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- 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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| 4. |
- Birnbaum, Yochai, et al.
(författare)
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Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report
- 2012
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 45:5, s. 463-475
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Tidskriftsartikel (refereegranskat)abstract
- Acute coronary syndromes (ACS) with narrow QRS are divided into 2 groups: ST-elevation ACS that requires emergency percutaneous coronary intervention, and non-ST elevation ACS. The classification of ACS into these 2 groups is not always straightforward. In this document, we discuss several electrocardiogram patterns of acute ischemia that are often misinterpreted. We suggest that any new recommendations or guidelines from the Scientific Societies should acknowledge these aspects of electrocardiogram interpretation by including appropriate diagnostic criteria that should prove helpful for the optimal management of patients with ACS. (C) 2012 Elsevier Inc. All rights reserved.
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| 5. |
- Birnbaum, Yochai, et al.
(författare)
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The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document
- 2014
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 19:5, s. 412-425
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Forskningsöversikt (refereegranskat)abstract
- The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V-1-V-3) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V-1-V-3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.
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| 6. |
- Brudin, Lars, et al.
(författare)
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Comparison of two commonly used reference materials for exercise bicycle tests with a Swedish clinical database of patients with normal outcome
- 2014
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 34:4, s. 297-307
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reference values for working capacity, blood pressure, heart rate, perceived exertion, etc. during bicycle exercise tests have been sought after for many years. This is because earlier commonly used reference values for physical work capacity have been either too low or too high when compared to the clinical experience of several Swedish departments of clinical physiology. The aim of the study was to compare two commonly used reference materials with normal outcomes from a clinical database. Methods: Data from a clinical database of standardized exercise tests in Kalmar, Sweden, between 2004 and 2012, and having been judged as normal, were divided into 5-year categories of 5-10 to 75-80 years of age covering people from 7 to 80 years of age. Results: Maximal working capacity (W-max), maximal heart rate, maximal systolic blood pressure and maximal perceived exertion are presented for each of the 15 age categories. Regression equations are also presented for each sex with age and height as independent predictors. Quantitative comparisons of W-max are calculated for the three materials and possible explanations discussed. Conclusions: Values of W-max lie between the two reference materials most commonly used in Sweden. In addition, the present material covers subjects aged 7-19 years.
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| 7. |
- Hakacova, Nina, et al.
(författare)
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Aspects of Left Ventricular Morphology Outperform Left Ventricular Mass for Prediction of QRS Duration
- 2010
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Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 15:2, s. 124-129
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Tidskriftsartikel (refereegranskat)abstract
- Methods: The study population of healthy adult volunteers was divided into a sample for development of a prediction model (n = 63) and a testing sample (n = 30). Magnetic resonance imaging data were used to assess anatomical characteristics of the left ventricle: the angle between papillary muscles (PMA), the length of the left ventricle (LVL) and left ventricular mass (LVM). Twelve-lead electrocardiogram (ECG) was used for measurement of the QRS duration. Multiple linear regression analysis was used to develop a prediction model to estimate the QRS duration. The accuracy of the prediction model was assessed by comparing predicted with measured QRS duration in the test set. Results: The angle between PMA and the length of the LVL were statistically significant predictors of QRS duration. Correlation between QRS duration and PMA and LVL was r = 0.57, P = 0.0001 and r = 0.45, P = 0.0002, respectively. The final model for prediction of the QRS was: QRS(Predicted) = 97 + (0.35 x LVL) - (0.45 x PMA). The predicted and real QRS duration differed with median 1 ms. Conclusions: The model for prediction of QRS duration opens the ability to predict case-specific normal QRS duration. This knowledge can have clinical importance, when determining the normality on case-specific basis. Ann Noninvasive Electrocardiol 2010;15(2):124-129.
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| 8. |
- Hakacova, Nina, et al.
(författare)
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Computer-based rhythm diagnosis and its possible influence on nonexpert electrocardiogram readers.
- 2012
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 45, s. 18-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Systems providing computer-based analysis of the resting electrocardiogram (ECG) seek to improve the quality of health care by providing accurate and timely automatic diagnosis of, for example, cardiac rhythm to clinicians. The accuracy of these diagnoses, however, remains questionable. OBJECTIVES: We tested the hypothesis that (a) 2 independent automated ECG systems have better accuracy in rhythm diagnosis than nonexpert clinicians and (b) both systems provide correct diagnostic suggestions in a large percentage of cases where the diagnosis of nonexpert clinicians is incorrect. METHODS: Five hundred ECGs were manually analyzed by 2 senior experts, 3 nonexpert clinicians, and automatically by 2 automated systems. The accuracy of the nonexpert rhythm statements was compared with the accuracy of each system statement. The proportion of rhythm statements when the clinician's diagnoses were incorrect and the systems instead provided correct diagnosis was assessed. RESULTS: A total of 420 sinus rhythms and 156 rhythm disturbances were recognized by expert reading. Significance of the difference in accuracy between nonexperts and systems was P = .45 for system A and P = .11 for system B. The percentage of correct automated diagnoses in cases when the clinician was incorrect was 28% ± 10% for system A and 25% ± 11% for system B (P = .09). CONCLUSION: The rhythm diagnoses of automated systems did not reach better average accuracy than those of nonexpert readings. The computer diagnosis of rhythm can be incorrect in cases where the clinicians fail in reaching the correct ECG diagnosis.
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| 10. |
- Jögi, Jonas, et al.
(författare)
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Arbetsprov på barn
- 2013
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Ingår i: Kliniska arbetsprov: metoder för diagnos och prognos. - 9789144083834 ; , s. 447-456
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Bokkapitel (refereegranskat)
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