II. The 24-lead ECG is a display of the standard 12-lead ECG as both the classical positive leads and their negative (inverted) counterparts. Leads +V1, +V2, +V3, +V4, +V5, and +V6 and their inverted counterparts are used to generate a "clock-face display" for the transverse plane. Similarly, +aVL, +I, -aVR, +II, +aVF, +III in the frontal plane and their inverted counterparts are used to generate a clock-face display for the frontal plane. Optimum results, 78% sensitivity and 93% specificity, were obtained using the following 19 ECG leads: frontal plane: +aVR, -III, +aVL, +I, -aVR, +II, +aVF, +III, -aVL; transverse plane: +V1, +V2, +V3, +V4, +V5, +V6, -V1, -V2, -V3.
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| 5. |
- Perron, Annick, et al.
(författare)
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Maximal increase in sensitivity with minimal loss of specificity for diagnosis of acute coronary occlusion achieved by sequentially adding leads from the 24-lead electrocardiogram to the orderly sequenced 12-lead electrocardiogram
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:6, s. 463-469
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180 degrees) orientation, generating a 24-lead ECG. Methods: The study population included 162 patients who underwent prolonged coronary occlusion during elective percutaneoas transluminal coronary angioplasty. Balloon occlusion was performed in the left anterior descending coronary artery (51 patients), in the right coronary artery (67 patients), or in the left circumflex coronary artery (44 patients). To be classified as indicative of the epicardial injury current of acute ischemia, the ECGs had to fulfill either the criteria of a consensus document from the American College of Cardiology or the European Society of Cardiology or thresholds for the inverted leads based on a population study from Scotland. Results: The addition of -V1, -V2, -V3, -aVL, -I, aVR, and -III increased sensitivity from 61% to 78% (P <= .01) and decreased specificity from 96% to 93% (P = .06). Conclusions: Addition of 7 leads from the 24-lead ECG, thus creating a 19-lead ECG, was found optimal for attaining high sensitivity while retaining high specificity when compared with the performance of the standard 12-lead ECG. (C) 2007 Elsevier Inc. All rights reserved.
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| 6. |
- Wagner, Galen S, et al.
(författare)
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Use of the 24-lead "standard" electrocardiogram to identify the site of acute coronary occlusion
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41:3, s. 238-244
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Tidskriftsartikel (refereegranskat)abstract
- This review presents the added value for diagnosis of acute ischemia/infarction of considering ST elevation in the 12 inverted leads (-I, -II, -II, -aVR, etc) of the standard electrocardiogram in addition to ST elevation in 12 positive leads. A small number of studies have been published showing substantial increases in sensitivity at the "cost of' slight decreases in specificity. One recent study indicated that only 7 of the inverted leads should be considered, yielding a "19-lead electrocardiogram" encompassing the following leads (presented here in the logical secquences): -III, aVL, I, -aVR, II, aVF, III, -aVL, -I, aVR; and V1, V2, V3, V4, V5, V6, -V1, -V2, -V3. Studies have to be performed to establish the thresholds that should be applied to these leads for achievement of sensitivity/specificity.
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| 7. |
- Lindqvist, A, et al.
(författare)
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Artery blood pressure oscillation after active standing up: an indicator of sympathetic function in diabetic patients
- 1997
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Ingår i: Clinical Physiology. - : Wiley. - 1365-2281 .- 0144-5979. ; 17:2, s. 159-169
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Tidskriftsartikel (refereegranskat)abstract
- Dynamic artery blood pressure (Finapres) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline (overshoot), was compared with the early steady-state artery blood pressure level to measure sympathetic vasomotor function in healthy subjects (n = 23, age 35 +/- 9 years; mean +/-SD) and in type I diabetic patients without autonomic neuropathy (AN) (group 1: n = 18, 38 +/- 13 years), with AN but no cardiovascular drugs (group 2a: n = 7, 44 +/- 11 years) and with both AN and cardiovascular drugs (group 2b: n = 10, 47 +/- 7 years). Systolic and diastolic overshoot were similar in the control (15 +/- 13/15 +/- 11 mmHg) and group 1 subjects. Systolic overshoot disappeared in 57% of patients in group 2a (-1 +/- 9 mmHg; P < 0.03), whereas artery blood pressure still overshot in diastole (8 +/- 7 mmHg; NS). Systolic overshoot disappeared in all patients in group 2b (-22 +/- 22 mmHg; P < 0.0006) and diastolic overshoot disappeared in 60% of these patients (-6 +/- 16 mmHg; P = 0.0006). Systolic early steady-state level was not lower in group 2a than in group 1 (NS), but it was impaired in group 2b (P < 0.006), in which six diabetic patients had a pathological response beyond the age-related reference values. There was a strong association between the overshoot and steady-state levels (P for chi 2 < 0.001, n = 58). Overshoot of the control subjects and patients in group 2b correlated to their respective steady-state blood pressure levels (r > or = 0.76; P < or = 0.001). In conclusion, baroreceptor reflex-dependent overshoot of the artery blood pressure after active standing up diminishes with the development of AN and it is associated with the early steady-state level of the artery blood pressure.
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| 8. |
- Torffvit, Ole, et al.
(författare)
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The association between diabetic nephropathy and autonomic nerve function in type 1 diabetic patients
- 1997
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - 1502-7686. ; 57:2, s. 183-191
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Tidskriftsartikel (refereegranskat)abstract
- Diabetic cardiovascular autonomic neuropathy increases the risk of deterioration in renal function and is associated with increased mortality in patients with renal failure. Type 1 diabetic patients with long diabetes duration, matched for age (38 +/- 9 years) and diabetes duration (28 +/- 8 years) were studied regarding the association between cardiovascular autonomic nerve function and different degrees of diabetic nephropathy. Eighteen patients were normo- (< 30 mg/l), six micro- (30-300 mg/l), and 13 macroalbuminuric (> 300 mg/l) based on urinary albumin concentrations in three separate morning samples. They were compared with 33 control subjects with similar age. Autonomic nerve function was evaluated by measuring the response of heart rate to deep breathing and active standing. Beat-to-beat finger artery blood pressure (Finapres) was tested during active standing. During deep breathing both change in heart rate (17 +/- 11, 9 +/- 7 and 4 +/- 3 beats/min) and ratio between expiratory and inspiratory R-R intervals (1.32 +/- 0.24, 1.14 +/- 0.15 and 1.05 +/- 0.04) decreased from normo- over micro- to macroalbuminuria (p < 0.05 vs normoalbuminuric and control subjects [17 +/- 5 beats/min and 1.28 +/- 0.10, respectively]). Similar results were obtained during active standing with respect to change in systolic arterial blood pressure (3 +/- 8, 2 +/- 13 and -6 +/- 11 mmHg; p < 0.05 vs control subjects [8 +/- 11 mmHg]). However, the response of diastolic arterial blood pressure or mean heart rate to standing up did not differ between any of the groups. The ratio of maximum to minimum R-R interval during the dynamic response of heart rate to active standing decreased with the degree of nephropathy (1.27 +/- 0.17, 1.11 +/- 0.11 and 1.05 +/- 0.06) with significantly higher values in patients with normo- compared with patients with macroalbuminuria (p < 0.05). All patients groups had significantly lower values than control subjects (1.46 +/- 0.22, p < 0.05). The overshoot of the blood pressure after an initial fall during active standing decreased with the degree of diabetic nephropathy. In conclusion, type 1 diabetic patients with long duration of diabetes have signs of cardiovascular autonomic neuropathy, the severity of which is related to the degree of nephropathy.
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| 9. |
- Lindgren, Arne, et al.
(författare)
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Electrocardiographic changes in stroke patients without primary heart disease
- 1994
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Ingår i: Clinical Physiology. - 1365-2281. ; 14:2, s. 223-231
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Tidskriftsartikel (refereegranskat)abstract
- Consecutive electrocardiograms were recorded in 28 stroke patients without signs of primary heart disease. Individuals with subarachnoidal haemorrhage, or electrolyte disturbances were excluded. A computerized tomography of the brain was performed in each case and showed a cerebral haemorrhage (n = 4), cortical infarction (n = 6), subcortical infarction (n = 14) and normal finding (n = 4). One patient developed atrial fibrillation but no other case of serious disturbances in rate of rhythm occurred. None developed AV block, bundle branch blocks or significant changes in QRS complexes. The most common abnormalities in ECG were transient STT changes in lateral leads, which were seen in 13 cases. The typical findings were flat or slightly negative T waves, horizontal or down-sloping ST segments and sometimes a small ST depression. In no case did ECG show typical signs of acute myocardial infarction. A transient prolonged QT interval was seen in three patients and transient U waves in four. ECG did not correlate to the location of the vascular lesion seen on CT or the clinical outcome. It is concluded that STT changes of a small magnitude are seen in about half of the cases of stroke patients without primary heart disease and that they do not resemble the typical pattern of acute myocardial ischaemia.
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| 10. |
- Lindow, Thomas, et al.
(författare)
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Diagnostic Accuracy of the Electrocardiographic Decision Support – Myocardial Ischaemia (EDS-MI) Algorithm in Detection of Acute Coronary Occlusion
- 2020
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Ingår i: European Heart Journal: Acute Cardiovascular Care. - : Oxford University Press (OUP). - 2048-8734 .- 2048-8726. ; 9:S1, s. 13-25
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Tidskriftsartikel (refereegranskat)abstract
- Electrocardiographic Decision Support - Myocardial Ischaemia (EDS-MI) is a graphical decision support for detection and localization of acute transmural ischaemia. A recent study indicated that EDS-MI performs well for detection of acute transmural ischaemia. However, its performance has not been tested in patients with non-ischaemic ST-deviation. We aimed to optimize the diagnostic accuracy of EDS-MI in patients with verified acute coronary occlusion as well as patients with non-ischaemic ST deviation and compare its performance with STEMI criteria. We studied 135 patients with non-ischaemic ST deviation (perimyocarditis, left ventricular hypertrophy, takotsubo cardiomyopathy and early repolarization) and 117 patients with acute coronary occlusion. In 63 ischaemic patients, the extent and location of the ischaemic area (myocardium at risk) was assessed by both cardiovascular magnetic resonance imaging and EDS-MI. Sensitivity and specificity of ST elevation myocardial infarction criteria were 85% (95% confidence interval (CI) 77, 90) and 44% (95% CI 36, 53) respectively. Using EDS-MI, sensitivity and specificity increased to 92% (95% CI 85, 95) and 81% (95% CI 74, 87) respectively (p=0.035 and p<0.001). Agreement was strong (83%) between cardiovascular magnetic resonance imaging and EDS-MI in localization of ischaemia. Mean myocardium at risk was 32% (± 10) by cardiovascular magnetic resonance imaging and 33% (± 11) by EDS-MI when the estimated infarcted area according to Selvester QRS scoring was included in myocardium at risk estimation. In conclusion, EDS-MI increases diagnostic accuracy and may serve as an automatic decision support in the early management of patients with suspected acute coronary syndrome. The added clinical benefit in a non-selected clinical chest pain population needs to be assessed.
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