Changes in canine electrocardiogram values from three thermal floors in Cundinamarca, Colombia

Directory of Open Access Journals (Sweden)

Marta Elena Sánchez Klinge

2008-06-01

Full Text Available The electrocardiogram is a written register of electric changes that take place in the heart during a heart cycle. The voltage changes are the result of depolarization and repolarization of heart muscle fibers that produce electric changes able to reach body surface and that are detected by electrodes connected to a galvanometer called electrocardiograph. Heart problems are detected with the electrocardiogram, but it is necessary to know the normal values of canine electrocardiogram in a tropical country because values can change compared with normal values reported in other places. The purpose is to show variations of electrocardiogram values from clinically healthy canines from Bogotá D. C at 2600 mosl, Fusagasugá at 1700 mosl and Girardot at 326 mosl. Studied animals were separated in six groups depending on the altitude over sea level and the animal weight (less than 15 Kg and more than 15 Kg. The electrocardiograms were taken with a one channel portable electrocardiograph and derivations I, II, III, aVR, aVL, aVF, CV6LL, CV6LU, CV5RL and V10 were included. Significant differences of electrocardiogram values were observed in derivation II, in relation to the altitude over sea level and to the animals weight, which acquires importance when a diagnose of heart abnormalities is needed from animals located at different altitudes over sea levels.

Respiratory Information Extraction from Electrocardiogram Signals

KAUST Repository

Amin, Gamal El Din Fathy

2010-01-01

The Electrocardiogram (ECG) is a tool measuring the electrical activity of the heart, and it is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological

Electrocardiograms digitally processed for the investigation of new measures of cardiac diagnosis

International Nuclear Information System (INIS)

Gutierrez, Rafael M; Cerquera, Alexander

2003-01-01

The ECG F D 1 database that comprises electrocardiograms processed with digital filters is presented. The aim of this work is to build databases in order to perform high sensibility studies of new methods for electrocardiographic analysis based on statistical physics, actually on research. The changes in the original electrocardiograms generated by the digital filters used to build the ECG F D 1 database cannot be detected visually. The effect of these filters on the information, which escapes visual analysis, is actually object of study in order to develop its potential in the support of cardiac diagnosis using the electrocardiogram as the only source of information. The ECG F D 1 database may be very useful in the investigation directed to construct new diagnostic tools in cardiology, using simpler and less expensive electrocardiograms, obtained in more diverse conditions. the study of cardiac dynamics as a complex system starting from a source of information as simple as an electrocardiogram offers possibilities of creating new services that may improve the quality of human life and life expectancy at low costs and possibility of great coverage. One of the purposes of this publication is to draw the scientific community's attention to these investigative problems and its interdisciplinary applications

The Electrocardiogram as an Example of Electrostatics

Science.gov (United States)

Hobbie, Russell K.

1973-01-01

Develops a simplified electrostatic model of the heart with conduction within the torso neglected to relate electrocardiogram patterns to the charge distribution within the myocardium. Suggests its application to explanation of Coulomb's law in general physics. (CC)

Nonlinear time series analysis of the human electrocardiogram

International Nuclear Information System (INIS)

Perc, Matjaz

2005-01-01

We analyse the human electrocardiogram with simple nonlinear time series analysis methods that are appropriate for graduate as well as undergraduate courses. In particular, attention is devoted to the notions of determinism and stationarity in physiological data. We emphasize that methods of nonlinear time series analysis can be successfully applied only if the studied data set originates from a deterministic stationary system. After positively establishing the presence of determinism and stationarity in the studied electrocardiogram, we calculate the maximal Lyapunov exponent, thus providing interesting insights into the dynamics of the human heart. Moreover, to facilitate interest and enable the integration of nonlinear time series analysis methods into the curriculum at an early stage of the educational process, we also provide user-friendly programs for each implemented method

The Normal Electrocardiogram: Resting 12-Lead and Electrocardiogram Monitoring in the Hospital.

Science.gov (United States)

Harris, Patricia R E

2016-09-01

The electrocardiogram (ECG) is a well-established diagnostic tool extensively used in clinical settings. Knowledge of cardiac rhythm and mastery of cardiac waveform interpretation are fundamental for intensive care nurses. Recognition of the normal findings for the 12-lead ECG and understanding the significance of changes from baseline in continuous cardiac monitoring are essential steps toward ensuring safe patient care. This article highlights historical developments in electrocardiography, describes the normal resting 12-lead ECG, and discusses the need for continuous cardiac monitoring. In addition, future directions for the ECG are explored briefly. Copyright © 2016 Elsevier Inc. All rights reserved.

Myocardial infarction false alarm: initial electrocardiogram and cardiac enzymes.

Science.gov (United States)

Gupta, Esha Das; Sakthiswary, Rajalingham

2014-05-01

The objectives of this study were to determine the incidence of a myocardial infarction "false alarm" and evaluate the efficacy of the initial electrocardiogram and cardiac enzymes in diagnosing myocardial infarction in Malaysia. We recruited patients who were admitted with suspected myocardial infarction from June to August 2008. The medical records of these patients were reviewed for the initial electrocardiogram, initial cardiac enzyme levels (creatinine kinase-MB and troponin T), and the final diagnosis upon discharge. The subjects were stratified into 2 groups: true myocardial infarction, and false alarm. 125 patients were enrolled in this study. Following admission and further evaluation, the diagnosis was revised from myocardial infarction to other medical conditions in 48 (38.4%) patients. The sensitivity and specificity of the initial ischemic electrocardiographic changes were 54.5% and 70.8%, respectively. Raised cardiac enzymes had a sensitivity of 44.3% and specificity of 95.8%. A significant proportion of patients in Malaysia are admitted with a false-alarm myocardial infarction. The efficacy of the electrocardiogram in diagnosing myocardial infarction in Malaysia was comparable to the findings of Western studies, but the cardiac enzymes had a much lower sensitivity.

ALTERATIONS IN ELECTROCARDIOGRAMS OF LABRADOR RETRIEVER DOGS DURING HANDLING WITH AND WITHOUT GLOVES

Directory of Open Access Journals (Sweden)

Swagat Mohapatra

2016-12-01

Full Text Available Healthy male Labrador Retriever dogs (n=8 aged between one to three years constituted the study material. The study was carried out to peruse the alterations in electrocardiograms, when the attendant restrained the dogs with bare hands and when the dogs were restrained by the attendant wearing gloves. The mean amplitude of P wave was higher in dogs handled with gloves. Similarly, the amplitudes of QRS complex and T wave were higher in the electrocardiograms of dogs handled with insulated hands. Meanwhile, the duration of T wave and Q-T interval were higher in the electrocardiograms recorded without gloves in hands. However, no alterations were perceived with respect to the duration of P wave, duration of T wave, the P-R interval, R-R interval and the heart rate. Except for the amplitude of P wave, no other differences were statistically significant. The study reported the alterations in the electrocardiogram while handling the animals with bare hands.

Non-invasive electrocardiogram detection of in vivo zebrafish embryos using electric potential sensors

Science.gov (United States)

Rendon-Morales, E.; Prance, R. J.; Prance, H.; Aviles-Espinosa, R.

2015-11-01

In this letter, we report the continuous detection of the cardiac electrical activity in embryonic zebrafish using a non-invasive approach. We present a portable and cost-effective platform based on the electric potential sensing technology, to monitor in vivo electrocardiogram activity from the zebrafish heart. This proof of principle demonstration shows how electrocardiogram measurements from the embryonic zebrafish may become accessible by using electric field detection. We present preliminary results using the prototype, which enables the acquisition of electrophysiological signals from in vivo 3 and 5 days-post-fertilization zebrafish embryos. The recorded waveforms show electrocardiogram traces including detailed features such as QRS complex, P and T waves.

Thallium-201 myocardial imaging in evaluation of asymptomatic individuals with ischaemic ST segment depression on exercise electrocardiogram

International Nuclear Information System (INIS)

Caralis, D.G.; Bailey, I.; Kennedy, H.L.; Pitt, B.

1979-01-01

This study showed that asymptomatic adults with normal physical examination, normal resting electrocardiogram, and normal routine laboratory evaluation who had a positive exercise electrocardiogram and abnormal exercise thallium-201 myocardial image had a very high probability of angiographically significant coronary artery disease. If, on the other hand, the exercise electrocardiogram was positive for 'ischaemic' ST segment changes, but the exercise thallium image was normal, the probability for coronary disease was low. The exercise electrocardiogram combined with thallium-201 myocardial image are safe non-invasive methods which can be performed on an out-patient basis. (author)

Comparative analyses of the effect of radiotherapy and chemotherapy or chemotherapy alone on patients' electrocardiogram

International Nuclear Information System (INIS)

Liang Li; Zhang Shulan; Zhang Zhaohui; Wang Junjie; Jia Tingzhen

2005-01-01

Objective: To investigate the change of breast cancer patients' electrocardiogram during combined radiotherapy and chemotherapy or chemotherapy alone for the sake of predicting the cardiotoxicity of combined radiotherapy and chemotherapy. Methods: From January, 1998 to June, 2004, 47 postoperative breast cancer patients were enrolled. Among them 29 patients received chemotherapy combined with radiotherapy (combinative group), and 18 patients received chemotherapy alone (non combinative group). The changes of electrocardiogram were observed and correlation factors were analyzed. Results: Abnormal electrocardiograms were noted in 11 (37.9%) and 2 patients (11.1%) of the combinative group and the non-combinative group respectively(z=-1.977, P=0.048). In the combinative group, heart events were significantly increased in patients above 60 years old (z=- 2.094 P=0.036). The changes of electrocardiogram were not significantly correlative with hypertension history, tumor site, dose of radiotherapy or chemotherapeutic drugs. But the incidence of abnormal electrocardiogram was higher in patients with a hypertension history than in those without it (54.5% vs 27.8%). Conclusion: The abnormalities of electrocardiogram were are more frequent in patients treated with both radiotherapy combined with chemotherapy. Our results suggest that breast cancer patients should be regularly reexamined with electrocardiography during therapy, especially whose age was those have a hypertension history and above 60 years old. (authors)

The electrocardiogram in traumatic right atrial rupture

NARCIS (Netherlands)

van Veldhuisen, DJ; van den Berg, MP

1999-01-01

We:report the case of a previously healthy 20-year-old man who had a traumatic rupture of the right atrium. On admission an electrocardiogram (ECG) was recorded which is highly remarkable and, retrospectively, suggestive for the diagnosis. The patient died soon after the EGG, and the diagnosis was

Electrocardiogram of Clinically Healthy Mithun (Bos frontalis): Variation among Strains

Science.gov (United States)

Sanyal, Sagar; Das, Pradip Kumar; Ghosh, Probal Ranjan; Das, Kinsuk; Vupru, Kezha V.; Rajkhowa, Chandan; Mondal, Mohan

2010-01-01

A study was conducted to establish the normal electrocardiogram in four different genetic strains of mithun (Bos frontalis). Electrocardiography, cardiac electrical axis, heart rate, rectal temperature and respiration rate were recorded in a total of 32 adult male mithun of four strains (n = 8 each). It was found that the respiration and heart rates were higher (P electrocardiogram of mithun revealed that the amplitude and duration of P wave, QRS complex and T wave were different among four different genetic strains of mithun and the electrical axis of QRS complex for Nagamese and Mizoram mithuns are dissimilar to bovine species. PMID:20886013

Gender differences in the electrocardiogram screening of athletes

NARCIS (Netherlands)

Bessem, Bram; de Bruijn, Matthijs C.; Nieuwland, Wybe

Objectives: Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the

Assessment of the electrocardiogram in dogs with visceral leishmaniasis

Directory of Open Access Journals (Sweden)

Marlos G. Sousa

2013-05-01

Full Text Available As myocarditis and arrhythmias have been shown to occur in both human beings and dogs with leishmaniasis, electrocardiograms of 105 dogs serologically positive for this disease were assessed for rhythm disturbances and changes in ECG waves. A few expressive alterations were seen, including sinus arrest, right bundle branch block, and atrial premature beats in 14.3%, 4.8%, and 4.8% of the studied subjects, respectively. Also, the analysis of ECG waves showed changes suggestive of left atrium and ventricle enlargements, and myocardial hypoxia in some animals. Although cardiac compromise has been previously reported in dogs with leishmaniasis, only a small subset of dogs showed any alteration in the electrocardiogram, which cannot support the occurrence of myocarditis in this investigation.

Pneumopyopericardium mimicking an inferior ST elevation myocardial infarction with regional electrocardiogram changes: a case report.

Science.gov (United States)

Ratnayake, Eranda Chamara; Premaratne, Sandamali; Lokunarangoda, Niroshan; Fernando, Sanduni; Fernando, Nilanthi; Ponnamperuma, Chandrike; Santharaj, W Samuel

2015-04-30

Pneumopyopericardium is a rare disease with poor prognosis. The usual presentation is with fever, shortness of breath and haemodynamic compromise. The Electrocardiogram changes associated with this disease entity would be similar to pericarditis such as concave shaped ST elevations in all leads with PR sagging. Pneumopyopericardium mimicking an acute ST Elevation Myocardial Infarction, with regional Electrocardiogram changes has hitherto not been described in world literature. We describe the case of a 48 year old native Sri Lankan man, presenting with chest pain and Electrocardiogram changes compatible with an Acute ST Elevation Myocardial Infarction, subsequently found to have Pneumopyopericardium secondary to an oesophageal tear. Retrospective history revealed repetitive vomiting due to heavy alcohol consumption, prior to presentation. It unfortunately led to a fatal outcome. Pneumopyopericardium may mimic an acute ST elevation myocardial infarction with associated regional Electrocardiogram changes. A high degree of suspicion should be maintained and an adequate history should always be obtained prior to any intervention in all ST Elevation Myocardial Infarction patients.

Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition.

Science.gov (United States)

Hernández-Padilla, José M; Granero-Molina, José; Márquez-Hernández, Verónica V; Suthers, Fiona; López-Entrambasaguas, Olga M; Fernández-Sola, Cayetano

2017-06-01

Rapid and accurate interpretation of cardiac arrhythmias by nurses has been linked with safe practice and positive patient outcomes. Although training in electrocardiogram rhythm recognition is part of most undergraduate nursing programmes, research continues to suggest that nurses and nursing students lack competence in recognising cardiac rhythms. In order to promote patient safety, nursing educators must develop valid and reliable assessment tools that allow the rigorous assessment of this competence before nursing students are allowed to practise without supervision. The aim of this study was to develop and psychometrically evaluate a toolkit to holistically assess competence in electrocardiogram rhythm recognition. Following a convenience sampling technique, 293 nursing students from a nursing faculty in a Spanish university were recruited for the study. The following three instruments were developed and psychometrically tested: an electrocardiogram knowledge assessment tool (ECG-KAT), an electrocardiogram skills assessment tool (ECG-SAT) and an electrocardiogram self-efficacy assessment tool (ECG-SES). Reliability and validity (content, criterion and construct) of these tools were meticulously examined. A high Cronbach's alpha coefficient demonstrated the excellent reliability of the instruments (ECG-KAT=0.89; ECG-SAT=0.93; ECG-SES=0.98). An excellent context validity index (scales' average content validity index>0.94) and very good criterion validity were evidenced for all the tools. Regarding construct validity, principal component analysis revealed that all items comprising the instruments contributed to measure knowledge, skills or self-efficacy in electrocardiogram rhythm recognition. Moreover, known-groups analysis showed the tools' ability to detect expected differences in competence between groups with different training experiences. The three-instrument toolkit developed showed excellent psychometric properties for measuring competence in

Reconstruction of electrocardiogram using ionic current models for heart muscles.

Science.gov (United States)

Yamanaka, A; Okazaki, K; Urushibara, S; Kawato, M; Suzuki, R

1986-11-01

A digital computer model is presented for the simulation of the electrocardiogram during ventricular activation and repolarization (QRS-T waves). The part of the ventricular septum and the left ventricular free wall of the heart are represented by a two dimensional array of 730 homogeneous functional units. Ionic currents models are used to determine the spatial distribution of the electrical activities of these units at each instant of time during simulated cardiac cycle. In order to reconstruct the electrocardiogram, the model is expanded three-dimensionally with equipotential assumption along the third axis and then the surface potentials are calculated using solid angle method. Our digital computer model can be used to improve the understanding of the relationship between body surface potentials and intracellular electrical events.

[Parameters of cardiac muscle repolarization on the electrocardiogram when changing anatomical and electric position of the heart].

Science.gov (United States)

Chaĭkovskiĭ, I A; Baum, O V; Popov, L A; Voloshin, V I; Budnik, N N; Frolov, Iu A; Kovalenko, A S

2014-01-01

While discussing the diagnostic value of the single channel electrocardiogram a set of theoretical considerations emerges inevitably, one of the most important among them is the question about dependence of the electrocardiogram parameters from the direction of electrical axis of heart. In other words, changes in what of electrocardiogram parameters are in fact liable to reflect pathological processes in myocardium, and what ones are determined by extracardiac factors, primarily by anatomic characteristics of patients. It is arguable that while analyzing electrocardiogram it is necessary to orient to such physiologically based informative indexes as ST segment displacement. Also, symmetry of the T wave shape is an important parameter which is independent of patients anatomic features. The results obtained are of interest for theoretical and applied aspects of the biophysics of the cardiac electric field.

A Real-Time Intrauterine Catheter Technique for Fetal Electrocardiogram Monitoring

National Research Council Canada - National Science Library

Horner, S

2001-01-01

..., two sensors that include the invasive scalp electrode and intrauterine pressure catheter are used clink ally, Signal processing is required to obtain a FECG via the IC, Usually the maternal electrocardiogram (ECG...

Limited Relationship of Voltage Criteria for Electrocardiogram Left Ventricular Hypertrophy to Cardiovascular Mortality.

Science.gov (United States)

Ha, Le Dung; Elbadawi, Ayman; Froelicher, Victor F

2018-01-01

Numerous methods have been proposed for diagnosing left ventricular hypertrophy using the electrocardiogram. They have limited sensitivity for recognizing pathological hypertrophy, at least in part due to their inability to distinguish pathological from physiological hypertrophy. Our objective is to compare the major electrocardiogram-left ventricular hypertrophy criteria using cardiovascular mortality as a surrogate for pathological hypertrophy. This study was a retrospective analysis of 16,253 veterans electrocardiogram-left ventricular hypertrophy, and there were 744 cardiovascular deaths (annual cardiovascular mortality 0.25%). Receiver operating characteristic analysis demonstrated that the greatest area under the curve (AUC) for classification of cardiovascular death was obtained using the Romhilt-Estes score (0.63; 95% confidence interval, 0.61-0.65). Most of the voltage-only criteria had nondiagnostic area under the curves, with the Cornell being the best at 0.59 (95% confidence interval, 0.57-0.62). When the components of the Romhilt-Estes score were examined using step-wise Wald analysis, the voltage criteria dropped from the model. The Romhilt-Estes score ≥ 4, the Cornell, and the Peguero had the highest association with cardiovascular mortality (adjusted hazard ratios 2.2, 2.0, and 2.1, consecutively). None of the electrocardiogram leads with voltage criteria exhibited sufficient classification power for clinical use. Copyright © 2018 Elsevier Inc. All rights reserved.

An Analysis Of QRS Interval Of The Electrocardiogram In ...

African Journals Online (AJOL)

Objectives: This cross-sectional study of the 12-lead electrocardiogram (ECG) was undertaken to establish the normal QRS interval of the adult Nigerian from Jos; to find significant correlation coefficients for QRS interval and the various anthropometric measurements and also to establish prediction equations for the QRS ...

Computerized electrocardiogram in agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam

Directory of Open Access Journals (Sweden)

Anaemilia N. Diniz

Full Text Available ABSTRACT: An electrocardiogram is a test that assesses heart electrical activity and is applied more frequently in the veterinary care of wild animals. The present study aimed to define the electrocardiogram pattern of agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam. Eighteen clinically healthy agoutis (D. prymnolopha were used from the Nucleus for Wild Animal Studies and Conservation (NEPAS of the Federal University of Piauí, Brazil. The animals were chemically restrained with 5% ketamine hydrochloride at a dose of 15mg/kg and midazolam at a dose of 1mg/kg by intramuscular injection. Electrocardiogram tests were carried out by a computerized method with the veterinary electrocardiogram [Acquisition Model for Computer (ECG - PC version Windows 95 Brazilian Electronic Technology (TEB consisting of an electronic circuit externally connected to a notebook computer with ECGPC-VET (TEB software installed on the hard disc. In analysing the EKG results, significant differences were observed for QRS complex duration, PR and QT intervals and for R wave millivoltage between the genders; but we observed a significant influence of weight despite the gender. In the present experiment, the anaesthetic protocol was shown to be well tolerated by the agoutis, and no arrhythmias occurred during the time the animals were monitored. The reference values obtained should be used to better understand the cardiac electrophysiology of the species and for its clinical and surgical management.

Wavelet transform analysis of transient signals: the seismogram and the electrocardiogram

Energy Technology Data Exchange (ETDEWEB)

Anant, K.S.

1997-06-01

In this dissertation I quantitatively demonstrate how the wavelet transform can be an effective mathematical tool for the analysis of transient signals. The two key signal processing applications of the wavelet transform, namely feature identification and representation (i.e., compression), are shown by solving important problems involving the seismogram and the electrocardiogram. The seismic feature identification problem involved locating in time the P and S phase arrivals. Locating these arrivals accurately (particularly the S phase) has been a constant issue in seismic signal processing. In Chapter 3, I show that the wavelet transform can be used to locate both the P as well as the S phase using only information from single station three-component seismograms. This is accomplished by using the basis function (wave-let) of the wavelet transform as a matching filter and by processing information across scales of the wavelet domain decomposition. The `pick` time results are quite promising as compared to analyst picks. The representation application involved the compression of the electrocardiogram which is a recording of the electrical activity of the heart. Compression of the electrocardiogram is an important problem in biomedical signal processing due to transmission and storage limitations. In Chapter 4, I develop an electrocardiogram compression method that applies vector quantization to the wavelet transform coefficients. The best compression results were obtained by using orthogonal wavelets, due to their ability to represent a signal efficiently. Throughout this thesis the importance of choosing wavelets based on the problem at hand is stressed. In Chapter 5, I introduce a wavelet design method that uses linear prediction in order to design wavelets that are geared to the signal or feature being analyzed. The use of these designed wavelets in a test feature identification application led to positive results. The methods developed in this thesis; the

Noninvasive extraction of fetal electrocardiogram based on Support Vector Machine

Science.gov (United States)

Fu, Yumei; Xiang, Shihan; Chen, Tianyi; Zhou, Ping; Huang, Weiyan

2015-10-01

The fetal electrocardiogram (FECG) signal has important clinical value for diagnosing the fetal heart diseases and choosing suitable therapeutics schemes to doctors. So, the noninvasive extraction of FECG from electrocardiogram (ECG) signals becomes a hot research point. A new method, the Support Vector Machine (SVM) is utilized for the extraction of FECG with limited size of data. Firstly, the theory of the SVM and the principle of the extraction based on the SVM are studied. Secondly, the transformation of maternal electrocardiogram (MECG) component in abdominal composite signal is verified to be nonlinear and fitted with the SVM. Then, the SVM is trained, and the training results are compared with the real data to ensure the effect of the training. Meanwhile, the parameters of the SVM are optimized to achieve the best performance so that the learning machine can be utilized to fit the unknown samples. Finally, the FECG is extracted by removing the optimal estimation of MECG component from the abdominal composite signal. In order to evaluate the performance of FECG extraction based on the SVM, the Signal-to-Noise Ratio (SNR) and the visual test are used. The experimental results show that the FECG with good quality can be extracted, its SNR ratio is significantly increased as high as 9.2349 dB and the time cost is significantly decreased as short as 0.802 seconds. Compared with the traditional method, the noninvasive extraction method based on the SVM has a simple realization, the shorter treatment time and the better extraction quality under the same conditions.

Tripolar Laplacian electrocardiogram and moment of activation isochronal mapping.

Science.gov (United States)

Besio, W; Chen, T

2007-05-01

The electrocardiogram (ECG) provides useful global temporal assessment of the cardiac activity, but has limited spatial capabilities. The Laplacian electrocardiogram (LECG), an improvement over the ECG, provides high spatiotemporal distributed information about cardiac electrical activation. We designed and developed LECG tripolar concentric ring electrode active sensors based on the finite element algorithm 'nine-point method' (NPM). The active sensors were used in an array of 6 by 12 (72) locations to record bipolar and tripolar LECG from the body surface over the anterolateral chest. Compared to bipolar LECG, tripolar LECG showed significantly higher spatial selectivity which may be helpful in inferring information about cardiac activations detected on the body surface. In this study the moment of activation (MOA), an indicator of a depolarization wave passing below the active sensors, was used to surmise possible timing information of the cardiac electrical activation below the active sensors' recording sites. The MOA on the body surface was used to generate isochronal maps that may some day be used by clinicians in diagnosing arrhythmias and assessing the efficacy of therapies.

Normal Limits of Electrocardiogram and Cut-Off Values for Left ...

African Journals Online (AJOL)

Gender difference exists in some cut-off values for LVH. This study defined the normal limits for electrocardiographic variables for young adult Nigerians. Racial factor should be taken into consideration in interpretation of ECG. Keywords: Normal limits, Electrocardiogram, Cut-off values, Left ventricular hypertrophy, Young ...

Sinabro: A Smartphone-Integrated Opportunistic Electrocardiogram Monitoring System

OpenAIRE

Sungjun Kwon; Dongseok Lee; Jeehoon Kim; Youngki Lee; Seungwoo Kang; Sangwon Seo; Kwangsuk Park

2016-01-01

In our preliminary study, we proposed a smartphone-integrated, unobtrusive electrocardiogram (ECG) monitoring system, Sinabro, which monitors a user?s ECG opportunistically during daily smartphone use without explicit user intervention. The proposed system also monitors ECG-derived features, such as heart rate (HR) and heart rate variability (HRV), to support the pervasive healthcare apps for smartphones based on the user?s high-level contexts, such as stress and affective state levels. In th...

The prevalence and relevance of the Brugada-type electrocardiogram in the Danish general population: data from the Copenhagen City Heart Study

DEFF Research Database (Denmark)

Pecini, Redi; Cedergreen, Pernille Kallerup; Theilade, Simone

2010-01-01

The prevalence of the Brugada-type electrocardiogram (ECG) in the Danish population is not known.......The prevalence of the Brugada-type electrocardiogram (ECG) in the Danish population is not known....

A new methodology to study customer electrocardiogram using RFM analysis and clustering

Directory of Open Access Journals (Sweden)

Mohammad Reza Gholamian

2011-04-01

Full Text Available One of the primary issues on marketing planning is to know the customer's behavioral trends. A customer's purchasing interest may fluctuate for different reasons and it is important to find the declining or increasing trends whenever they happen. It is important to study these fluctuations to improve customer relationships. There are different methods to increase the customer's willingness such as planning good promotions, an increase on advertisement, etc. This paper proposes a new methodology to measure customer's behavioral trends called customer electrocardiogram. The proposed model of this paper uses K-means clustering method with RFM analysis to study customer's fluctuations over different time frames. We also apply the proposed electrocardiogram methodology for a real-world case study of food industry and the results are discussed in details.

Computer Decision Support as a Source of Interpretation Error: The Case of Electrocardiograms

OpenAIRE

Tsai, Theodore L.; Fridsma, Douglas B.; Gatti, Guido

2003-01-01

Objective: The aim of this study was to determine the effect that the computer interpretation (CI) of electrocardiograms (EKGs) has on the accuracy of resident (noncardiologist) physicians reading EKGs.

Biometric identification with high frequency electrocardiogram: Unregistered user refusal method and performance evaluation.

Science.gov (United States)

Kyoso, Masaki

2015-08-01

As a new modality for biometric identification, electrocardiogram-based identification technique has been developed. We proposed a technique with high frequency component of electrocardiogram (HFECG) in QRS segment. In this report, an unregistered user refusal algorithm was combined with the artificial neural network based waveform classifier. The refusal function was realized by simple thresholding technique. HFECGs from twenty collaborators were used for supervised learning. Twenty HFECGs from the same collaborators were tested and false acceptance rate (FAR) and false rejection rate (FRR) were evaluated. Ten HFECGs from other collaborators were also tested to find unregistered user refusal performance. The results show that FAR and FRR in the registrants can be kept within 1%, however, unregistered user refusal performance was not acceptable under the same condition.

[Factors influencing electrocardiogram results in workers exposed to noise in steel-making and steel-rolling workshops of an iron and steel plant].

Science.gov (United States)

Li, Y H; Yu, S F; Gu, G Z; Chen, G S; Zhou, W H; Wu, H; Jiao, J

2016-02-20

To investigate the factors influencing the electrocardiogram results in the workers exposed to noise in steel-making and steel rolling workshops of an iron and steel plant. From September to December, 2013, cluster sampling was used to select 3 150 workers exposed to noise in the steel-making and steel-rolling workshops of an iron and steel plant, and a questionnaire survey and physical examinations were performed. The number of valid workers was 2 915, consisting of 1 606 workers in the steel-rolling workshop and 1 309 in the steel-making workshop. The electrocardiogram results of the workers in steel-making and steel-rolling workshops were analyzed. The overall abnormal rate of electrocardiogram was 26.35%, and the workers in the steel-making workshop had a significantly higher abnormal rate of electrocardiogram than those in the steel-rolling workshop(32.24% vs 21.54%, Pelectrocardiogram than female workers(27.59% vs 18.61%, Pelectrocardiogram than those who did not drink(28.17% vs 23.75%, Pelectrocardiogram than those who were not exposed to high temperature(29.43% vs 20.14%, Pelectrocardiogram in the workers with cumulative noise exposure levels of electrocardiogram results. High cumulative noise exposure, alcohol consumption, and high temperature may affect the abnormal rate of electrocardiogram in the workers exposed to noise in steel-making and steel-rolling workshops.

Diagnostic accuracy of pace spikes in the electrocardiogram to diagnose paced rhythm

DEFF Research Database (Denmark)

Andersson, Hedvig Bille; Hansen, Marco Bo; Thorsberger, Mads

2015-01-01

OBJECTIVE: To determine how often cardiac resynchronization therapy (CRT) pacing systems generate visible pace spikes in the electrocardiogram (ECG). METHODS: In 46 patients treated with CRT pacing systems, we recorded ECGs during intrinsic rhythm, atrial pacing and ventricular pacing. ECGs were...

Factors associated with failure to identify the culprit artery by the electrocardiogram in inferior ST-elevation myocardial infarction

DEFF Research Database (Denmark)

Tahvanainen, Minna; Nikus, Kjell C; Holmvang, Lene

2011-01-01

Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored.......Right and left circumflex coronary artery occlusions cause inferior myocardial infarction. To improve the targeting of diagnostic and therapeutic measures individually, factors interfering with identification of the culprit artery by the electrocardiogram (ECG) were explored....

An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram.

Science.gov (United States)

Sammon, Maura; Dawood, Alveena; Beaudoin, Scott; Harrigan, Richard A

2017-03-01

One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

The asymptomatic teenager with an abnormal electrocardiogram.

Science.gov (United States)

Singh, Harinder R

2014-02-01

Use of medications for attention-deficit hyperkinetic disorder and preparticipation sports physical examination has led to an increase in number of electrocardiograms (ECG) performed during adolescence. Interpreting ECGs in children and young adults must take into account the evolutionary changes with age and the benign variants, which are usually not associated with heart disease. It is crucial for primary-care providers to recognize the changes on ECG associated with heart disease and risk of sudden death. In this article, the significance, sensitivity, specificity, and the diagnostic workup of these findings in the asymptomatic teenager are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of qtc duration on electrocardiogram between patients of liver cirrhosis and non cirrhotic controls

International Nuclear Information System (INIS)

Umair, M.; Nadeem, K.; Azam, M.N.; Mansoor, J.; Khan, H.

2012-01-01

Objective: To compare the QTc duration on electrocardiogram (ECG) of patients of cirrhosis (hep B and C origin) with non cirrhotic controls. Study Design: Case control study. Place and duration of study: The study was carried out at the Department of Medicine, Military Hospital, Rawalpindi, from 8th Feb 2009 to 8th Aug 2009. Material and Method: After meeting the exclusion and inclusion criteria, 80 cirrhotic patients were enrolled in group-I and equal number of non cirrhotic controls were enrolled in group-II. Three 12 lead ECG recording were taken for each patient, 5 minutes apart, and QTc value was calculated for each ECG and then mean of the three was used for the analysis. A QTc value more than 0.44 seconds was taken as prolonged. Results: The mean QTc interval on electrocardiogram in group-I i.e. cirrhotic was 0.4603 seconds (SD+-0.1312) and mean QTc interval on electrocardiogram in group-II i.e. noncirrhotic was 0.407 seconds (SD+-0.029). These findings were statistically significant (p value < 0.001). Conclusion: Cirrhotic patients have prolonged QTc interval as compared to noncirrhotic controls. (author)

Electrocardiogram application based on heart rate variability ontology and fuzzy markup language

NARCIS (Netherlands)

Wang, M.-H.; Lee, C.-S.; Acampora, G.; Loia, V.; Gacek, A.; Pedrycz, W.

2011-01-01

The electrocardiogram (ECG) signal is adopted extensively as a low-cost diagnostic procedure to provide information concerning the healthy status of the heart. Heart rate variability (HRV) is a physiological phenomenon where the time interval between heart beats varies. It is measured by the

Quantification of the first-order high-pass filter's influence on the automatic measurements of the electrocardiogram.

Science.gov (United States)

Isaksen, Jonas; Leber, Remo; Schmid, Ramun; Schmid, Hans-Jakob; Generali, Gianluca; Abächerli, Roger

2017-02-01

The first-order high-pass filter (AC coupling) has previously been shown to affect the ECG for higher cut-off frequencies. We seek to find a systematic deviation in computer measurements of the electrocardiogram when the AC coupling with a 0.05 Hz first-order high-pass filter is used. The standard 12-lead electrocardiogram from 1248 patients and the automated measurements of their DC and AC coupled version were used. We expect a large unipolar QRS-complex to produce a deviation in the opposite direction in the ST-segment. We found a strong correlation between the QRS integral and the offset throughout the ST-segment. The coefficient for J amplitude deviation was found to be -0.277 µV/(µV⋅s). Potential dangerous alterations to the diagnostically important ST-segment were found. Medical professionals and software developers for electrocardiogram interpretation programs should be aware of such high-pass filter effects since they could be misinterpreted as pathophysiology or some pathophysiology could be masked by these effects. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Syncope: electrocardiogram and autonomic function tests].

Science.gov (United States)

Uribe, William; Baranchuk, Adrián; Botero, Federico

2016-12-23

Syncope represents one of the most frequent reasons for consultation in the emergency department. A proper identification will allow a precise etiologic approach and the optimization of delivery of health resources.
Once knowing the classification of syncope; it is the clinical interrogatory what enables to discriminate which of these patients present with a neurogenic mediated syncope or a cardiac mediated syncope. The use of diagnostic methods such as the tilt test, will clarify what type of neurally mediated syncope predominates in the patient.
The electrocardiogram is the cornerstone in the identification of those patients who had a true episode of self-limited or aborted sudden death as the first manifestation of their syncope, a fact which provides prognostic and therapeutic information that will impact the morbidity and mortality.

Exercise thallium-201 scintigraphy in men with nondiagnostic exercise electrocardiograms. Prognostic implications

International Nuclear Information System (INIS)

Iskandrian, A.S.; Hakki, A.H.; Kane-Marsch, S.

1986-01-01

We studied the prognostic value of exercise thallium-201 imaging in 196 men with suspected or known coronary artery disease who had nondiagnostic exercise electrocardiograms. The perfusion images in each of three projections were divided into three segments; each segment was assessed for perfusion defects (fixed or reversible). There were 12 cardiac events at a mean follow-up of 15 months (range, one to 66 months). Of those, five patients died of cardiac causes and seven had nonfatal acute myocardial infarctions (MIs). Only the number of perfusion defects significantly predicted cardiac events; clinical presentation, history of MI, presence of Q-wave MI, exercise duration, and exercise heart rate and double product did not predict cardiac events or add to information provided by the number of defects. Furthermore, actuarial life-table analysis showed that patients with three or more perfusion defects had significantly worse prognoses than patients with fewer than three defects. Exercise thallium-201 imaging helps in risk stratification of men with nondiagnostic exercise electrocardiograms

Electrocardiogram of the Mixmaster universe

International Nuclear Information System (INIS)

Bini, Donato; Cherubini, Christian; Geralico, Andrea; Jantzen, Robert T

2009-01-01

The Mixmaster dynamics is revisited in a new light as revealing a series of transitions in the complex scale invariant scalar invariant of the Weyl curvature tensor best represented by the speciality index S, which gives a four-dimensional measure of the evolution of the spacetime independent of all the three-dimensional gauge-dependent variables except for the time used to parametrize it. Its graph versus time characterized by correlated isolated pulses in its real and imaginary parts corresponding to curvature wall collisions serves as a sort of electrocardiogram of the Mixmaster universe, with each such pulse pair arising from a single circuit or 'complex pulse' around the origin in the complex plane. These pulses in the speciality index and their limiting points on the real axis seem to invariantly characterize some of the so-called spike solutions in inhomogeneous cosmology and should play an important role as a gauge-invariant lens through which to view current investigations of inhomogeneous Mixmaster dynamics.

Towards Quasi-continuous Heart Rate Variability Estimation using a Patch Type Electrocardiogram Recorder

DEFF Research Database (Denmark)

Bodholt Saadi, Dorthe; Ahrens, Esben; Sørensen, Helge Bjarup Dissing

2015-01-01

electrocardiogram recorders facilitates new possibilities for long-term monitoring, real-time data analysis, and wireless transmission of clinically relevant parameters, e.g. short-term HRV measures. This information might in the future assist the healthcare professionals in timely notification of changes...

Wavelet-based unsupervised learning method for electrocardiogram suppression in surface electromyograms.

Science.gov (United States)

Niegowski, Maciej; Zivanovic, Miroslav

2016-03-01

We present a novel approach aimed at removing electrocardiogram (ECG) perturbation from single-channel surface electromyogram (EMG) recordings by means of unsupervised learning of wavelet-based intensity images. The general idea is to combine the suitability of certain wavelet decomposition bases which provide sparse electrocardiogram time-frequency representations, with the capacity of non-negative matrix factorization (NMF) for extracting patterns from images. In order to overcome convergence problems which often arise in NMF-related applications, we design a novel robust initialization strategy which ensures proper signal decomposition in a wide range of ECG contamination levels. Moreover, the method can be readily used because no a priori knowledge or parameter adjustment is needed. The proposed method was evaluated on real surface EMG signals against two state-of-the-art unsupervised learning algorithms and a singular spectrum analysis based method. The results, expressed in terms of high-to-low energy ratio, normalized median frequency, spectral power difference and normalized average rectified value, suggest that the proposed method enables better ECG-EMG separation quality than the reference methods. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction

NARCIS (Netherlands)

F.W.H.M. Bär (Frits); C. de Zwaan (Chris); S.H. Braat (Simon); M.L. Simoons (Maarten); W.T. Hermens (Wim); A. van der Laarse (Arnoud); W.T. Wellens; M. Ramentol; F.W.A. Verheugt (Freek); F. Vermeer (Frank); X.H. Krauss

1987-01-01

textabstractTo determine the value of the admission 12-lead electrocardiogram to predict infarct size limitation by thrombolytic therapy, data were analyzed in 488 of 533 patients with acute myocardial infarction (AMI) from a randomized multicenter study. All patients had typical

Automatic Real-Time Embedded QRS Complex Detection for a Novel Patch-Type Electrocardiogram Recorder

DEFF Research Database (Denmark)

Saadi, Dorthe Bodholt; Tanev, George; Flintrup, Morten

2015-01-01

Cardiovascular diseases are projected to remain the single leading cause of death globally. Timely diagnosis and treatment of these diseases are crucial to prevent death and dangerous complications. One of the important tools in early diagnosis of arrhythmias is analysis of electrocardiograms (ECGs...

Automatic QRS complex detection algorithm designed for a novel wearable, wireless electrocardiogram recording device

DEFF Research Database (Denmark)

Saadi, Dorthe Bodholt; Egstrup, Kenneth; Branebjerg, Jens

2012-01-01

We have designed and optimized an automatic QRS complex detection algorithm for electrocardiogram (ECG) signals recorded with the DELTA ePatch platform. The algorithm is able to automatically switch between single-channel and multi-channel analysis mode. This preliminary study includes data from ...

Improvement of electrocardiogram by empirical wavelet transform

Science.gov (United States)

Chanchang, Vikanda; Kumchaiseemak, Nakorn; Sutthiopad, Malee; Luengviriya, Chaiya

2017-09-01

Electrocardiogram (ECG) is a crucial tool in the detection of cardiac arrhythmia. It is also often used in a routine physical exam, especially, for elderly people. This graphical representation of electrical activity of heart is obtained by a measurement of voltage at the skin; therefore, the signal is always contaminated by noise from various sources. For a proper interpretation, the quality of the ECG should be improved by a noise reduction. In this article, we present a study of a noise filtration in the ECG by using an empirical wavelet transform (EWT). Unlike the traditional wavelet method, EWT is adaptive since the frequency spectrum of the ECG is taken into account in the construction of the wavelet basis. We show that the signal-to-noise ratio increases after the noise filtration for different noise artefacts.

Chameleons: Electrocardiogram Imitators of ST-Segment Elevation Myocardial Infarction.

Science.gov (United States)

Nable, Jose V; Lawner, Benjamin J

2015-08-01

The imperative for timely reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) underscores the need for clinicians to have an understanding of how to distinguish patterns of STEMI from its imitators. These imitating diagnoses may confound an evaluation, potentially delaying necessary therapy. Although numerous diagnoses may mimic STEMI, several morphologic clues may allow the physician to determine if the pattern is concerning for either STEMI or a mimicking diagnosis. Furthermore, obtaining a satisfactory history, comparing previous electrocardiograms, and assessing serial tests may provide valuable clues. Copyright © 2015 Elsevier Inc. All rights reserved.

Common Atrium with Unusual Electrocardiogram in Ellis-van Creveld Syndrome: A Case Report

Directory of Open Access Journals (Sweden)

Amit Kumar

2015-01-01

This report describes a case of common atrium with unusual electrocardiographic findings in a patient with EVC syndrome. This 17-year-old male of Indian origin born of a consanguineous marriage had short stature, genu valgum, polydactyly, gingival hypertrophy, multiple frenula, common atrium, and right axis deviation of QRS with clockwise depolarization in electrocardiogram.

Effect of gender on computerized electrocardiogram measurements in college athletes.

Science.gov (United States)

Mandic, Sandra; Fonda, Holly; Dewey, Frederick; Le, Vy-van; Stein, Ricardo; Wheeler, Matt; Ashley, Euan A; Myers, Jonathan; Froelicher, Victor F

2010-06-01

Broad criteria for classifying an electrocardiogram (ECG) as abnormal and requiring additional testing prior to participating in competitive athletics have been recommended for the preparticipation examination (PPE) of athletes. Because these criteria have not considered gender differences, we examined the effect of gender on the computerized ECG measurements obtained on Stanford student athletes. Currently available computer programs require a basis for "normal" in athletes of both genders to provide reliable interpretation. During the 2007 PPE, computerized ECGs were recorded and analyzed on 658 athletes (54% male; mean age, 19 +/- 1 years) representing 22 sports. Electrocardiogram measurements included intervals and durations in all 12 leads to calculate 12-lead voltage sums, QRS amplitude and QRS area, spatial vector length (SVL), and the sum of the R wave in V5 and S wave in V2 (RSsum). By computer analysis, male athletes had significantly greater QRS duration, PR interval, Q-wave duration, J-point amplitude, and T-wave amplitude, and shorter QTc interval compared with female athletes (all P < 0.05). All ECG indicators of left ventricular electrical activity were significantly greater in males. Although gender was consistently associated with indices of atrial and ventricular electrical activity in multivariable analysis, ECG measurements correlated poorly with body dimensions. Significant gender differences exist in ECG measurements of college athletes that are not explained by differences in body size. Our tables of "normal" computerized gender-specific measurements can facilitate the development of automated ECG interpretation for screening young athletes.

77 FR 6127 - Submission of Extended Digital Electrocardiogram Waveform Data; Notice of Public Meeting

Science.gov (United States)

2012-02-07

...] Submission of Extended Digital Electrocardiogram Waveform Data; Notice of Public Meeting AGENCY: Food and... Drug Administration (FDA) is announcing a public meeting to consider changes in how digital... encouraged. There is no fee to attend the meeting, and attendees who do not wish to make an oral presentation...

Normal ranges for fetal electrocardiogram values for the healthy fetus of 18-24 weeks of gestation: a prospective cohort study.

Science.gov (United States)

Verdurmen, Kim M J; Lempersz, Carlijn; Vullings, Rik; Schroer, Christian; Delhaas, Tammo; van Laar, Judith O E H; Oei, S Guid

2016-08-17

The fetal anomaly ultrasound only detects 65 to 81 % of the patients with congenital heart disease, making it the most common structural fetal anomaly of which a significant part is missed during prenatal life. Therefore, we need a reliable non-invasive diagnostic method which improves the predictive value for congenital heart diseases early in pregnancy. Fetal electrocardiography could be this desired diagnostic method. There are multiple technical challenges to overcome in the conduction of the fetal electrocardiogram. In addition, interpretation is difficult due to the organisation of the fetal circulation in utero. We want to establish the normal ranges and values of the fetal electrocardiogram parameters in healthy fetuses of 18 to 24 weeks of gestation. Women with an uneventful singleton pregnancy between 18 and 24 weeks of gestation are asked to participate in this prospective cohort study. A certified and experienced sonographist performs the fetal anomaly scan. Subsequently, a fetal electrocardiogram recording is performed using dedicated signal processing methods. Measurements are performed at two institutes. We will include 300 participants to determine the normal values and 95 % confidence intervals of the fetal electrocardiogram parameters in a healthy fetus. We will evaluate the fetal heart rate, segment intervals, normalised amplitude and the fetal heart axis. Three months postpartum, we will evaluate if a newborn is healthy through a questionnaire. Fetal electrocardiography could be a promising tool in the screening program for congenital heart diseases. The electrocardiogram is a depiction of the intimate relationship between the cardiac nerve conduction pathways and the structural morphology of the fetal heart, and therefore particularly suitable for the detection of secondary effects due to a congenital heart disease (hypotrophy, hypertrophy and conduction interruption).

Rejection of the maternal electrocardiogram in the electrohysterogram signal.

Science.gov (United States)

Leman, H; Marque, C

2000-08-01

The electrohysterogram (EHG) signal is mainly corrupted by the mother's electrocardiogram (ECG), which remains present despite analog filtering during acquisition. Wavelets are a powerful denoising tool and have already proved their efficiency on the EHG. In this paper, we propose a new method that employs the redundant wavelet packet transform. We first study wavelet packet coefficient histograms and propose an algorithm to automatically detect the histogram mode number. Using a new criterion, we compute a best basis adapted to the denoising. After EHG wavelet packet coefficient thresholding in the selected basis, the inverse transform is applied. The ECG seems to be very efficiently removed.

Availability of a baseline Electrocardiogram changes the application of the Sclarovsky-Birnbaum Myocardial Ischemia Grade

DEFF Research Database (Denmark)

Carlsen, Esben A; Bang, Lia E; Køber, Lars

2014-01-01

BACKGROUND AND AIMS: The electrocardiogram (ECG) based Sclarovsky-Birnbaum Ischemia Grade may be used to determine the prognosis of patients with ST-elevation myocardial infarction (STEMI). However, application of the method is based on assumption of the baseline QRS morphology. Thus, the aims...

[Research on electrocardiogram de-noising algorithm based on wavelet neural networks].

Science.gov (United States)

Wan, Xiangkui; Zhang, Jun

2010-12-01

In this paper, the ECG de-noising technology based on wavelet neural networks (WNN) is used to deal with the noises in Electrocardiogram (ECG) signal. The structure of WNN, which has the outstanding nonlinear mapping capability, is designed as a nonlinear filter used for ECG to cancel the baseline wander, electromyo-graphical interference and powerline interference. The network training algorithm and de-noising experiments results are presented, and some key points of the WNN filter using ECG de-noising are discussed.

Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only

NARCIS (Netherlands)

Vijgen, Sylvia M. C.; Westerhuis, Michelle E. M. H.; Opmeer, Brent C.; Visser, Gerard H. A.; Moons, Karl G. M.; Porath, Martina M.; Oei, Guid S.; van Geijn, Herman P.; Bolte, Antoinette C.; Willekes, Christine; Nijhuis, Jan G.; van Beek, Erik; Graziosi, Giuseppe C. M.; Schuitemaker, Nico W. E.; van Lith, Jan M. M.; van den Akker, Eline S. A.; Drogtrop, Addy P.; van Dessel, Hendrikus J. H. M.; Rijnders, Robbert J. P.; Oosterbaan, Herman P.; Mol, Ben Willem J.; Kwee, Anneke

2011-01-01

To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric

Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

DEFF Research Database (Denmark)

Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco

2017-01-01

AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG...

64-slice spiral CT coronary angiography with prospective electrocardiogram-gating: an initial study

International Nuclear Information System (INIS)

Yuan Xuchun; Wang Xianzhu; Liao Wenling; Chen Qin; Deng Huiyi

2008-01-01

Objective: To evaluate the feasibility of prospective electrocardiogram (ECG)-gating computed tomography coronary angiography (CTCA). Methods: Sixty patients with suspected or known coronary artery disease underwent 64-slice CTCA using prospective ECG-gating. Multi-planar reconstruction ( MPR), curved-planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) were used to demonstrate the coronary arteries. The image quality and radiation dose was evaluated. Results: The mean effective radiation dose was (2.7±0.2) mSv. 93.3% (720/772) segments of all coronary arteries were of diagnostic image quality, 44.2% (341/772)was classified as excellent and 49.1% (379/772)was good. Non-diagnostic coronary segments were found in 6.7% (52/772) of all coronary arteries. There were 5(8.3%) cases with severe coronary stenosis(>75%) or occlusion, 17 (28.4%) cases with moderate stenosis (50%-75%), 18 (30.0%) cases with mild stenosis (<50% )or irregular lumen, 20(33.3%) cases with normal coronary, artery. Conclusion: With a low radiation dose, prospective electrocardiogram (ECG)-gated coronary 64-MSCT angiography has a good potential for the detection of coronary stenosis, especially for excluding coronary artery disease. (authors)

Prognostic value of predischarge 12 lead electrocardiogram after myocardial infarction compared with other routine clinical variables

NARCIS (Netherlands)

Fioretti, P.; Tijssen, J. G.; Azar, A. J.; Lazzeroni, E.; Brower, R. W.; ten Katen, H. J.; Lubsen, J.; Hugenholtz, P. G.

1987-01-01

The prognostic value of QRS score (Selvester), ST depression, ST elevation, extrasystoles, P terminal force in V1, and QTc derived from the predischarge 12 lead electrocardiogram was assessed after myocardial infarction in 474 patients without intraventricular conduction defects, ventricular

Mechanism underlying the absence of ischemic changes on the exercise electrocardiogram in patients with abnormal exercise thallium-201 imaging and coronary artery disease

International Nuclear Information System (INIS)

Coplan, N.L.; Horowitz, S.F.; Hoffman, D.P.; Goldman, M.E.; Machac, J.

1985-01-01

Patients with coronary artery disease may have reversible abnormalities on a thallium myocardial perfusion study without simultaneous ischemic changes on the exercise electrocardiogram, but the mechanisms responsible for this disparity have not been fully elucidated. A group of 37 patients with angiographically demonstrated coronary artery disease and abnormal thallium perfusion imaging were divided into two groups on the basis of their exercise electrocardiographic ST segment response. Thirteen patients (Group A) had no significant electrocardiographic changes with exercise, while 24 patients (Group B) had ST changes consistent with ischemia during the test. There were no significant differences in clinical or angiographic characteristics between the two groups. Stress test results showed a similar mean duration of exercise in the two groups, but the patients in Group A achieved a significantly lower mean maximal heart rate and mean maximal double product. These results suggest that exercise thallium-electrocardiogram discordance is mediated by the level of myocardial workload achieved. An abnormal perfusion scan accompanying an exercise electrocardiogram which does not demonstrate any ischemic ST change may occur when there is sufficient increase in myocardial oxygen demand to result in differential augmentation of myocardial blood flow, but insufficient imbalance of supply and demand to result in signs of ischemia on the surface electrocardiogram

The normal electrocardiogram of four species of conscious raptors.

Science.gov (United States)

Talavera, J; Guzmán, M J; del Palacio, M J Fernández; Albert, A P; Bayón, A

2008-02-01

The aim of this study was to describe normal ECG patterns and values in four species of conscious raptors (Eurasian kestrel, Griffon vulture, Little owl, and Eurasian Eagle owl). Electrocardiograms were carried out in 75 conscious birds belonging to four species of raptors. Lead II waveforms were analysed to determine amplitudes and durations of waves and intervals. Morphologic patterns of P-QRS-T deflections were analysed in the six limb leads. Rhythm, heart rate, mean electrical axis, presence of Ta wave, ST slurring, and P-on-T phenomenon were also studied. The influence of species, body weight and heart rate in electrocardiographic variables were statistically analysed (P raptors that can be used to establish comparisons for clinical purposes.

Preventive effects of p-coumaric acid on cardiac hypertrophy and alterations in electrocardiogram, lipids, and lipoproteins in experimentally induced myocardial infarcted rats.

Science.gov (United States)

Roy, Abhro Jyoti; Stanely Mainzen Prince, P

2013-10-01

The present study evaluated the preventive effects of p-coumaric acid on cardiac hypertrophy and alterations in electrocardiogram, lipids, and lipoproteins in experimentally induced myocardial infarcted rats. Rats were pretreated with p-coumaric acid (8 mg/kg body weight) daily for a period of 7 days and then injected with isoproterenol (100mg/kg body weight) on 8th and 9th day to induce myocardial infarction. Myocardial infarction induced by isoproterenol was indicated by increased level of cardiac sensitive marker and elevated ST-segments in the electrocardiogram. Also, the levels/concentrations of serum and heart cholesterol, triglycerides and free fatty acids were increased in myocardial infarcted rats. Isoproterenol also increased the levels of serum low density and very low density lipoprotein cholesterol and decreased the levels of high density lipoprotein cholesterol. It also enhanced the activity of liver 3-hydroxy-3 methyl glutaryl-Coenzyme-A reductase. p-Coumaric acid pretreatment revealed preventive effects on all the biochemical parameters and electrocardiogram studied in myocardial infarcted rats. The in vitro study confirmed the free radical scavenging property of p-coumaric acid. Thus, p-coumaric acid prevented cardiac hypertrophy and alterations in lipids, lipoproteins, and electrocardiogram, by virtue of its antihypertrophic, antilipidemic, and free radical scavenging effects in isoproterenol induced myocardial infarcted rats. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluation of an electrocardiogram on QR code.

Science.gov (United States)

Nakayama, Masaharu; Shimokawa, Hiroaki

2013-01-01

An electrocardiogram (ECG) is an indispensable tool to diagnose cardiac diseases, such as ischemic heart disease, myocarditis, arrhythmia, and cardiomyopathy. Since ECG patterns vary depend on patient status, it is also used to monitor patients during treatment and comparison with ECGs with previous results is important for accurate diagnosis. However, the comparison requires connection to ECG data server in a hospital and the availability of data connection among hospitals is limited. To improve the portability and availability of ECG data regardless of server connection, we here introduce conversion of ECG data into 2D barcodes as text data and decode of the QR code for drawing ECG with Google Chart API. Fourteen cardiologists and six general physicians evaluated the system using iPhone and iPad. Overall, they were satisfied with the system in usability and accuracy of decoded ECG compared to the original ECG. This new coding system may be useful in utilizing ECG data irrespective of server connections.

Inferior ST-Elevation Acute Myocardial Infarction or an Inferior-Lead Brugada-like Electrocardiogram Pattern Associated With the Use of Pregabalin and Quetiapine?

Science.gov (United States)

Brunetti, Natale D; Ieva, Riccardo; Correale, Michele; Cuculo, Andrea; Santoro, Francesco; Guaricci, Andrea I; De Gennaro, Luisa; Gaglione, Antonio; Di Biase, Matteo

2016-01-01

The Brugada electrocardiogram pattern is characterized by coved-type ST-elevation (>2 mm) in the right precordial leads. We report the case of a 62-year-old man, with bipolar disorder, admitted to the emergency department because of dyspnea and chest discomfort. The patient was on treatment with pregabalin and quetiapine. Unexpectedly, electrocardiogram at admission showed diffuse ST-elevation, more evident in inferior leads, where a Brugada-like pattern was present. The patient underwent coronary angiography with a diagnosis of suspected acute coronary syndrome. Coronary angiography, however, showed mild coronary artery disease not requiring coronary angioplasty. Echocardiography did not reveal left ventricular dysfunction or pericardial effusion. Troponin levels remained normal over serial controls. Eventually, chest radiography showed lung opacities and consolidation suggestive for pneumonia. To the best of our knowledge, this is one of the first cases showing a transient Brugada-like electrocardiogram pattern in inferior leads, probably amplified by the administration of pregabalin and quetiapine.

Electrocardiogram (ECG Signal Modeling and Noise Reduction Using Hopfield Neural Networks

Directory of Open Access Journals (Sweden)

F. Bagheri

2013-02-01

Full Text Available The Electrocardiogram (ECG signal is one of the diagnosing approaches to detect heart disease. In this study the Hopfield Neural Network (HNN is applied and proposed for ECG signal modeling and noise reduction. The Hopfield Neural Network (HNN is a recurrent neural network that stores the information in a dynamic stable pattern. This algorithm retrieves a pattern stored in memory in response to the presentation of an incomplete or noisy version of that pattern. Computer simulation results show that this method can successfully model the ECG signal and remove high-frequency noise.

A randomized control trial comparing use of a novel electrocardiogram simulator with traditional teaching in the acquisition of electrocardiogram interpretation skill.

Science.gov (United States)

Fent, Graham; Gosai, Jivendra; Purva, Makani

2016-01-01

Accurate interpretation of the electrocardiogram (ECG) remains an essential skill for medical students and junior doctors. While many techniques for teaching ECG interpretation are described, no single method has been shown to be superior. This randomized control trial is the first to investigate whether teaching ECG interpretation using a computer simulator program or traditional teaching leads to improved scores in a test of ECG interpretation among medical students and postgraduate doctors immediately after and 3months following teaching. Participants' opinions of the program were assessed using a questionnaire. There were no differences in ECG interpretation test scores immediately after or 3months after teaching in the lecture or simulator groups. At present therefore, there is insufficient evidence to suggest that ECG simulator programs are superior to traditional teaching. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigating the Effects of the 0.05 Hz First-order High-pass Filter on the Electrocardiogram

DEFF Research Database (Denmark)

Isaksen, Jonas; Leber, Remo; Schmid, Ramun

2016-01-01

Background: A thorough review is needed for the first-order 0.05 Hz high-pass filter, which was introduced almost fifty years ago before modern techniques were available. We quantify the effectiveness of inverse filtering and assess the changes that the filter imposes on the electrocardiogram (ECG...

Apical hypertrophy associated with rapid T wave inversion on the electrocardiogram.

Science.gov (United States)

Yamanari, H; Saito, D; Mikio, K; Nakamura, K; Nanba, T; Morita, H; Mizuo, K; Sato, T; Ohe, T

1995-01-01

A 53-year-old man who had no chest pain and no family history of heart disease demonstrated a rapid T wave change on an electrocardiogram, from a positive T wave to a giant negative T wave, within 1 year. Echocardiography showed no left ventricular hypertrophy before or after the T wave change. Cine-magnetic resonance imaging revealed focal apical hypertrophy after the appearance of the giant negative T wave. Although T wave inversions sometimes develop within a short period in patients with hypertrophic cardiomyopathy, they are rare in a patient without hypertension or chest pain.

Usefulness of the Electrocardiogram in Predicting Cardiovascular Mortality in Asymptomatic Adults With Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis Study)

DEFF Research Database (Denmark)

Greve, Anders M; Dalsgaard, Morten; Bang, Casper N

2014-01-01

Hypertension and coronary heart disease are common in aortic stenosis (AS) and may impair prognosis for similar AS severity. Different changes in the electrocardiogram may be reflective of the separate impacts of AS, hypertension, and coronary heart disease, which could lead to enhanced risk...... stratification in AS. The aim of this study was therefore to examine if combining prognostically relevant electrocardiographic (ECG) findings improves prediction of cardiovascular mortality in asymptomatic AS. All patients with baseline electrocardiograms in the SEAS study were included. The primary end point...

MagnetoHemoDynamics in the aorta and electrocardiograms

International Nuclear Information System (INIS)

Martin, Vincent; Drochon, Agnès; Fokapu, Odette; Gerbeau, Jean-Frédéric

2012-01-01

This paper addresses a complex multi-physical phenomenon involving cardiac electrophysiology and hemodynamics. The purpose is to model and simulate a phenomenon that has been observed in magnetic resonance imaging machines: in the presence of a strong magnetic field, the T-wave of the electrocardiogram (ECG) gets bigger, which may perturb ECG-gated imaging. This is due to a magnetohydrodynamic (MHD) effect occurring in the aorta. We reproduce this experimental observation through computer simulations on a realistic anatomy, and with a three-compartment model: inductionless MHD equations in the aorta, bi-domain equations in the heart and electrical diffusion in the rest of the body. These compartments are strongly coupled and solved using finite elements. Several benchmark tests are proposed to assess the numerical solutions and the validity of some modeling assumptions. Then, ECGs are simulated for a wide range of magnetic field intensities (from 0 to 20 T). (paper)

Sinabro: A Smartphone-Integrated Opportunistic Electrocardiogram Monitoring System.

Science.gov (United States)

Kwon, Sungjun; Lee, Dongseok; Kim, Jeehoon; Lee, Youngki; Kang, Seungwoo; Seo, Sangwon; Park, Kwangsuk

2016-03-11

In our preliminary study, we proposed a smartphone-integrated, unobtrusive electrocardiogram (ECG) monitoring system, Sinabro, which monitors a user's ECG opportunistically during daily smartphone use without explicit user intervention. The proposed system also monitors ECG-derived features, such as heart rate (HR) and heart rate variability (HRV), to support the pervasive healthcare apps for smartphones based on the user's high-level contexts, such as stress and affective state levels. In this study, we have extended the Sinabro system by: (1) upgrading the sensor device; (2) improving the feature extraction process; and (3) evaluating extensions of the system. We evaluated these extensions with a good set of algorithm parameters that were suggested based on empirical analyses. The results showed that the system could capture ECG reliably and extract highly accurate ECG-derived features with a reasonable rate of data drop during the user's daily smartphone use.

Sinabro: A Smartphone-Integrated Opportunistic Electrocardiogram Monitoring System

Directory of Open Access Journals (Sweden)

Sungjun Kwon

2016-03-01

Full Text Available In our preliminary study, we proposed a smartphone-integrated, unobtrusive electrocardiogram (ECG monitoring system, Sinabro, which monitors a user’s ECG opportunistically during daily smartphone use without explicit user intervention. The proposed system also monitors ECG-derived features, such as heart rate (HR and heart rate variability (HRV, to support the pervasive healthcare apps for smartphones based on the user’s high-level contexts, such as stress and affective state levels. In this study, we have extended the Sinabro system by: (1 upgrading the sensor device; (2 improving the feature extraction process; and (3 evaluating extensions of the system. We evaluated these extensions with a good set of algorithm parameters that were suggested based on empirical analyses. The results showed that the system could capture ECG reliably and extract highly accurate ECG-derived features with a reasonable rate of data drop during the user’s daily smartphone use.

Atrial Fibrillation Predictors: Importance of the Electrocardiogram.

Science.gov (United States)

German, David M; Kabir, Muammar M; Dewland, Thomas A; Henrikson, Charles A; Tereshchenko, Larisa G

2016-01-01

Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed. © 2015 Wiley Periodicals, Inc.

Predicting new-onset of postoperative atrial fibrillation in patients undergoing cardiac surgery using semi-automatic reading of perioperative electrocardiograms

DEFF Research Database (Denmark)

Gu, Jiwei; Graff, Claus; Melgaard, Jacob

2015-01-01

P10 Predicting new-onset of postoperative atrial fibrillation in patients undergoingcardiac surgery using semi-automatic reading of perioperative electrocardiograms. Jiwei Gu, Claus Graff, Jacob Melgaard, Søren Lundbye-Christensen, Erik Berg Schmidt, Christian Torp-Pedersen, Kristinn Thorsteinsson......, Jan Jesper Andreasen. Aalborg, DenmarkBackground: Postoperative new onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. The aim of this study was to evaluate if semi-automatic readings of perioperative electrocardiograms (ECGs) is of any value in predicting POAF after...... ECG monitoring. A semi-automatic machine capable of reading differentparameters of digitalized ECG’s was used to read both lead specific (P/QRS/T amplitudes/intervals) and global measurements (P-duration/QRS-duration/PR-interval/QT/Heart Rate/hypertrophy).Results: We divided the patients into two...

Development of electrocardiogram intervals during growth of FVB/N neonate mice

Science.gov (United States)

2010-01-01

Background Electrocardiography remains the best diagnostic tool and therapeutic biomarker for a spectrum of pediatric diseases involving cardiac or autonomic nervous system defects. As genetic links to these disorders are established and transgenic mouse models produced in efforts to understand and treat them, there is a surprising lack of information on electrocardiograms (ECGs) and ECG abnormalities in neonate mice. This is likely due to the trauma and anaesthesia required of many legacy approaches to ECG recording in mice, exacerbated by the fragility of many mutant neonates. Here, we use a non-invasive system to characterize development of the heart rate and electrocardiogram throughout the growth of conscious neonate FVB/N mice. Results We examine ECG waveforms as early as two days after birth. At this point males and females demonstrate comparable heart rates that are 50% lower than adult mice. Neonatal mice exhibit very low heart rate variability. Within 12 days of birth PR, QRS and QTc interval durations are near adult values while heart rate continues to increase until weaning. Upon weaning FVB/N females quickly develop slower heart rates than males, though PR intervals are comparable between sexes until a later age. This suggests separate developmental events may contribute to these gender differences in electrocardiography. Conclusions We provide insight with a new level of detail to the natural course of heart rate establishment in neonate mice. ECG can now be conveniently and repeatedly used in neonatal mice. This should serve to be of broad utility, facilitating further investigations into development of a diverse group of diseases and therapeutics in preclinical mouse studies. PMID:20735846

Mobile Messaging Services-Based Personal Electrocardiogram Monitoring System

Directory of Open Access Journals (Sweden)

Ashraf A. Tahat

2009-01-01

Full Text Available A mobile monitoring system utilizing Bluetooth and mobile messaging services (MMS/SMSs with low-cost hardware equipment is proposed. A proof of concept prototype has been developed and implemented to enable transmission of an Electrocardiogram (ECG signal and body temperature of a patient, which can be expanded to include other vital signs. Communication between a mobile smart-phone and the ECG and temperature acquisition apparatus is implemented using the popular personal area network standard specification Bluetooth. When utilizing MMS for transmission, the mobile phone plots the received ECG signal and displays the temperature using special application software running on the client mobile phone itself, where the plot can be captured and saved as an image before transmission. Alternatively, SMS can be selected as a transmission means, where in this scenario, dedicated application software is required at the receiving device. The experimental setup can be operated for monitoring from anywhere in the globe covered by a cellular network that offers data services.

Mobile messaging services-based personal electrocardiogram monitoring system.

Science.gov (United States)

Tahat, Ashraf A

2009-01-01

A mobile monitoring system utilizing Bluetooth and mobile messaging services (MMS/SMSs) with low-cost hardware equipment is proposed. A proof of concept prototype has been developed and implemented to enable transmission of an Electrocardiogram (ECG) signal and body temperature of a patient, which can be expanded to include other vital signs. Communication between a mobile smart-phone and the ECG and temperature acquisition apparatus is implemented using the popular personal area network standard specification Bluetooth. When utilizing MMS for transmission, the mobile phone plots the received ECG signal and displays the temperature using special application software running on the client mobile phone itself, where the plot can be captured and saved as an image before transmission. Alternatively, SMS can be selected as a transmission means, where in this scenario, dedicated application software is required at the receiving device. The experimental setup can be operated for monitoring from anywhere in the globe covered by a cellular network that offers data services.

Using the 12-Lead Electrocardiogram in the Care of Athletic Patients.

Science.gov (United States)

Yeo, Tee Joo; Sharma, Sanjay

2016-11-01

This article summarizes the role of the 12-lead electrocardiogram (ECG) for the clinical care of athletes, with particular reference to the influence of age, gender, ethnicity, and type of sport on the appearance of the ECG, and its role in differentiating physiologic exercise-related changes from pathologic conditions implicated in sudden cardiac death (SCD). The article also explores the potential role of the ECG in detecting athletes at risk of SCD. In addition, the article reviews the evolution of ECG interpretation criteria and emphasizes the limitations of the ECG as well as the potential for future research. Copyright © 2016 Elsevier Inc. All rights reserved.

[Ischemic Changes in the Electrocardiogram and Circulatory Collapse Accompanied by Severe Anemia Owing to the Delay of Red Blood Cell Concentrate Transfusion in Two Patients with Intraoperative Massive Bleeding].

Science.gov (United States)

Horiuchi, Toshinori; Noguchi, Teruo; Kurita, Naoko; Yamaguchi, Ayako; Takeda, Masafumi; Sha, Keiichi; Nagahata, Toshihiro

2016-01-01

We present two patients developing intraoperative massive bleeding and showed ischemic changes in the electrocardiogram and circulatory collapse accompanied by severe anemia owing to the delay of red blood cell concentrate transfusion. One patient underwent hepatectomy and the other pancreaticoduodenectomy. Their lowest hemoglobin concentration was around 2 g x dl(-1), and they showed ischemic changes in the electrocardiogram and severe decreases in blood pressure. The former received compatible red blood cell concentrate and the latter received uncrossmatched same blood group red blood cell concentrate immediately, and their electrocardiogram and blood pressure quickly improved. To avoid life-threatening anemia, emergency red blood cell concentrate transfusion including compatible different blood group transfusion should be applied for intraoperative massive bleeding.

Classification of hydration status using electrocardiogram and machine learning

Science.gov (United States)

Kaveh, Anthony; Chung, Wayne

2013-10-01

The electrocardiogram (ECG) has been used extensively in clinical practice for decades to non-invasively characterize the health of heart tissue; however, these techniques are limited to time domain features. We propose a machine classification system using support vector machines (SVM) that uses temporal and spectral information to classify health state beyond cardiac arrhythmias. Our method uses single lead ECG to classify volume depletion (or dehydration) without the lengthy and costly blood analysis tests traditionally used for detecting dehydration status. Our method builds on established clinical ECG criteria for identifying electrolyte imbalances and lends to automated, computationally efficient implementation. The method was tested on the MIT-BIH PhysioNet database to validate this purely computational method for expedient disease-state classification. The results show high sensitivity, supporting use as a cost- and time-effective screening tool.

Robust suppression of nonstationary power-line interference in electrocardiogram signals

International Nuclear Information System (INIS)

Li, Guojun; Zeng, Xiaopin; Zhou, Yu; Liu, Guojin; Zhou, Xichuan; Zhou, Xiaona

2012-01-01

It is a challenge to suppress time-varying power-line interference (PLI) with various levels in electrocardiogram (ECG) signals. Most previous attempts of tracking and suppressing the nonstationary PLI signal are based on the least-squares (LS) algorithm. This makes these methods susceptible to QRS complex in suppressing a low-level PLI signal which is frequently coupled in battery-operated ECG equipment. To address the limitation of LS-based methods, this study presents a robust PLI suppression system based on a robust extension of the Kalman filter. In addition, we used an improved version of empirical mode decomposition to further attenuate the QRS complex. Experiments show that our system could effectively suppress the PLI while preserving meaningful ECG components at various interference levels. (paper)

The Electrocardiogram as an Electronic Filter and Why AC Circuits Are Important for Pre-Health Physics Students

Science.gov (United States)

Dunlap, Justin C.; Kutschera, Ellynne; Van Ness, Grace R.; Widenhorn, Ralf

2015-01-01

We present a general physics laboratory exercise that centres around the use of the electrocardiogram sensor as an application of circuits and electronic signal filtering. Although these topics are commonly taught in the general physics classroom, many students consider topics such as alternating current as unrelated to their future professions.…

Applicability of initial optimal maternal and fetal electrocardiogram combination vectors to subsequent recordings

International Nuclear Information System (INIS)

Yan Hua-Wen; Huang Xiao-Lin; Zhao Ying; Si Jun-Feng; Liu Hong-Xing; Liu Tie-Bing

2014-01-01

A series of experiments are conducted to confirm whether the vectors calculated for an early section of a continuous non-invasive fetal electrocardiogram (fECG) recording can be directly applied to subsequent sections in order to reduce the computation required for real-time monitoring. Our results suggest that it is generally feasible to apply the initial optimal maternal and fetal ECG combination vectors to extract the fECG and maternal ECG in subsequent recorded sections. (interdisciplinary physics and related areas of science and technology)

Use of the Surface Electrocardiogram to Define the Nature of Challenging Arrhythmias.

Science.gov (United States)

Singh, David K; Peter, C Thomas

2016-03-01

Despite unprecedented advances in technology, the electrocardiogram (ECG) remains essential to the practice of modern electrophysiology. Since its emergence at the turn of the nineteenth century, the form of the ECG has changed little. What has changed is our ability to understand the complex mechanisms that underlie various arrhythmias. In this article, the authors review several important principles of ECG interpretation by providing illustrative tracings. The authors also highlight several important concepts that be can used in ECG analysis. There are several fundamental principles that should be considered in ECG interpretation. Copyright © 2016 Elsevier Inc. All rights reserved.

The history, hotspots, and trends of electrocardiogram.

Science.gov (United States)

Yang, Xiang-Lin; Liu, Guo-Zhen; Tong, Yun-Hai; Yan, Hong; Xu, Zhi; Chen, Qi; Liu, Xiang; Zhang, Hong-Hao; Wang, Hong-Bo; Tan, Shao-Hua

2015-07-01

The electrocardiogram (ECG) has broad applications in clinical diagnosis and prognosis of cardiovascular disease. Many researchers have contributed to its progressive development. To commemorate those pioneers, and to better study and promote the use of ECG, we reviewed and present here a systematic introduction about the history, hotspots, and trends of ECG. In the historical part, information including the invention, improvement, and extensive applications of ECG, such as in long QT syndrome (LQTS), angina, and myocardial infarction (MI), are chronologically presented. New technologies and applications from the 1990s are also introduced. In the second part, we use the bibliometric analysis method to analyze the hotspots in the field of ECG-related research. By using total citations and year-specific total citations as our main criteria, four key hotspots in ECG-related research were identified from 11 articles, including atrial fibrillation, LQTS, angina and MI, and heart rate variability. Recent studies in those four areas are also reported. In the final part, we discuss the future trends concerning ECG-related research. The authors believe that improvement of the ECG instrumentation, big data mining for ECG, and the accuracy of diagnosis and application will be areas of continuous concern.

Intrapartum electrocardiogram alteration in fetuses with congenital heart disease: a case-control study.

Science.gov (United States)

Gay, Estelle; Bornallet, Géraldine; Gaucherand, Pascal; Doret, Muriel

2015-11-01

To assess if the fetal electrocardiogram especially ST segment is modified by congenital heart diseases: modifications in frequencies of the different ST events and modifications in signal quality. A retrospective case-control study, comparing frequencies of the different ST events and the quality of the signal between fetuses with congenital heart diseases and fetuses without congenital heart disease. From 2000 to 2011, fifty-eight fetuses with congenital heart disease had their heart rate recording using a STAN device during labor. Control group was fetuses who were born just before a case and had a STAN as a second line for intrapartum surveillance. Cases and controls were matched on parity, gestational age at birth, presence of growth restriction and umbilical artery pH. Frequencies of the different ST event and quality of the signal were first analyzed for the global labor recording, and then separately for the first and the second phase of labor. No statistically significant difference in ST event frequencies between fetuses with congenital heart disease and the control group was found. Regarding the quality of the signal, 11.49% (±18.82) of recording time is a signal loss for fetus with congenital heart disease whereas only 5.18% (±10.67) for the control group (p=0.028). This is the first study investigating for intrapartum electrocardiogram modification in fetus with congenital heart disease. Congenital heart diseases do not modify frequencies of ST events. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Portable electrocardiogram device using Android smartphone.

Science.gov (United States)

Brucal, S G E; Clamor, G K D; Pasiliao, L A O; Soriano, J P F; Varilla, L P M

2016-08-01

Portable electrocardiogram (ECG) capturing device can be interfaced to a smart phone installed with an android-based application (app). This app processes and analyses the data sent by the device to provide an interpretation of the patient/user's heart current condition (e.g.: beats per minute, heart signal waveform, R-R interval). The ECG recorded by the app is stored in the smart phone's Secure Digital (SD) card and cloud storage which can be accessed remotely by a physician to aid in providing medical diagnosis. The project aims to help patients living at a far distance from hospitals and experience difficulty in consulting their physician for regular check-ups, and assist doctors in regularly monitoring their patient's heart condition. The hardware data acquisition device and software application were subjected to trials in a clinic with volunteer-patients to measure the ECG and heart rate, data saving speed on the SD card, success rate of the saved data and uploaded file. Different ECG tests using the project prototype were done for 12 patients/users and yielded a reading difference of 7.61% in an R-R interval reading and 5.35% in heart rate reading as compared with the cardiologist's conventional 12-electrode ECG machine. Using the developed ECG device, it took less than 5 seconds to save ECG reading using SD card and approximately 2 minutes to upload via cloud.

Respiratory Information Extraction from Electrocardiogram Signals

KAUST Repository

Amin, Gamal El Din Fathy

2010-12-01

The Electrocardiogram (ECG) is a tool measuring the electrical activity of the heart, and it is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological processes. The respiratory activity is a prominent process that affects the ECG signal due to the close proximity of the heart and the lungs. In this thesis, several methods for the extraction of respiratory process information from the ECG signal are presented. These methods allow an estimation of the lung volume and the lung pressure from the ECG signal. The potential benefit of this is to eliminate the corresponding sensors used to measure the respiration activity. A reduction of the number of sensors connected to patients will increase patients’ comfort and reduce the costs associated with healthcare. As a further result, the efficiency of diagnosing respirational disorders will increase since the respiration activity can be monitored with a common, widely available method. The developed methods can also improve the detection of respirational disorders that occur while patients are sleeping. Such disorders are commonly diagnosed in sleeping laboratories where the patients are connected to a number of different sensors. Any reduction of these sensors will result in a more natural sleeping environment for the patients and hence a higher sensitivity of the diagnosis.

Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries

International Nuclear Information System (INIS)

Berger, H.J.; Sands, M.J.; Davies, R.A.; Wackers, F.J.; Alexander, J.; Lachman, A.S.; Williams, B.W.; Zaret, B.L.

1981-01-01

Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. 201 Tl imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced 201 Tl perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries

A Review on the Nonlinear Dynamical System Analysis of Electrocardiogram Signal.

Science.gov (United States)

Nayak, Suraj K; Bit, Arindam; Dey, Anilesh; Mohapatra, Biswajit; Pal, Kunal

2018-01-01

Electrocardiogram (ECG) signal analysis has received special attention of the researchers in the recent past because of its ability to divulge crucial information about the electrophysiology of the heart and the autonomic nervous system activity in a noninvasive manner. Analysis of the ECG signals has been explored using both linear and nonlinear methods. However, the nonlinear methods of ECG signal analysis are gaining popularity because of their robustness in feature extraction and classification. The current study presents a review of the nonlinear signal analysis methods, namely, reconstructed phase space analysis, Lyapunov exponents, correlation dimension, detrended fluctuation analysis (DFA), recurrence plot, Poincaré plot, approximate entropy, and sample entropy along with their recent applications in the ECG signal analysis.

[Synchronous playing and acquiring of heart sounds and electrocardiogram based on labVIEW].

Science.gov (United States)

Dan, Chunmei; He, Wei; Zhou, Jing; Que, Xiaosheng

2008-12-01

In this paper is described a comprehensive system, which can acquire heart sounds and electrocardiogram (ECG) in parallel, synchronize the display; and play of heart sound and make auscultation and check phonocardiogram to tie in. The hardware system with C8051F340 as the core acquires the heart sound and ECG synchronously, and then sends them to indicators, respectively. Heart sounds are displayed and played simultaneously by controlling the moment of writing to indicator and sound output device. In clinical testing, heart sounds can be successfully located with ECG and real-time played.

Pit-a-Pat: A Smart Electrocardiogram System for Detecting Arrhythmia.

Science.gov (United States)

Park, Juyoung; Lee, Kuyeon; Kang, Kyungtae

2015-10-01

Electrocardiogram (ECG) telemonitoring is one of the most promising applications of medical telemetry. However, previous approaches to ECG telemonitoring have largely relied on public databases of ECG results. In this article we propose a smart ECG system called Pit-a-Pat, which extracts features from ECG signals and detects arrhythmia. It is designed to run on an Android™ (Google, Mountain View, CA) device, without requiring modifications to other software. We implemented the Pit-a-Pat system using a commercial ECG device, and the experimental results demonstrate the effectiveness and accuracy of Pit-a-Pat for monitoring the ECG signal and analyzing the cardiac activity of a mobile patient. The proposed system allows monitoring of cardiac activity with automatic analysis, thereby providing a convenient, inexpensive, and ubiquitous adjunct to personal healthcare.

Adaptive noise canceling of electrocardiogram artifacts in single channel electroencephalogram.

Science.gov (United States)

Cho, Sung Pil; Song, Mi Hye; Park, Young Cheol; Choi, Ho Seon; Lee, Kyoung Joung

2007-01-01

A new method for estimating and eliminating electrocardiogram (ECG) artifacts from single channel scalp electroencephalogram (EEG) is proposed. The proposed method consists of emphasis of QRS complex from EEG using least squares acceleration (LSA) filter, generation of synchronized pulse with R-peak and ECG artifacts estimation and elimination using adaptive filter. The performance of the proposed method was evaluated using simulated and real EEG recordings, we found that the ECG artifacts were successfully estimated and eliminated in comparison with the conventional multi-channel techniques, which are independent component analysis (ICA) and ensemble average (EA) method. From this we can conclude that the proposed method is useful for the detecting and eliminating the ECG artifacts from single channel EEG and simple to use for ambulatory/portable EEG monitoring system.

Clinical evaluation of automated processing of electrocardiograms by the Veterans Administration program (AVA 3.4).

Science.gov (United States)

Brohet, C R; Richman, H G

1979-06-01

Automated processing of electrocardiograms by the Veterans Administration program was evaluated for both agreement with physician interpretation and interpretative accuracy as assessed with nonelectrocardiographic criteria. One thousand unselected electrocardiograms were analyzed by two reviewer groups, one familiar and the other unfamiliar with the computer program. A significant number of measurement errors involving repolarization changes and left axis deviation occurred; however, interpretative disagreements related to statistical decision were largely language-related. Use of a printout with a more traditional format resulted in agreement with physician interpretation by both reviewer groups in more than 80 percent of cases. Overall sensitivity based on agreement with nonelectrocardiographic criteria was significantly greater with use of the computer program than with use of the conventional criteria utilized by the reviewers. This difference was particularly evident in the subgroup analysis of myocardial infarction and left ventricular hypertrophy. The degree of overdiagnosis of left ventricular hypertrophy and posteroinferior infarction was initially unacceptable, but this difficulty was corrected by adjustment of probabilities. Clinical acceptability of the Veterans Administration program appears to require greater physician education than that needed for other computer programs of electrocardiographic analysis; the flexibility of interpretation by statistical decision offers the potential for better diagnostic accuracy.

Myocardial ischemia analysis based on electrocardiogram QRS complex

International Nuclear Information System (INIS)

Song, J.; Yan, H.; Xu, Z.; Yu, X.; Zhu, R.

2011-01-01

Full text: Electrocardiogram (ECG) is an economic, convenient, and non-invasive detecting tool in myocardial ischemia (MI), and its clinical appearance is mainly exhibited by the changes in ST-T complex. Recently, QRS complex characters were proposed to analyze MI by more and more researchers. In this paper, various QRS complex characters were extracted in ECG signals, and their relationship was analyzed systematically. As a result, these characters were divided into two groups, and there existed good relationship among them for each group, while the poor relationship between the groups. Then these QRS complex characters were applied for statistical analysis on MI, and five characters had significant differences after ECG recording verification, which were: QRS upward and downward slopes, transient heart rate, angle R and angle Q. On the other hand, these QRS complex characters were analyzed in frequency domain. Experimental results showed that the frequency features of RR interval series (Heart Rate Variability, HRV), and QRS barycenter sequence had signjficant differences between MI states and normal states. Moreover, QRS barycenter sequence performed better. (author)

Measurement and monitoring of electrocardiogram belt tension in premature infants for assessment of respiratory function

OpenAIRE

Hegyi Thomas; Hiatt Mark; Ciaccio Edward J; Drzewiecki Gary M

2007-01-01

Abstract Background Monitoring of the electrocardiogram (ECG) in premature infants with conventional adhesive-backed electrodes can harm their sensitive skin. Use of an electrode belt prevents skin irritation, but the effect of belt pressure on respiratory function is unknown. A strain gauge sensor is described which measures applied belt tension. Method The device frame was comprised of an aluminum housing and slide to minimize the device weight. Velcro tabs connected housing and slide to op...

Use of Electrocardiogram as Part of the Preparticipation Examination.

Science.gov (United States)

Chain, Kelly; Gregory, Andrew

2016-01-01

A sudden cardiac event or death in a young athlete is a traumatic and memorable event. These tragic events have long-lasting and widespread influences that not only affect the person's immediate family, but also have profound effects on the team, school, and entire community. Over the past several decades there has been a significant research effort in the area of sudden cardiac death (SCD) in athletes in hopes of decreasing preventable deaths. One area of research and discussion that has emerged is the use of electrocardiograms (EKGs) in preparticipation screening examinations as a tool to help identify athletes at risk for SCD. The use of an EKG in addition to a detailed history and physical examination is a controversial and frequently debated topic. To help sort through some of the controversy, this article discusses some of the pros and cons of incorporating the EKG as a screening modality in the preparticipation evaluation for clearance to participate in sports. Copyright 2016, SLACK Incorporated.

Teaching the interpretation of electrocardiograms: which method is best?

Science.gov (United States)

Fent, Graham; Gosai, Jivendra; Purva, Makani

2015-01-01

Electrocardiogram (ECG) interpretation is poorly performed at undergraduate and post-graduate level. Incorrect ECG interpretation can lead to serious clinical error. Despite the incorporation of computerized ECG interpretation software into modern ECG machines, the sensitivity and specificity of current technology remain poor, emphasizing the on-going need for doctors to perform ECG interpretation accurately. This is the first review in this important area and aims to critically evaluate the current literature in relation to the optimal format and method of teaching ECG interpretation at undergraduate and postgraduate level. No single method or format of teaching is most effective in delivering ECG interpretation skills; however, self-directed learning appears to be associated with poorer interpretation competence. Summative in preference to formative assessment is associated with improved interpretation competence. Web-based learning offers a promising modern approach to learning ECG interpretation, though caution must be exercised in accessing user-uploaded content to supplement learning. Copyright © 2015 Elsevier Inc. All rights reserved.

Utility of electrocardiogram in the assessment and monitoring of pulmonary hypertension (idiopathic or secondary to pulmonary developmental abnormalities) in patients≤18 years of age.

Science.gov (United States)

Lau, Kelvin C; Frank, David B; Hanna, Brian D; Patel, Akash R

2014-07-15

Electrocardiograms have utility in disease stratification and monitoring in adult pulmonary arterial hypertension (PAH). We examined the electrocardiographic findings that are common in pediatric PAH and assessed for correlation with disease severity and progression. We retrospectively identified patients aged≤18 years followed at a single institution from January 2001 to June 2012 with catheterization-confirmed diagnosis of idiopathic PAH and PAH secondary to pulmonary developmental abnormalities. Patients with an electrocardiography performed within 60 days of catheterization were included. Primary and secondary outcomes are the prevalence of abnormal electrocardiographic findings at the time of catheterization and the association between electrocardiographic and hemodynamic findings and electrocardiographic changes with disease progression on follow-up catheterization, respectively. Of the 100 electrocardiography-catheterization pairs derived from the 46 patients identified, 93% had an electrocardiographic abnormality: 78% had right ventricular hypertrophy (RVH) and 52% had right axis deviation (RAD) for age. In patients with idiopathic PAH, the presence of RVH and RAD correlated with pulmonary vascular resistance and transpulmonary gradient. RAD and RVH on baseline electrocardiogram was associated with an increased risk of disease progression on subsequent catheterization (odds ratio 11.0, 95% confidence interval 1.3 to 96.2, p=0.03) after adjusting for PAH subgroup. The sensitivity, specificity, and positive and negative predictive values of RAD and RVH on baseline electrocardiogram for disease progression were 92%, 48%, 33%, and 95%, respectively. In conclusion, electrocardiographic abnormalities are common in pediatric PAH. RAD and RVH on electrocardiogram were associated with worse hemodynamics, whereas their absence is suggestive of a lack of disease progression. Copyright © 2014 Elsevier Inc. All rights reserved.

A Review on the Nonlinear Dynamical System Analysis of Electrocardiogram Signal

Science.gov (United States)

Mohapatra, Biswajit

2018-01-01

Electrocardiogram (ECG) signal analysis has received special attention of the researchers in the recent past because of its ability to divulge crucial information about the electrophysiology of the heart and the autonomic nervous system activity in a noninvasive manner. Analysis of the ECG signals has been explored using both linear and nonlinear methods. However, the nonlinear methods of ECG signal analysis are gaining popularity because of their robustness in feature extraction and classification. The current study presents a review of the nonlinear signal analysis methods, namely, reconstructed phase space analysis, Lyapunov exponents, correlation dimension, detrended fluctuation analysis (DFA), recurrence plot, Poincaré plot, approximate entropy, and sample entropy along with their recent applications in the ECG signal analysis. PMID:29854361

Retrospective study of pre-anesthetic electrocardiogram examination of 700 dogs conducted at the Veterinary Hospital of UFMG (2013-2014

Directory of Open Access Journals (Sweden)

Ana Flávia Machado Botelho

2016-02-01

Full Text Available Abstract: Pre-operative electrocardiograms performed in 700 dogs were analyzed in order to establish correlation between sex, age, indication for surgery, body condition score, breed and weight. Initially a clinical questionnaire was filled out from each owner, including age, breed, sex, weight, clinical history and surgical indication. Dogs above 6 years of age or those showing any kind of cardiac auscultation disturbances were referred to electrocardiogram (ECG evaluation. All ECG were performed and analyzed by the same veterinary specialist. Abnormalities at ECG were founnd in 364 of 700 (52% evaluated dogs, and the most frequent variation was sinus arrhythmia, observed in 293 dogs (25.4%. No significant correlation was found between the electrocardiographic alterations with weight, sex and age of the animals. Therefore ECG should be conducted routinely regardless of age, sex, breed or surgical indication, highlighting its value for determining a safe anesthetic protocol that promotes minimal cardiopulmonary depression and allows rapid post-surgical recovery.

Intelligent classification of electrocardiogram (ECG) signal using extended Kalman Filter (EKF) based neuro fuzzy system.

Science.gov (United States)

Meau, Yeong Pong; Ibrahim, Fatimah; Narainasamy, Selvanathan A L; Omar, Razali

2006-05-01

This study presents the development of a hybrid system consisting of an ensemble of Extended Kalman Filter (EKF) based Multi Layer Perceptron Network (MLPN) and a one-pass learning Fuzzy Inference System using Look-up Table Scheme for the recognition of electrocardiogram (ECG) signals. This system can distinguish various types of abnormal ECG signals such as Ventricular Premature Cycle (VPC), T wave inversion (TINV), ST segment depression (STDP), and Supraventricular Tachycardia (SVT) from normal sinus rhythm (NSR) ECG signal.

A Correction Formula for the ST Segment Measurements for the AC-coupled Electrocardiograms

DEFF Research Database (Denmark)

Schmid, Ramun; Isaksen, Jonas; Leber, Remo

2017-01-01

Goal: The ST segment of an electrocardiogram (ECG) is very important for the correct diagnosis of an acute myocardial infarction. Most clinical ECGs are recorded using an AC-coupled ECG amplifier. It is well known, that first-order high-pass filters used for the AC coupling can affect the ST...... segment of an ECG. This effect is stronger the higher the filter's cut-off frequency is and the larger the QRS integral is. We present a formula that estimates these changes in the ST segment and therefore allows for correcting ST measurements that are based on an AC-coupled ECG. Methods: The presented...

Normalizing Electrocardiograms of Both Healthy Persons and Cardiovascular Disease Patients for Biometric Authentication

Science.gov (United States)

Zhao, Miaomiao; Li, Fan; Wang, Guoqing; Zhou, Fengfeng

2013-01-01

Although electrocardiogram (ECG) fluctuates over time and physical activity, some of its intrinsic measurements serve well as biometric features. Considering its constant availability and difficulty in being faked, the ECG signal is becoming a promising factor for biometric authentication. The majority of the currently available algorithms only work well on healthy participants. A novel normalization and interpolation algorithm is proposed to convert an ECG signal into multiple template cycles, which are comparable between any two ECGs, no matter the sampling rates or health status. The overall accuracies reach 100% and 90.11% for healthy participants and cardiovascular disease (CVD) patients, respectively. PMID:23977063

Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome

DEFF Research Database (Denmark)

Clark, Elaine N; Ripa, Maria Sejersten; Clemmensen, Peter

2010-01-01

The aims of this study were to assess the effectiveness of 2 automated electrocardiogram interpretation programs in patients with suspected acute coronary syndrome transported to hospital by ambulance in 1 rural region of Denmark with hospital discharge diagnosis used as the gold standard...

ASSESSMENT OF RELATION BETWEEN MICROALBUMINURIA AND ISCHEMIC ELECTROCARDIOGRAM IN IRANIAN GENERAL POPULATION

Directory of Open Access Journals (Sweden)

Alireza Khosravi

2010-12-01

Full Text Available Abstract    BACKGROUND: Enhancement of albumin exertion in urine increases the risk of renal and ischemic heart diseases (IHD. We assessed the association of urine albumin and sub-clinical IHD in a random sample of Iranian general population.    METHODS: The random sample in general population in Isfahan County was recruited to the cross-sectional study. From the all sample blood pressure and lipid profile were assessed and morning urine spot was measured for albumin and Creatinine. Microalbuminuria was defined either Albumin-Creatinine Ratio (ACR was 30-300mg. Also, the standard 12 lead electrocardiogram (ECG was carried out for all participants. The ECG pattern was divided to two categories; normal or ECG with ischemia. The logistic regression model was determined the odds of albuminuria for ischemic changes in ECG.    RESULTS: 999 subjects, age 35-70 years, participated to study. From all, 40.8% were male. Microalbuminuria was detected in 8% and sub-clinical ECG ischemic changes were found in 23.4%. The most frequent ischemic change was T wave inversion. The mean urine albumin levels in subjects with normal ECG was 9.6±14.6 mg/ml and in ischemic group was 8.5±12.2 mg/ml and they did not have statistically different. The odds ratios of neither Albumin-Creatinine ratio nor microalbuminuria were in significant range for risk to ischemic changes in ECG of apparently healthy participants. They was consecutively OR=0.9 (0.51-1.6, OR=0.99 (0.98-1.004.     CONCLUSION: Our finding didn’t declare any association between ACR and IHD. Because of showing this association in the other study; it needs more exploration regarding to association between microalbuminuria and cardiovascular diseases incidence.      Keywords: Ischemic heart diseases, electrocardiogram, Albumin-Creatinine Ratio, Urine Albumin

Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

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Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R. [University Hospital Zurich, Cardiac Imaging, Department of Nuclear Medicine, Zurich (Switzerland)

2017-11-15

To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering

International Nuclear Information System (INIS)

Clerc, Olivier F.; Kaufmann, Basil P.; Possner, Mathias; Liga, Riccardo; Vontobel, Jan; Mikulicic, Fran; Graeni, Christoph; Benz, Dominik C.; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R.

2017-01-01

To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. (orig.)

Design of portable electrocardiogram device using DSO138

Science.gov (United States)

Abuzairi, Tomy; Matondang, Josef Stevanus; Purnamaningsih, Retno Wigajatri; Basari, Ratnasari, Anita

2018-02-01

Cardiovascular disease has been one of the leading causes of sudden cardiac deaths in many countries, covering Indonesia. Electrocardiogram (ECG) is a medical test to detect cardiac abnormalities by measuring the electrical activity generated by the heart, as the heart contracts. By using ECG, we can observe anomaly at the time of heart abnormalities. In this paper, design of portable ECG device is presented. The portable ECG device was designed to easily use in the village clinic or houses, due to the small size device and other benefits. The device was designed by using four units: (1) ECG electrode; (2) ECG analog front-end; (3) DSO138; and (4) battery. To create a simple electrode system in the portable ECG, 1-lead ECG with two electrodes were applied. The analog front-end circuitry consists of three integrated circuits, an instrumentation amplifier AD820AN, a low noise operational amplifier OPA134, and a low offset operational amplifier TL082. Digital ECG data were transformed to graphical data on DSO138. The results show that the portable ECG is successfully read the signal from 1-lead ECG system.

Privacy-Preserving Electrocardiogram Monitoring for Intelligent Arrhythmia Detection.

Science.gov (United States)

Son, Junggab; Park, Juyoung; Oh, Heekuck; Bhuiyan, Md Zakirul Alam; Hur, Junbeom; Kang, Kyungtae

2017-06-12

Long-term electrocardiogram (ECG) monitoring, as a representative application of cyber-physical systems, facilitates the early detection of arrhythmia. A considerable number of previous studies has explored monitoring techniques and the automated analysis of sensing data. However, ensuring patient privacy or confidentiality has not been a primary concern in ECG monitoring. First, we propose an intelligent heart monitoring system, which involves a patient-worn ECG sensor (e.g., a smartphone) and a remote monitoring station, as well as a decision support server that interconnects these components. The decision support server analyzes the heart activity, using the Pan-Tompkins algorithm to detect heartbeats and a decision tree to classify them. Our system protects sensing data and user privacy, which is an essential attribute of dependability, by adopting signal scrambling and anonymous identity schemes. We also employ a public key cryptosystem to enable secure communication between the entities. Simulations using data from the MIT-BIH arrhythmia database demonstrate that our system achieves a 95.74% success rate in heartbeat detection and almost a 96.63% accuracy in heartbeat classification, while successfully preserving privacy and securing communications among the involved entities.

Prevalence and associated factors of resting electrocardiogram abnormalities among systemic lupus erythematosus patients without cardiovascular disease

OpenAIRE

Al Rayes, Hanan; Harvey, Paula J.; Gladman, Dafna D.; Su, Jiandong; Sabapathy, Arthy; Urowitz, Murray B.; Touma, Zahi

2017-01-01

Background Electrocardiogram (ECG) cardiovascular disease (CVD) abnormalities (ECG-CVD) are predictive of subsequent CVD events in the general population. Systemic lupus erythematosus (SLE) patients are vulnerable to CVD. We aimed to determine the prevalence of ECG-CVD in SLE patients and to examine the risk factors associated with ECG-CVD. Methods A 12-lead resting supine ECG was performed on consecutive adult patients attending the clinic. One cardiologist interpreted the ECGs. ECG-CVD were...

Personal Identification Based on Vectorcardiogram Derived from Limb Leads Electrocardiogram

Directory of Open Access Journals (Sweden)

Jongshill Lee

2012-01-01

Full Text Available We propose a new method for personal identification using the derived vectorcardiogram (dVCG, which is derived from the limb leads electrocardiogram (ECG. The dVCG was calculated from the standard limb leads ECG using the precalculated inverse transform matrix. Twenty-one features were extracted from the dVCG, and some or all of these 21 features were used in support vector machine (SVM learning and in tests. The classification accuracy was 99.53%, which is similar to the previous dVCG analysis using the standard 12-lead ECG. Our experimental results show that it is possible to identify a person by features extracted from a dVCG derived from limb leads only. Hence, only three electrodes have to be attached to the person to be identified, which can reduce the effort required to connect electrodes and calculate the dVCG.

Electrocardiogram interpretation skills among ambulance nurses.

Science.gov (United States)

Werner, Kristoffer; Kander, Kristofer; Axelsson, Christer

2016-06-01

To describe ambulance nurses' practical electrocardiogram (ECG) interpretation skills and to measure the correlation between these skills and factors that may impact on the level of knowledge. This study was conducted using a prospective quantitative survey with questionnaires and a knowledge test. A convenience sample collection was conducted among ambulance nurses in three different districts in western Sweden. The knowledge test consisted of nine different ECGs. The score of the ECG test were correlated against the questions in the questionnaire regarding both general ECG interpretation skill and ability to identify acute myocardial infarction using Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation. On average, the respondents had 54% correct answers on the test and identified 46% of the ECGs indicating acute myocardial infarction. The median total score was 9 of 16 (interquartile range 7-11) and 1 of 3 (IQR 1-2) in infarction points. No correlation between ECG interpretation skill and factors such as education and professional experience was found, except that coronary care unit experience was associated with better results on the ECG test. Ambulance nurses have deficiencies in their ECG interpretation skills. This also applies to conditions where the ambulance crew has great potential to improve the outcome of the patient's health, such as myocardial infarction and cardiac arrest. Neither education, extensive experience in ambulance service nor in nursing contributed to an improved result. The only factor of importance for higher ECG interpretation knowledge was prior experience of working in a coronary care unit. © The European Society of Cardiology 2014.

Electrocardiogram voltage discordance: Interpretation of low QRS voltage only in the precordial leads.

Science.gov (United States)

Kim, Diana H; Verdino, Ralph J

To define clinical correlates of low voltage isolated to precordial leads on the surface electrocardiogram (ECG). Low voltage (V) on the ECG is defined as QRS Vvoltage isolated to the precordial leads with normal limb lead voltages is unclear. Twelve-lead ECGs with QRS V>5mm in one or more limb leads and voltage was found in 256 of 150,000 ECGs (~0.2%). 50.4% of patients had discordant ECGs that correlated with classic etiologies, with a higher incidence of LV dilation in those with classic etiologies than those without. Low precordial voltage is associated with classic etiologies and LV dilation. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of agreement between temporal series obtained from electrocardiogram and pulse wave.

Science.gov (United States)

Leikan, GM; Rossi, E.; Sanz, MCuadra; Delisle Rodríguez, D.; Mántaras, MC; Nicolet, J.; Zapata, D.; Lapyckyj, I.; Siri, L. Nicola; Perrone, MS

2016-04-01

Heart rate variability allows to study the cardiovascular autonomic nervous system modulation. Usually, this signal is obtained from the electrocardiogram (ECG). A simpler method for recording the pulse wave (PW) is by means of finger photoplethysmography (PPG), which also provides information about the duration of the cardiac cycle. In this study, the correlation and agreement between the time series of the intervals between heartbeats obtained from the ECG with those obtained from the PPG, were studied. Signals analyzed were obtained from young, healthy and resting subjects. For statistical analysis, the Pearson correlation coefficient and the Bland and Altman limits of agreement were used. Results show that the time series constructed from the PW would not replace the ones obtained from ECG.

The ability of an electrocardiogram to predict fatal and non-fatal cardiac events in asymptomatic middle-aged subjects.

Science.gov (United States)

Terho, Henri K; Tikkanen, Jani T; Kenttä, Tuomas V; Junttila, M Juhani; Aro, Aapo L; Anttonen, Olli; Kerola, Tuomas; Rissanen, Harri A; Knekt, Paul; Reunanen, Antti; Huikuri, Heikki V

2016-11-01

The long-term prognostic value of a standard 12-lead electrocardiogram (ECG) for predicting cardiac events in apparently healthy middle-aged subjects is not well defined. A total of 9511 middle-aged subjects (mean age 43 ± 8.2 years, 52% males) without a known cardiac disease and with a follow-up 40 years were included in the study. Fatal and non-fatal cardiac events were collected from the national registries. The predictive value of ECG was separately analyzed for 10 and 30 years. Major ECG abnormalities were classified according to the Minnesota code. Subjects with major ECG abnormalities (N = 1131) had an increased risk of cardiac death after 10-years (adjusted hazard ratio [HR] 1.7; 95% confidence interval [95% CI], 1.1-2.5, p = 0.009) and 30-years of follow-up (HR 1.3, 95% CI, 1.1-1.5, p electrocardiogram are shown to have prognostic significance for cardiac events in elderly subjects without known cardiac disease. Our results suggest that ECG abnormalities increase the risk of fatal cardiac events also in middle-aged healthy subjects.

Combined electrocardiogram and photoplethysmogram measurements as an indicator of objective sleepiness

International Nuclear Information System (INIS)

Chua, Chern-Pin; McDarby, Gary; Heneghan, Conor

2008-01-01

There is considerable interest in unobtrusive and portable methods of monitoring sleepiness outside the laboratory setting. This study evaluates the usefulness of combined electrocardiogram (ECG) and photoplethysmogram (PPG) measurements for estimating psychomotor vigilance. The psychomotor vigilance test (PVT) was performed at various points over the course of a day, and one channel each of ECG and PPG was recorded simultaneously. Features derived from ECG and PPG were entered into multiple linear regression models to estimate PVT values. A double-loop, subject-independent validation scheme was used to develop and validate the models. We show that features obtained from the RR interval were reasonably useful for estimating absolute PVT levels, but were somewhat inadequate for estimating within-subject PVT changes. Combined ECG and PPG measurements appear to be useful for predicting PVT values, and deserve further investigation for portable sleepiness monitoring

Cardiointegram: detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram

International Nuclear Information System (INIS)

Teichholz, L.E.; Steinmetz, M.Y.; Escher, D.; Herman, M.V.; Naimi, S.; Mahony, D.V.; Ellestad, M.H.

1986-01-01

The cardiointegram is a non-invasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage vs. time format by a series of integrations. This multicenter study compares the results of the cardiointegram with coronary arteriography in 140 male patients with chest pain and a normal resting electrocardiogram. The cardiointegram was determined on two resting complexes of Leads I, II, V4, V5 and V6 and called abnormal if greater than or equal to four of ten complexes were abnormal, i.e., fell outside of a previously determined template of normality. The sensitivity was 73% and specificity was 78% for the diagnosis of occlusive coronary artery disease. When greater than or equal to five of ten abnormal complexes were used as the cut-off for an abnormal test and ''equivocal'' results (four of ten abnormal, n = 18) were excluded from analysis there was a sensitivity of 69% and specificity of 88%. Thirty-seven of 38 patients (97%) with an abnormal cardiointegram and a positive exercise stress test had coronary artery disease. Thus, the cardiointegram appears to be a useful non-invasive test for the detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram in whom the diagnosis of coronary artery disease is being considered

Exercise electrocardiogram testing in two brothers with different outcome – a case study exercise testing in master cyclists

Directory of Open Access Journals (Sweden)

Rüst CA

2013-06-01

Full Text Available Christoph Alexander Rüst,1 Beat Knechtle,1,2 Thomas Rosemann11Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, SwitzerlandAbstract: The cases of two brothers training and competing as master cyclists and both preparing for a cycling tour are presented. The older brother aged 66 years went first to the primary care physician and presented with an asymptomatic depression in the exercise stress test of the ST segment in V5 and V6 during recovery after complete exhaustion. Coronary angiography revealed a multi vessel coronary artery disease and he underwent bypass surgery. One year later, he successfully completed his planned cycling tour of ~600 km in seven stages and covering ~12,000 m of total ascent. The younger brother aged 59 years went a few months later to the primary care physician and also performed asymptomatic exercise stress testing without changes in the ST segments. Unfortunately, 2 months later he suffered a cardiac arrest during his cycling tour and survived following immediate successful cardiopulmonary resuscitation on the road by his cycling colleagues. Immediate invasive coronary arteriography showed a complete stenosis of the trunk of arteria coronaria sinistra (left coronary artery, a 40%–50% stenosis of ramus circumflexus, and a 20% stenosis of arteria coronaria dextra (right coronary artery. The left coronary artery was dilated and he continued cycling 2 months later. In both brothers, familial hypercholesterolemia was the main cardiovascular risk factor for the multi vessel coronary artery disease. A negative exercise electrocardiogram in siblings with an increased risk for coronary artery disease seemed not to exclude an advanced multi vessel coronary artery disease. In master athletes with asymptomatic exercise electrocardiogram but a positive family history, further examinations should be performed in order to detect

Accuracy of electrocardiogram reading by family practice residents.

Science.gov (United States)

Sur, D K; Kaye, L; Mikus, M; Goad, J; Morena, A

2000-05-01

This study evaluated the electrocardiogram (EKG) reading skills of family practice residents. A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18. Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents. We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.

Value of electrocardiogram in predialytic chronic kidney disease patient without known coronary artery disease

Directory of Open Access Journals (Sweden)

Dutta PK, Das S

2014-11-01

Full Text Available Chronic Kidney disease (CKD is a pressing public health burden occurring in about 10% of the population. The majority of them die before reaching End Stage Renal Disease (ESRD due to cardiovascular disease (CVD. Hypertension (HTN and anaemia are two reversible factors for progression of CKD. Besides asymptomatic coronary artery disease, the electrolyte abnormalities such as hyperkalaemia and hypocalcaemia also subject these patients to sudden cardiac death. This study is aimed at to see the changes in electrocardiogram (ECG in hospitalized predialytic CKD patients due to these abnormalities. Methods: This is a 6 months cross-sectional study carried out at Chittagong Medical College Hospital in Chittagong, Bangladesh. 50 patients with stages 3, 4 and 5 CKD were recruited from the Nephrology and Medicine wards. Patients with prior history of coronary artery disease, cardiomyopathy, valvular heart disease and dialysis were excluded. All had their standard 12–lead electrocardiogram (ECG recorded and various findings were critically studied and interpreted independently by two consultant physicians including a cardiologist. Data analysis was done using SPSS version 19. Results: LVH (left ventricular hypertrophy (66%, LAE (left atrial enlargement (30% and unrecognized myocardial infarction (28% were very common ECG abnormalities in our predialytic CKD patients. HTN, anaemia, late presentation, and male gender appear to be associated with ECG abnormalities. Though 28 patients (56% were hyperkalaemic only 9 patients (38% of them had tall tented T wave in ECG. Conclusion: Detection of HTN and anaemia in male predialytic CKD patients will arouse suspicion which will help in early detection of cardiac outcome by ECG abnormality which will help in taking treatment strategy in resource limited country.

Effect of a real-time tele-transmission system of 12-lead electrocardiogram on the first-aid for athletes with ST-elevation myocardial infarction.

Science.gov (United States)

Zhang, Huan; Song, Donghan; An, Lina

2016-05-01

To study the effect of a real-time tele-transmission system of 12-lead electrocardiogram on door-to-balloon time in athletes with ST-elevation myocardial infarction. A total of 60 athletes with chest pain diagnosed as ST-elevation myocardial infarction (STEMI) from our hospital were randomly divided into group A (n=35) and group B (n=25), the patients in group A transmitted the real-time tele-transmission system of 12-lead electrocardiogram to the chest pain center before arriving in hospital, however, the patients in group B not. The median door-to-balloon time was significant shorter in-group A than group B (38min vs 94 min, p0.05). The median length of stay was significant reduced in-group A (5 days vs 7 days, pelectrocardiogram is beneficial to the pre-hospital diagnosis of STEMI.

Referral of patients with ST-segment elevation acute myocardial infarction directly to the catheterization suite based on prehospital teletransmission of 12-lead electrocardiogram

DEFF Research Database (Denmark)

Sillesen, Martin; Sejersten, Maria; Strange, Søren

2008-01-01

BACKGROUND: Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-lead electrocardiogram (ECG) transmission can reduce time to reperfusion. PURPOSE: Determine 12-lead ECG transmission...

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients.

Science.gov (United States)

Palhares, Daniel M F; Marcolino, Milena S; Santos, Thales M M; da Silva, José L P; Gomes, Paulo R; Ribeiro, Leonardo B; Macfarlane, Peter W; Ribeiro, Antonio L P

2017-06-13

Knowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients. This retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies. A total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements. This study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.

Privacy-Preserving Electrocardiogram Monitoring for Intelligent Arrhythmia Detection †

Science.gov (United States)

Son, Junggab; Park, Juyoung; Oh, Heekuck; Bhuiyan, Md Zakirul Alam; Hur, Junbeom; Kang, Kyungtae

2017-01-01

Long-term electrocardiogram (ECG) monitoring, as a representative application of cyber-physical systems, facilitates the early detection of arrhythmia. A considerable number of previous studies has explored monitoring techniques and the automated analysis of sensing data. However, ensuring patient privacy or confidentiality has not been a primary concern in ECG monitoring. First, we propose an intelligent heart monitoring system, which involves a patient-worn ECG sensor (e.g., a smartphone) and a remote monitoring station, as well as a decision support server that interconnects these components. The decision support server analyzes the heart activity, using the Pan–Tompkins algorithm to detect heartbeats and a decision tree to classify them. Our system protects sensing data and user privacy, which is an essential attribute of dependability, by adopting signal scrambling and anonymous identity schemes. We also employ a public key cryptosystem to enable secure communication between the entities. Simulations using data from the MIT-BIH arrhythmia database demonstrate that our system achieves a 95.74% success rate in heartbeat detection and almost a 96.63% accuracy in heartbeat classification, while successfully preserving privacy and securing communications among the involved entities. PMID:28604628

Incidence of major vascular events after cardiac surgery: impact of preoperative monitoring with troponin and electrocardiogram

International Nuclear Information System (INIS)

Sandra M Quiroga; Juan C Villar; Luz X, Martinez

2009-01-01

Recent demographic changes have led to an increased risk of major vascular events among patients undergoing non-cardiac surgery. Troponin and electrocardiogram monitoring would further identify these major vascular events. Methods: we prospectively collected data on eligible patients (non-selected individuals aged 45 or older undergoing non-cardiac surgery under general or regional anesthesia in two hospitals in Bucaramanga, with expected length of stay longer than 24 hours) during a time-interrupted series,before and after postoperative diagnostic monitoring (blinded assessment of troponin T and electrocardiograms ignoring clinical data). For the period before the intervention (usual clinical care),two independent reviewers extracted clinical information from clinical histories (of all eligible patients from 3 randomly-selected months of 2005). For the period after diagnostic monitoring, we followed 100 consecutive eligible patients. Primary outcome was a composite of major vascular events within hospital, including myocardial infarction (defined as any troponin elevation associated with electrocardiographic changes suggesting ischemia, regardless of symptoms). Results: we included 534 clinical charts and 100 prospective surgical patients (mean age 62.2, SD 12.9 years; 56% women). The more frequent surgical procedures were orthopedics (26.8%) followed by abdominal (20.2%).The incidence of major vascular events recorded in clinical charts was 2.8%, compared with 7% among monitored patients (p=0,071). All four myocardial infarctions identified among the later group were silent. Conclusion: postoperative monitoring with troponin and electrocardiography identified a higher proportion of major vascular events, mainly silent myocardial infarctions.

P-wave characteristics on routine preoperative electrocardiogram improve prediction of new-onset postoperative atrial fibrillation in cardiac surgery.

Science.gov (United States)

Wong, Jim K; Lobato, Robert L; Pinesett, Andre; Maxwell, Bryan G; Mora-Mangano, Christina T; Perez, Marco V

2014-12-01

To test the hypothesis that including preoperative electrocardiogram (ECG) characteristics with clinical variables significantly improves the new-onset postoperative atrial fibrillation prediction model. Retrospective analysis. Single-center university hospital. Five hundred twenty-six patients, ≥ 18 years of age, who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement/repair, or a combination of valve surgery and coronary artery bypass grafting requiring cardiopulmonary bypass. Retrospective review of medical records. Baseline characteristics and cardiopulmonary bypass times were collected. Digitally-measured timing and voltages from preoperative electrocardiograms were extracted. Postoperative atrial fibrillation was defined as atrial fibrillation requiring therapeutic intervention. Two hundred eight (39.5%) patients developed postoperative atrial fibrillation. Clinical predictors were age, ejection fractionelectrocardiogram variables to the prediction model with only clinical predictors significantly improved the area under the receiver operating characteristic curve, from 0.71 to 0.78 (p<0.01). Overall net reclassification improvement was 0.059 (p = 0.09). Among those who developed postoperative atrial fibrillation, the net reclassification improvement was 0.063 (p = 0.03). Several p-wave characteristics are independently associated with postoperative atrial fibrillation. Addition of these parameters improves the postoperative atrial fibrillation prediction model. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Teaching crucial skills: An electrocardiogram teaching module for medical students.

Science.gov (United States)

Chudgar, Saumil M; Engle, Deborah L; Grochowski, Colleen O'Connor; Gagliardi, Jane P

2016-01-01

Medical student performance in electrocardiogram (ECG) interpretation at our institution could be improved. Varied resources exist to teach students this essential skill. We created an ECG teaching module (ECGTM) of 75 cases representing 15 diagnoses to improve medical students' performance and confidence in ECG interpretation. Students underwent pre- and post-clerkship testing to assess ECG interpretation skills and confidence and also end-of-clinical-year testing in ECG and laboratory interpretation. Performance was compared for the years before and during ECGTM availability. Eighty-four percent of students (total n=101) reported using the ECGTM; 98% of those who used it reported it was useful. Students' performance and confidence were higher on the post-test. Students with access to the ECGTM (n=101) performed significantly better than students from the previous year (n=90) on the end-of-year ECG test. The continuous availability of an ECGTM was associated with improved confidence and ability in ECG interpretation. The ECGTM may be another available tool to help students as they learn to read ECGs. Copyright © 2016 Elsevier Inc. All rights reserved.

Noninvasive recording of electrocardiogram in conscious rat: A new device.

Science.gov (United States)

Kumar, Pradeep; Srivastava, Pooja; Gupta, Ankit; Bajpai, Manish

2017-01-01

Electrocardiogram (ECG) is an important tool for the study of cardiac electrophysiology both in human beings and experimental animals. Existing methods of ECG recording in small animals like rat have several limitations and ECG recordings of the anesthetized rat lack validity for heart rate (HR) variability analysis. The aim of the present study was to validate the ECG data from new device with ECG of anesthetized rat. The ECG was recorded on student's physiograph (BioDevice, Ambala) and suitable coupler and electrodes in six animals first by the newly developed device in conscious state and second in anesthetized state (stabilized technique). The data obtained were analyzed using unpaired t -test showed no significant difference ( P < 0.05) in QTc, QRS, and HR recorded by new device and established device in rats. No previous study describes a similar ECG recording in conscious state of rats. Thus, the present method may be a most physiological and inexpensive alternative to other methods. In this study, the animals were not restrained; they were just secured and represent a potential strength of the study.

The electrocardiogram signal of Seba's short-tailed bat, Carollia perspicillata.

Science.gov (United States)

Mihova, Diana; Hechavarría, Julio C

2016-07-01

A number of studies have successfully used electrocardiogram (ECG) signals to characterize complex physiological phenomena such as associative learning in bats. However, at present, no thorough characterization of the structure of ECG signals is available for these animals. The aim of the present study was to quantitatively characterize features of the ECG signals in the bat species Carollia perspicillata, a species that is commonly used in neuroethology studies. Our results show that the ECG signals of C. perspicillata follow the typical mammalian pattern, in that they are composed by a P wave, QRS complex and a T wave. Peak-to-peak amplitudes in the bats' ECG signals were larger in measuring configurations in which one of the electrodes was attached to the right thumb. In addition, large differences in the instantaneous heart rate (HR) distributions were observed between ketamine/xylazine anesthetized and awake bats. Ketamine/xylazine might target the neural circuits that control HR, therefore, instantaneous HR measurements should only be used as physiological marker in awake animals.

Real-time electrocardiogram transmission from Mount Everest during continued ascent.

Science.gov (United States)

Kao, Wei-Fong; Huang, Jyh-How; Kuo, Terry B J; Chang, Po-Lun; Chang, Wen-Chen; Chan, Kuo-Hung; Liu, Wen-Hsiung; Wang, Shih-Hao; Su, Tzu-Yao; Chiang, Hsiu-chen; Chen, Jin-Jong

2013-01-01

The feasibility of a real-time electrocardiogram (ECG) transmission via satellite phone from Mount Everest to determine a climber's suitability for continued ascent was examined. Four Taiwanese climbers were enrolled in the 2009 Mount Everest summit program. Physiological measurements were taken at base camp (5300 m), camp 2 (6400 m), camp 3 (7100 m), and camp 4 (7950 m) 1 hour after arrival and following a 10 minute rest period. A total of 3 out of 4 climbers were able to summit Mount Everest successfully. Overall, ECG and global positioning system (GPS) coordinates of climbers were transmitted in real-time via satellite phone successfully from base camp, camp 2, camp 3, and camp 4. At each camp, Resting Heart Rate (RHR) was transmitted and recorded: base camp (54-113 bpm), camp 2 (94-130 bpm), camp 3 (98-115 bpm), and camp 4 (93-111 bpm). Real-time ECG and GPS coordinate transmission via satellite phone is feasible for climbers on Mount Everest. Real-time RHR data can be used to evaluate a climber's physiological capacity to continue an ascent and to summit.

[The primary research and development of software oversampling mapping system for electrocardiogram].

Science.gov (United States)

Zhou, Yu; Ren, Jie

2011-04-01

We put forward a new concept of software oversampling mapping system for electrocardiogram (ECG) to assist the research of the ECG inverse problem to improve the generality of mapping system and the quality of mapping signals. We then developed a conceptual system based on the traditional ECG detecting circuit, Labview and DAQ card produced by National Instruments, and at the same time combined the newly-developed oversampling method into the system. The results indicated that the system could map ECG signals accurately and the quality of the signals was good. The improvement of hardware and enhancement of software made the system suitable for mapping in different situations. So the primary development of the software for oversampling mapping system was successful and further research and development can make the system a powerful tool for researching ECG inverse problem.

Measurement and monitoring of electrocardiogram belt tension in premature infants for assessment of respiratory function

Directory of Open Access Journals (Sweden)

Hegyi Thomas

2007-04-01

Full Text Available Abstract Background Monitoring of the electrocardiogram (ECG in premature infants with conventional adhesive-backed electrodes can harm their sensitive skin. Use of an electrode belt prevents skin irritation, but the effect of belt pressure on respiratory function is unknown. A strain gauge sensor is described which measures applied belt tension. Method The device frame was comprised of an aluminum housing and slide to minimize the device weight. Velcro tabs connected housing and slide to opposite tabs located at the electrode belt ends. The slide was connected to a leaf spring, to which were bonded two piezoresistive transducers in a half-bridge circuit configuration. The device was tested for linearity and calibrated. The effect on infant respiratory function of constant belt tension in the normal range (30 g–90 g was determined. Results The mechanical response to a step input was second order (fn = 401 Hz, ζ = 0.08. The relationship between applied tension and output voltage was linear in the range 25–225 gm of applied tension (r2 = 0.99. Measured device sensitivity was 2.18 mV/gm tension using a 5 V bridge excitation voltage. When belt tension was increased in the normal range from 30 gm to 90 gm, there was no significant change in heart rate and most respiratory functions during monitoring. At an intermediate level of tension of 50 gm, pulmonary resistance and work of breathing significantly decreased. Conclusion The mechanical and electrical design of a device for monitoring electrocardiogram electrode belt tension is described. Within the typical range of application tension, cardiovascular and respiratory function are not substantially negatively affected by electrode belt force.

Measurement and monitoring of electrocardiogram belt tension in premature infants for assessment of respiratory function.

Science.gov (United States)

Ciaccio, Edward J; Hiatt, Mark; Hegyi, Thomas; Drzewiecki, Gary M

2007-04-19

Monitoring of the electrocardiogram (ECG) in premature infants with conventional adhesive-backed electrodes can harm their sensitive skin. Use of an electrode belt prevents skin irritation, but the effect of belt pressure on respiratory function is unknown. A strain gauge sensor is described which measures applied belt tension. The device frame was comprised of an aluminum housing and slide to minimize the device weight. Velcro tabs connected housing and slide to opposite tabs located at the electrode belt ends. The slide was connected to a leaf spring, to which were bonded two piezoresistive transducers in a half-bridge circuit configuration. The device was tested for linearity and calibrated. The effect on infant respiratory function of constant belt tension in the normal range (30 g-90 g) was determined. The mechanical response to a step input was second order (fn = 401 Hz, zeta = 0.08). The relationship between applied tension and output voltage was linear in the range 25-225 gm of applied tension (r2 = 0.99). Measured device sensitivity was 2.18 mV/gm tension using a 5 V bridge excitation voltage. When belt tension was increased in the normal range from 30 gm to 90 gm, there was no significant change in heart rate and most respiratory functions during monitoring. At an intermediate level of tension of 50 gm, pulmonary resistance and work of breathing significantly decreased. The mechanical and electrical design of a device for monitoring electrocardiogram electrode belt tension is described. Within the typical range of application tension, cardiovascular and respiratory function are not substantially negatively affected by electrode belt force.

The electrocardiogram as an electronic filter and why ac circuits are important for pre-health physics students

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Dunlap, Justin C.; Kutschera, Ellynne; Van Ness, Grace R.; Widenhorn, Ralf

2015-01-01

We present a general physics laboratory exercise that centres around the use of the electrocardiogram sensor as an application of circuits and electronic signal filtering. Although these topics are commonly taught in the general physics classroom, many students consider topics such as alternating current as unrelated to their future professions. This exercise provides the motivation for life science and pre-health majors to learn concepts such as voltage, resistance, alternating and direct current, RLC circuits, as well as signal and noise, in an introductory undergraduate physics lab.

Robust electrocardiogram (ECG) beat classification using discrete wavelet transform

International Nuclear Information System (INIS)

Minhas, Fayyaz-ul-Amir Afsar; Arif, Muhammad

2008-01-01

This paper presents a robust technique for the classification of six types of heartbeats through an electrocardiogram (ECG). Features extracted from the QRS complex of the ECG using a wavelet transform along with the instantaneous RR-interval are used for beat classification. The wavelet transform utilized for feature extraction in this paper can also be employed for QRS delineation, leading to reduction in overall system complexity as no separate feature extraction stage would be required in the practical implementation of the system. Only 11 features are used for beat classification with the classification accuracy of ∼99.5% through a KNN classifier. Another main advantage of this method is its robustness to noise, which is illustrated in this paper through experimental results. Furthermore, principal component analysis (PCA) has been used for feature reduction, which reduces the number of features from 11 to 6 while retaining the high beat classification accuracy. Due to reduction in computational complexity (using six features, the time required is ∼4 ms per beat), a simple classifier and noise robustness (at 10 dB signal-to-noise ratio, accuracy is 95%), this method offers substantial advantages over previous techniques for implementation in a practical ECG analyzer

Real-time electrocardiogram transmission from Mount Everest during continued ascent.

Directory of Open Access Journals (Sweden)

Wei-Fong Kao

Full Text Available The feasibility of a real-time electrocardiogram (ECG transmission via satellite phone from Mount Everest to determine a climber's suitability for continued ascent was examined. Four Taiwanese climbers were enrolled in the 2009 Mount Everest summit program. Physiological measurements were taken at base camp (5300 m, camp 2 (6400 m, camp 3 (7100 m, and camp 4 (7950 m 1 hour after arrival and following a 10 minute rest period. A total of 3 out of 4 climbers were able to summit Mount Everest successfully. Overall, ECG and global positioning system (GPS coordinates of climbers were transmitted in real-time via satellite phone successfully from base camp, camp 2, camp 3, and camp 4. At each camp, Resting Heart Rate (RHR was transmitted and recorded: base camp (54-113 bpm, camp 2 (94-130 bpm, camp 3 (98-115 bpm, and camp 4 (93-111 bpm. Real-time ECG and GPS coordinate transmission via satellite phone is feasible for climbers on Mount Everest. Real-time RHR data can be used to evaluate a climber's physiological capacity to continue an ascent and to summit.

The Diagnostic Agreement of Original and Faxed Copies of Electrocardiograms

Directory of Open Access Journals (Sweden)

Sadrihe Hajesmaeel-Gohari

2013-02-01

Full Text Available Background: General practitioners working in remote and rural areas sometimes need consultation with cardiologists. One practical and cost-effective way is transmission of patients’ electrocardiographic images via ordinary fax machine to the cardiologists, but there is an important question that how much agreement exists between the diagnoses made by reading an original electrocardiogram and its copy transmitted via fax.Materials and Methods: In this cross-sectional study, 60 original electrocardiographic images were given to cardiologists for diagnosis. In the next step those electrocardiographic images were faxed to the hospital through a simple cheap fax machine, one month later the same cardiologist was asked to put his diagnosis on the copied versions of electrocardiographs, and the results were compared. Results: In 59 studied cases, the two method of diagnoses were exactly the same and only in one case the diagnoses were different. Therefore, Kappa agreement coefficient was calculated as 96%.Conclusion: According to the results of this study, general practitioners working in deprived areas can be certainly recommended to send patients’ electrocardiographic images to the cardiologists via fax in the case of needing consultation.

Comparison of infarct size changes with delayed contrast-enhanced magnetic resonance imaging and electrocardiogram QRS scoring during the 6 months after acutely reperfused myocardial infarction

DEFF Research Database (Denmark)

Bang, L.E.; Ripa, R.S.; Grande, P.

2008-01-01

INTRODUCTION: Magnetic resonance imaging using the delayed contrast-enhanced (DE-MRI) method can be used for characterizing and quantifying myocardial infarction (MI). Electrocardiogram (ECG) score after the acute phase of MI can be used to estimate the portion of left ventricular myocardium...

Electrocardiogram signal denoising based on empirical mode decomposition technique: an overview

International Nuclear Information System (INIS)

Han, G.; Lin, B.; Xu, Z.

2017-01-01

Electrocardiogram (ECG) signal is nonlinear and non-stationary weak signal which reflects whether the heart is functioning normally or abnormally. ECG signal is susceptible to various kinds of noises such as high/low frequency noises, powerline interference and baseline wander. Hence, the removal of noises from ECG signal becomes a vital link in the ECG signal processing and plays a significant role in the detection and diagnosis of heart diseases. The review will describe the recent developments of ECG signal denoising based on Empirical Mode Decomposition (EMD) technique including high frequency noise removal, powerline interference separation, baseline wander correction, the combining of EMD and Other Methods, EEMD technique. EMD technique is a quite potential and prospective but not perfect method in the application of processing nonlinear and non-stationary signal like ECG signal. The EMD combined with other algorithms is a good solution to improve the performance of noise cancellation. The pros and cons of EMD technique in ECG signal denoising are discussed in detail. Finally, the future work and challenges in ECG signal denoising based on EMD technique are clarified.

Human Age Recognition by Electrocardiogram Signal Based on Artificial Neural Network

Science.gov (United States)

Dasgupta, Hirak

2016-12-01

The objective of this work is to make a neural network function approximation model to detect human age from the electrocardiogram (ECG) signal. The input vectors of the neural network are the Katz fractal dimension of the ECG signal, frequencies in the QRS complex, male or female (represented by numeric constant) and the average of successive R-R peak distance of a particular ECG signal. The QRS complex has been detected by short time Fourier transform algorithm. The successive R peak has been detected by, first cutting the signal into periods by auto-correlation method and then finding the absolute of the highest point in each period. The neural network used in this problem consists of two layers, with Sigmoid neuron in the input and linear neuron in the output layer. The result shows the mean of errors as -0.49, 1.03, 0.79 years and the standard deviation of errors as 1.81, 1.77, 2.70 years during training, cross validation and testing with unknown data sets, respectively.

Electrocardiogram signal denoising based on empirical mode decomposition technique: an overview

Science.gov (United States)

Han, G.; Lin, B.; Xu, Z.

2017-03-01

Electrocardiogram (ECG) signal is nonlinear and non-stationary weak signal which reflects whether the heart is functioning normally or abnormally. ECG signal is susceptible to various kinds of noises such as high/low frequency noises, powerline interference and baseline wander. Hence, the removal of noises from ECG signal becomes a vital link in the ECG signal processing and plays a significant role in the detection and diagnosis of heart diseases. The review will describe the recent developments of ECG signal denoising based on Empirical Mode Decomposition (EMD) technique including high frequency noise removal, powerline interference separation, baseline wander correction, the combining of EMD and Other Methods, EEMD technique. EMD technique is a quite potential and prospective but not perfect method in the application of processing nonlinear and non-stationary signal like ECG signal. The EMD combined with other algorithms is a good solution to improve the performance of noise cancellation. The pros and cons of EMD technique in ECG signal denoising are discussed in detail. Finally, the future work and challenges in ECG signal denoising based on EMD technique are clarified.

Electrocardiogram interpretation and arrhythmia management: a primary and secondary care survey.

Science.gov (United States)

Begg, Gordon; Willan, Kathryn; Tyndall, Keith; Pepper, Chris; Tayebjee, Muzahir

2016-05-01

There is increasing desire among service commissioners to treat arrhythmia in primary care. Accurate interpretation of the electrocardiogram (ECG) is fundamental to this. ECG interpretation has previously been shown to vary widely but there is little recent data. To examine the interpretation of ECGs in primary and secondary care. A cross-sectional survey of participants' interpretation of six ECGs and hypothetical management of patients based on those ECGs, at primary care educational events, and a cardiology department in Leeds. A total of 262 primary care clinicians and 20 cardiology clinicians were surveyed via questionnaire. Answers were compared with expert electrophysiologist opinion. In primary care, abnormal ECGs were interpreted as normal by 23% of responders. ST elevation and prolonged QT were incorrectly interpreted as normal by 1% and 22%, respectively. In cardiology, abnormal ECGs were interpreted as normal by 3%. ECG provision and interpretation remains inconsistent in both primary and secondary care. Primary care practitioners are less experienced and less confident with ECG interpretation than cardiologists, and require support in this area. © British Journal of General Practice 2016.

Algorithm for the classification of multi-modulating signals on the electrocardiogram.

Science.gov (United States)

Mita, Mitsuo

2007-03-01

This article discusses the algorithm to measure electrocardiogram (ECG) and respiration simultaneously and to have the diagnostic potentiality for sleep apnoea from ECG recordings. The algorithm is composed by the combination with the three particular scale transform of a(j)(t), u(j)(t), o(j)(a(j)) and the statistical Fourier transform (SFT). Time and magnitude scale transforms of a(j)(t), u(j)(t) change the source into the periodic signal and tau(j) = o(j)(a(j)) confines its harmonics into a few instantaneous components at tau(j) being a common instant on two scales between t and tau(j). As a result, the multi-modulating source is decomposed by the SFT and is reconstructed into ECG, respiration and the other signals by inverse transform. The algorithm is expected to get the partial ventilation and the heart rate variability from scale transforms among a(j)(t), a(j+1)(t) and u(j+1)(t) joining with each modulation. The algorithm has a high potentiality of the clinical checkup for the diagnosis of sleep apnoea from ECG recordings.

Utility of the exercise electrocardiogram testing in sudden cardiac death risk stratification.

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Refaat, Marwan M; Hotait, Mostafa; Tseng, Zian H

2014-07-01

Sudden cardiac death (SCD) remains a major public health problem. Current established criteria identifying those at risk of sudden arrhythmic death, and likely to benefit from implantable cardioverter defibrillators (ICDs), are neither sensitive nor specific. Exercise electrocardiogram (ECG) testing was traditionally used for information concerning patients' symptoms, exercise capacity, cardiovascular function, myocardial ischemia detection, and hemodynamic responses during activity in patients with hypertrophic cardiomyopathy. We conducted a systematic review of MEDLINE on the utility of exercise ECG testing in SCD risk stratification. Exercise testing can unmask suspected primary electrical diseases in certain patients (catecholaminergic polymorphic ventricular tachycardia or concealed long QT syndrome) and can be effectively utilized to risk stratify patients at an increased (such as early repolarization syndrome and Brugada syndrome) or decreased risk of SCD, such as the loss of preexcitation on exercise testing in asymptomatic Wolff-Parkinson-White syndrome. Exercise ECG testing helps in SCD risk stratification in patients with and without arrhythmogenic hereditary syndromes. © 2014 Wiley Periodicals, Inc.

[Incidence of long (short) PR interval in electrocardiogram among healthy people in Changsha and its clinical significance].

Science.gov (United States)

Liu, Liping; Lin, Ping; Xu, Yi; Wu, Lijia; Zou, Runmei; Xie, Zhenwu; Wang, Cheng

2016-04-01

To analyze the incidence of long (short) PR interval in electrocardiogram among healthy people in Changsha and the clinical significance.
 Twelve-lead body surface electrocardiogram was taken to measure the heart rates and PR intervals from 4 025 healthy individuals (age range from 6 min after birth to 83 years old) who performed physical examination from Jan, 1993 to Dec, 2012 in the Second Xiangya Hospital, Central South University. Statistics were analyzed by SPSS 16.0.
 The total incidence of short PR interval was 19.65% (791/4 025). The age group from birth to 13 years old had a higher incidence than the other age groups (χ2=432, PPR intervals was 3.58% (144/4 025). The 1 year-old group had the highest incidence (6.74%), which decreased with the increase of age. The lowest incidence of long PR intervals occurred in the age group from 14-17 years old, which gradually increased after 50 years old. There were no significant differences in long (short) PR intervals between the gender (P>0.05).
 The incidence of long (short) PR intervals varies in different age groups of healthy people. The incidences of long (short) PR intervals in children before 10 years old are higher than those in adults, especially the short PR intervals, as a result of the heart rate affected by childhood autonomic nervous function and the change in atrial volume with age. Adults have long (short) PR interval should be regularly followed-up to prevent cardiovascular events.

Diagnostic advantages of the association of electrocardiograms and thallium 201 exercise scintigraphy in detecting coronary disease

International Nuclear Information System (INIS)

Tubau, J.F.; Chaitman, B.R.; Dupras, G.; Waters, D.D.; Bourassa, M.G.

1979-01-01

Thallium 201 exercise scintigraphy combined with 14-lead exercise electrocardiography detects coronary artery disease in 95-96 percent of the patients, whether men or women. When both tests were positive, 93 percent of the men and 100 percent of the women had coronary artery disease. In women, thallium 201 seems to do better than 14-lead exercise electrocardiogram, detecting the presence of coronary artery disease in 72 percent and its absence in 83 percent of the cases. In approximately 50 percent of the cases, the results of thallium 201 and multiple-lead exercise testing were discordant; in these cases, an accurate clinical history is helpful. (author) [fr

Individual identification via electrocardiogram analysis.

Science.gov (United States)

Fratini, Antonio; Sansone, Mario; Bifulco, Paolo; Cesarelli, Mario

2015-08-14

During last decade the use of ECG recordings in biometric recognition studies has increased. ECG characteristics made it suitable for subject identification: it is unique, present in all living individuals, and hard to forge. However, in spite of the great number of approaches found in literature, no agreement exists on the most appropriate methodology. This study aimed at providing a survey of the techniques used so far in ECG-based human identification. Specifically, a pattern recognition perspective is here proposed providing a unifying framework to appreciate previous studies and, hopefully, guide future research. We searched for papers on the subject from the earliest available date using relevant electronic databases (Medline, IEEEXplore, Scopus, and Web of Knowledge). The following terms were used in different combinations: electrocardiogram, ECG, human identification, biometric, authentication and individual variability. The electronic sources were last searched on 1st March 2015. In our selection we included published research on peer-reviewed journals, books chapters and conferences proceedings. The search was performed for English language documents. 100 pertinent papers were found. Number of subjects involved in the journal studies ranges from 10 to 502, age from 16 to 86, male and female subjects are generally present. Number of analysed leads varies as well as the recording conditions. Identification performance differs widely as well as verification rate. Many studies refer to publicly available databases (Physionet ECG databases repository) while others rely on proprietary recordings making difficult them to compare. As a measure of overall accuracy we computed a weighted average of the identification rate and equal error rate in authentication scenarios. Identification rate resulted equal to 94.95 % while the equal error rate equal to 0.92 %. Biometric recognition is a mature field of research. Nevertheless, the use of physiological signals

Synergistic effect of polymorphisms of paraoxonase gene cluster and arsenic exposure on electrocardiogram abnormality

International Nuclear Information System (INIS)

Liao, Y.-T.; Li, W.-F.; Chen, C.-J.; Prineas, Ronald J.; Chen, Wei J.; Zhang Zhuming; Sun, C.-W.; Wang, S.-L.

2009-01-01

Arsenic has been linked to increased prevalence of cancer and cardiovascular disease (CVD), but the long-term impact of arsenic exposure remains unclear. Human paraoxonase (PON1) is a high-density lipoprotein-associated antioxidant enzyme which hydrolyzes oxidized lipids and is thought to be protective against atherosclerosis, but evidence remains limited to case-control studies. Only recently have genes encoding enzymes responsible for arsenic metabolism, such as AS3MT and GSTO, been cloned and characterized. This study was designed to evaluate the synergistic interaction of genetic factors and arsenic exposure on electrocardiogram abnormality. A total of 216 residents from three tap water implemented villages of previous arseniasis-hyperendemic regions in Taiwan were prospectively followed for an average of 8 years. For each resident, a 12-lead conventional electrocardiogram (ECG) was recorded and coded by Minnesota Code standard criteria. Eight functional polymorphisms of PON1, PON2, AS3MT, GSTO1, and GSTO2 were examined for genetic susceptibility to ECG abnormality. Among 42 incident cases with ECG deterioration identified among 121 baseline-normal subjects, arsenic exposure was significantly correlated with incidence of ECG abnormality. In addition, polymorphisms in two paraoxonase genes were also found associated with the incidence of ECG abnormality. A haplotype R-C-S constituted by polymorphisms of PON1 Q192R, -108C/T and PON2 C311S was linked to the increased risk. Subjects exposed to high levels of As (cumulative As exposure > 14.7 ppm-year or drinking artesian well water > 21 years) and carrying the R-C-S haplotype had significantly increased risks for ECG abnormality over those with only one risk factor. Results of this study showed a long-term arsenic effect on ECG abnormality and significant gene-gene and gene-environment interactions linked to the incidence of CVD. This finding might have important implications for a novel and potentially useful

Rural emergency medical technician pre-hospital electrocardiogram transmission.

Science.gov (United States)

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

Electrocardiogram signal denoising based on a new improved wavelet thresholding

Science.gov (United States)

Han, Guoqiang; Xu, Zhijun

2016-08-01

Good quality electrocardiogram (ECG) is utilized by physicians for the interpretation and identification of physiological and pathological phenomena. In general, ECG signals may mix various noises such as baseline wander, power line interference, and electromagnetic interference in gathering and recording process. As ECG signals are non-stationary physiological signals, wavelet transform is investigated to be an effective tool to discard noises from corrupted signals. A new compromising threshold function called sigmoid function-based thresholding scheme is adopted in processing ECG signals. Compared with other methods such as hard/soft thresholding or other existing thresholding functions, the new algorithm has many advantages in the noise reduction of ECG signals. It perfectly overcomes the discontinuity at ±T of hard thresholding and reduces the fixed deviation of soft thresholding. The improved wavelet thresholding denoising can be proved to be more efficient than existing algorithms in ECG signal denoising. The signal to noise ratio, mean square error, and percent root mean square difference are calculated to verify the denoising performance as quantitative tools. The experimental results reveal that the waves including P, Q, R, and S waves of ECG signals after denoising coincide with the original ECG signals by employing the new proposed method.

Temporal abstraction and inductive logic programming for arrhythmia recognition from electrocardiograms.

Science.gov (United States)

Carrault, G; Cordier, M-O; Quiniou, R; Wang, F

2003-07-01

This paper proposes a novel approach to cardiac arrhythmia recognition from electrocardiograms (ECGs). ECGs record the electrical activity of the heart and are used to diagnose many heart disorders. The numerical ECG is first temporally abstracted into series of time-stamped events. Temporal abstraction makes use of artificial neural networks to extract interesting waves and their features from the input signals. A temporal reasoner called a chronicle recogniser processes such series in order to discover temporal patterns called chronicles which can be related to cardiac arrhythmias. Generally, it is difficult to elicit an accurate set of chronicles from a doctor. Thus, we propose to learn automatically from symbolic ECG examples the chronicles discriminating the arrhythmias belonging to some specific subset. Since temporal relationships are of major importance, inductive logic programming (ILP) is the tool of choice as it enables first-order relational learning. The approach has been evaluated on real ECGs taken from the MIT-BIH database. The performance of the different modules as well as the efficiency of the whole system is presented. The results are rather good and demonstrate that integrating numerical techniques for low level perception and symbolic techniques for high level classification is very valuable.

Quality Aware Compression of Electrocardiogram Using Principal Component Analysis.

Science.gov (United States)

Gupta, Rajarshi

2016-05-01

Electrocardiogram (ECG) compression finds wide application in various patient monitoring purposes. Quality control in ECG compression ensures reconstruction quality and its clinical acceptance for diagnostic decision making. In this paper, a quality aware compression method of single lead ECG is described using principal component analysis (PCA). After pre-processing, beat extraction and PCA decomposition, two independent quality criteria, namely, bit rate control (BRC) or error control (EC) criteria were set to select optimal principal components, eigenvectors and their quantization level to achieve desired bit rate or error measure. The selected principal components and eigenvectors were finally compressed using a modified delta and Huffman encoder. The algorithms were validated with 32 sets of MIT Arrhythmia data and 60 normal and 30 sets of diagnostic ECG data from PTB Diagnostic ECG data ptbdb, all at 1 kHz sampling. For BRC with a CR threshold of 40, an average Compression Ratio (CR), percentage root mean squared difference normalized (PRDN) and maximum absolute error (MAE) of 50.74, 16.22 and 0.243 mV respectively were obtained. For EC with an upper limit of 5 % PRDN and 0.1 mV MAE, the average CR, PRDN and MAE of 9.48, 4.13 and 0.049 mV respectively were obtained. For mitdb data 117, the reconstruction quality could be preserved up to CR of 68.96 by extending the BRC threshold. The proposed method yields better results than recently published works on quality controlled ECG compression.

Singularity detection by wavelet approach: application to electrocardiogram signal

Science.gov (United States)

Jalil, Bushra; Beya, Ouadi; Fauvet, Eric; Laligant, Olivier

2010-01-01

In signal processing, the region of abrupt changes contains the most of the useful information about the nature of the signal. The region or the points where these changes occurred are often termed as singular point or singular region. The singularity is considered to be an important character of the signal, as it refers to the discontinuity and interruption present in the signal and the main purpose of the detection of such singular point is to identify the existence, location and size of those singularities. Electrocardiogram (ECG) signal is used to analyze the cardiovascular activity in the human body. However the presence of noise due to several reasons limits the doctor's decision and prevents accurate identification of different pathologies. In this work we attempt to analyze the ECG signal with energy based approach and some heuristic methods to segment and identify different signatures inside the signal. ECG signal has been initially denoised by empirical wavelet shrinkage approach based on Steins Unbiased Risk Estimate (SURE). At the second stage, the ECG signal has been analyzed by Mallat approach based on modulus maximas and Lipschitz exponent computation. The results from both approaches has been discussed and important aspects has been highlighted. In order to evaluate the algorithm, the analysis has been done on MIT-BIH Arrhythmia database; a set of ECG data records sampled at a rate of 360 Hz with 11 bit resolution over a 10mv range. The results have been examined and approved by medical doctors.

Detection of Atrial Fibrillation Using Artifical Neural Network with Power Spectrum Density of RR Interval of Electrocardiogram

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Afdala, Adfal; Nuryani, Nuryani; Satrio Nugroho, Anto

2017-01-01

Atrial fibrillation (AF) is a disorder of the heart with fairly high mortality in adults. AF is a common heart arrythmia which is characterized by a missing or irregular contraction of atria. Therefore, finding a method to detect atrial fibrillation is necessary. In this article a system to detect atrial fibrillation has been proposed. Detection system utilized backpropagation artifical neural network. Data input in this method includes power spectrum density of R-peaks interval of electrocardiogram which is selected by wrapping method. This research uses parameter learning rate, momentum, epoch and hidden layer. System produces good performance with accuracy, sensitivity, and specificity of 83.55%, 86.72 % and 81.47 %, respectively.

Computer decision support as a source of interpretation error: the case of electrocardiograms.

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Tsai, Theodore L; Fridsma, Douglas B; Gatti, Guido

2003-01-01

The aim of this study was to determine the effect that the computer interpretation (CI) of electrocardiograms (EKGs) has on the accuracy of resident (noncardiologist) physicians reading EKGs. A randomized, controlled trial was conducted in a laboratory setting from February through June 2001, using a two-period crossover design with matched pairs of subjects randomly assigned to sequencing groups. Subjects' interpretive accuracy of discrete, cardiologist-determined EKG findings were measured as judged by a board-certified internist. Without the CI, subjects interpreted 48.9% (95% confidence interval, 45.0% to 52.8%) of the findings correctly. With the CI, subjects interpreted 55.4% (51.9% to 58.9%) correctly (p EKG 67.7% (57.2% to 76.7%) than when it was not 34.6% (23.8% to 47.3%; p reading EKGs. However, subjects were influenced significantly by incorrect advice, which tempers the overall usefulness of computer-generated advice in this and perhaps other areas.

The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report.

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Ogunlade, Oluwadare; Ayoka, Abiodun O; Akomolafe, Rufus O; Akinsomisoye, Olumide S; Irinoye, Adedayo I; Ajao, Adewale; Asafa, Muritala A

2015-09-28

Dextrocardia with situs inversus is a rare congenital disease. In patients with this condition, the heart is presented as a mirror image of itself with its apex pointing to the right. The pulmonary and abdominal anatomies are reversed. Dextrocardia with situs inversus occurs at birth but its diagnosis may be in adulthood. This case advances knowledge by graphically describing the unusual electrocardiographic features of dextrocardia in a young adult. We report a case of a 22-year-old Nigerian man of Yoruba ethnicity who presented himself for preadmission medical test. He had a standard 12-lead electrocardiogram which revealed uncommon features: inversion of P waves in leads I, aVL and aVR; dominantly negative QRS waves in leads I, V1 to V6; reverse R wave progression in chest leads; low voltage in V4 to V6; extreme QRS axis; flattened T waves in V4 to V6 and aVR; and inverted T waves in lead I and aVL. An electrocardiogram diagnosis of dextrocardia was made. The differential diagnosis considered was right ventricular hypertrophy. A cardiovascular examination showed pulse rate of 70 beats per minute, blood pressure of 119/62mmHg, visible cardiac impulse at right precordium, apex beat was located at his fifth right intercostal space mid-clavicular line. A chest X-ray (posterior anterior view) including upper abdomen showed dextrocardia; his aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His trachea was slightly deviated to the left. The findings in his lung fields were not remarkable. Abdominopelvic ultrasonography showed that right-sided intra-abdominal organs (liver, gallbladder) were located on the left while left-sided organs (stomach, spleen) were located on the right. His abdominal aorta was on the right while his inferior vena cava was located on the left. A diagnosis of dextrocardia with situs inversus was made ultrasonographically. A properly interpreted electrocardiogram was useful in suspecting the

Effects of electrocardiogram gating on CT pulmonary angiography image quality

International Nuclear Information System (INIS)

Ardley, Nicholas D.; Lau, Ken K.; Troupis, John M.; Buchan, Kevin; Paul, Eldho

2014-01-01

Pulmonary embolism (PE) is the third most common cause of death from cardiovascular disease. Computed-tomographic pulmonary angiography (CTPA) is an accurate and safe test for diagnosing PE. The aim of this retrospective analysis was to evaluate the effects on image quality (IQ) of electrocardiogram (ECG) gating during CTPA. Fifty consecutive patients presenting for CTPA were included in the study. A single acquisition was performed, resulting in two reconstructions: one at 75% of the R–R interval and the other without ECG influence. IQ evaluation was undertaken by two radiologists, focusing on respiratory and cardiac motion, image noise, low-contrast resolution, vessel and lung clarity, contrast media opacification and artefacts. Various regions of the lungs and vasculature were evaluated, and IQ scores were statistically compared. For the ECG-tagged reconstructions, IQ was noted to be better overall with regard to vessel clarity (P<0.05) and cardiac motion (P<0.05), while lung clarity was better only in the left lower zone (P<0.05). IQ was better with regard to image noise (P<0.05) and low-contrast resolution (P<0.05) in the non-ECG-tagged reconstructions. No statistical IQ difference between the two types of reconstruction was noted with regard to respiratory motion, contrast media opacification or presence of artefacts. The two types of reconstruction provide complementary information for evaluating CTPA results.

Utility of QGS for 201Tl electrocardiogram-gated SPECT in cardiac function evaluations

International Nuclear Information System (INIS)

Shimazaki, Hiroshi; Oono, Ryuichi

2001-01-01

QGS (quantitative gated SPECT) was applied to 201 Tl SPECT, whose images are inferior to those of Tc SPECT, and its utility was evaluated. More specifically, the cardiac function index was calculated by QGS, and local wall motion was evaluated visually. Accuracy was assessed by comparison with left ventriculography. The subjects were 29 patients (21 males, 8 females; 6 with myocardial infarction, 18 with stenocardia, 2 with pericardial disease, 3 with other heart diseases) who had undergone myocardial scintigraphy and left ventriculography between February and May, 2000. 201 Tl (74 or 111 MBq) was administered to all patients. The resting image was obtained 10 minutes later, and the delayed image during loading was obtained 4 hours later. The conditions for acquiring the images were as follows. Two detectors were arranged at a 90-degree angle in the form of an L. The 180 degrees from 45 degrees right anterior oblique (RAO) to 45 degrees left posterior oblique (LPO) were divided into 30 sections at 6-degree intervals, and the image in each section was acquired for 60 seconds. The matrix was 64 x 64. As a cardiac function index, the left ventricular ejection function (LVEF) obtained by electrocardiogram-gated SPECT (QGS-EF) at the rest (14 cases) and the QGS-EF on the delayed images (15 cases) were compared with the LVEF determined by left ventriculography (LVG-EF). There was an excellent positive correlation between the data obtained by two methods, with a correlation coefficient of r=0.93 (y=1.04x-0.04). Most of the difference between the values fell within two standard deviations, and the error was in the clinically allowable range. There was no significant difference between the correlation coefficient at rest and during loading or between the cases that showed an obvious defect on the image and those that did not. The local wall motion of the left ventricle was visually evaluated in five stages in two directions (RAO, 30 degrees, and LAO, 60 degrees). The motion

How the knowledge of genetic "makeup" and cellular data can affect the analysis of repolarization in surface electrocardiogram.

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Shimizu, Wataru

2010-01-01

This review article sought to describe patterns of repolarization on the surface electrocardiogram in inherited cardiac arrhythmias and to discuss how the knowledge of genetic makeup and cellular data can affect the analysis based on the data derived from the experimental studies using arterially perfused canine ventricular wedge preparations. Molecular genetic studies have established a link between a number of inherited cardiac arrhythmia syndromes and mutations in genes encoding cardiac ion channels or membrane components during the past 2 decades. Twelve forms of congenital long QT syndrome have been so far identified, and genotype-phenotype correlations have been investigated especially in the 3 major genotypes-LQT1, LQT2, and LQT3. Abnormal T waves are reported in the LQT1, LQT2, and LQT3, and the differences in the time course of repolarization of the epicardial, midmyocardial, and endocardial cells give rise to voltage gradients responsible for the manifestation of phenotypic appearance of abnormal T waves. Brugada syndrome is characterized by ST-segment elevation in leads V1 to V3 and an episode of ventricular fibrillation, in which 7 genotypes have been reported. An intrinsically prominent transient outward current (I(to))-mediated action potential notch and a subsequent loss of action potential dome in the epicardium, but not in the endocardium of the right ventricular outflow tract, give rise to a transmural voltage gradient, resulting in ST-segment elevation, and a subsequent phase 2 reentry-induced ventricular fibrillation. In conclusion, transmural electrical heterogeneity of repolarization across the ventricular wall profoundly affects the phenotypic manifestation of repolarization patterns on the surface electrocardiogram in inherited cardiac arrhythmias. Copyright © 2010 Elsevier Inc. All rights reserved.

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy.

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Chen, Jan-Yow; Lin, Kuo-Hung; Chang, Kuan-Cheng; Chou, Che-Yi

2017-08-03

QRS duration has been associated with the response to cardiac resynchronization therapy (CRT). However, the methods for defining QRS duration to predict the outcome of CRT have discrepancies in previous reports. The aim of this study was to determine an optimal measurement of QRS duration to predict the response to CRT.Sixty-one patients who received CRT were analyzed. All patients had class III-IV heart failure, left ventricular ejection fraction not more than 35%, and complete left bundle branch block. The shortest, longest, and average QRS durations from the 12 leads of each electrocardiogram (ECG) were measured. The responses to CRT were determined using the changes in echocardiography after 6 months. Thirty-five (57.4%) patients were responders and 26 (42.6%) patients were non-responders. The pre-procedure shortest, average, and longest QRS durations and the QRS shortening (ΔQRS) of the shortest QRS duration were significantly associated with the response to CRT in a univariate logistic regression analysis (P = 0.002, P = 0.03, P = 0.04 and P = 0.04, respectively). Based on the measurement of the area under curve of the receiver operating characteristic curve, only the pre-procedure shortest QRS duration and the ΔQRS of the shortest QRS duration showed significant discrimination for the response to CRT (P = 0.002 and P = 0.038, respectively). Multivariable logistic regression showed the pre-procedure shortest QRS duration is an independent predictor for the response to CRT.The shortest QRS duration from the 12 leads of the electrocardiogram might be an optimal measurement to predict the response to CRT.

Value of the Electrocardiogram as a Predictor of Right Ventricular Dysfunction in Patients With Chronic Right Ventricular Volume Overload.

Science.gov (United States)

Alonso, Pau; Andrés, Ana; Rueda, Joaquín; Buendía, Francisco; Igual, Begoña; Rodríguez, María; Osa, Ana; Arnau, Miguel A; Salvador, Antonio

2015-05-01

Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with right ventricular volume. The receiver operating characteristic curve indicated a cut-off point for QRS width of 140ms, which showed good sensitivity for a diagnosis of right ventricular dilation (> 80%) and dysfunction (> 95%). In logistic regression models, a QRS duration > 140ms was found to be the only independent predictor of right ventricular dilation and dysfunction. Electrocardiography is a rapid, widely available, and reproducible tool. QRS width constitutes an independent predictor of the presence of right ventricular dilation and dysfunction. This study is the first to provide a cutoff value for QRS width to screen for right ventricle involvement. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Gender differences in the electrocardiogram screening of athletes.

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Bessem, Bram B; de Bruijn, Matthijs M C; Nieuwland, Wybe W

2017-02-01

Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the cardiovascular screening of young athletes. Observational cross-sectional study. In 2013 and 2014 all the ECGs from the cardiovascular screenings performed at University Sports Medical Centre in Groningen of the student athletes who wanted to participate in a college sports program were collected. The ECG characteristics were scored using computer-based measurements and the Seattle ECG criteria. The study population included 1436 athletes, of which 72% were male. Male athletes were older (19.3 years vs. 18.6 years), participated in sports more frequently (4.0/week vs. 3.8/week) and spent more hours per week practising sports (6.4h/week vs. 5.8h/week) than female athletes. Male athletes had significantly higher PR intervals (149ms vs. 141ms), lead voltages and QRS duration (98ms vs. 88ms). Female athletes had significantly higher resting heart rates (69/min vs. 64/min) and QTc intervals (407ms vs. 400ms). Male athletes also had significantly higher amounts of sinus bradycardia (38.3% vs. 23.0%), incomplete RBBB (15.0% vs. 3.7%), early repolarisation (4.5% vs. 1.0%) and isolated QRS voltage criteria for LVH (26.3% vs. 4.6%). All P-values were ≤0.001. ECGs of young athletes demonstrate gender-related differences. These differences could be considered in their cardiovascular screening. For the Seattle ECG criteria we advise additional research into the clinical implications of using gender-based cut-off values for the QRS duration in the intraventricular conduction delay criterion. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A Bayesian-optimized spline representation of the electrocardiogram

International Nuclear Information System (INIS)

Guilak, F G; McNames, J

2013-01-01

We introduce an implementation of a novel spline framework for parametrically representing electrocardiogram (ECG) waveforms. This implementation enables a flexible means to study ECG structure in large databases. Our algorithm allows researchers to identify key points in the waveform and optimally locate them in long-term recordings with minimal manual effort, thereby permitting analysis of trends in the points themselves or in metrics derived from their locations. In the work described here we estimate the location of a number of commonly-used characteristic points of the ECG signal, defined as the onsets, peaks, and offsets of the P, QRS, T, and R′ waves. The algorithm applies Bayesian optimization to a linear spline representation of the ECG waveform. The location of the knots—which are the endpoints of the piecewise linear segments used in the spline representation of the signal—serve as the estimate of the waveform’s characteristic points. We obtained prior information of knot times, amplitudes, and curvature from a large manually-annotated training dataset and used the priors to optimize a Bayesian figure of merit based on estimated knot locations. In cases where morphologies vary or are subject to noise, the algorithm relies more heavily on the estimated priors for its estimate of knot locations. We compared optimized knot locations from our algorithm to two sets of manual annotations on a prospective test data set comprising 200 beats from 20 subjects not in the training set. Mean errors of characteristic point locations were less than four milliseconds, and standard deviations of errors compared favorably against reference values. This framework can easily be adapted to include additional points of interest in the ECG signal or for other biomedical detection problems on quasi-periodic signals. (paper)

Electrocardiogram signal quality measures for unsupervised telehealth environments

International Nuclear Information System (INIS)

Redmond, S J; Xie, Y; Chang, D; Lovell, N H; Basilakis, J

2012-01-01

The use of telehealth paradigms for the remote management of patients suffering from chronic conditions has become more commonplace with the advancement of Internet connectivity and enterprise software systems. To facilitate clinicians in managing large numbers of telehealth patients, and in digesting the vast array of data returned from the remote monitoring environment, decision support systems in various guises are often utilized. The success of decision support systems in interpreting patient conditions from physiological data is dependent largely on the quality of these recorded data. This paper outlines an algorithm to determine the quality of single-lead electrocardiogram (ECG) recordings obtained from telehealth patients. Three hundred short ECG recordings were manually annotated to identify movement artifact, QRS locations and signal quality (discrete quality levels) by a panel of three experts, who then reconciled the annotation as a group to resolve any discrepancies. After applying a published algorithm to remove gross movement artifact, the proposed method was then applied to estimate the remaining ECG signal quality, using a Parzen window supervised statistical classifier model. The three-class classifier model, using a number of time-domain features and evaluated using cross validation, gave an accuracy in classifying signal quality of 78.7% (κ = 0.67) when using fully automated preprocessing algorithms to remove gross motion artifact and detect QRS locations. This is a similar level of accuracy to the reported human inter-scorer agreement when generating the gold standard annotation (accuracy = 70–89.3%, κ = 0.54–0.84). These results indicate that the assessment of the quality of single-lead ECG recordings, acquired in unsupervised telehealth environments, is entirely feasible and may help to promote the acceptance and utility of future decision support systems for remotely managing chronic disease conditions. (paper)

Educational Software Applied in Teaching Electrocardiogram: A Systematic Review

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Paulo A. I. Pontes

2018-01-01

Full Text Available Background. The electrocardiogram (ECG is the most used diagnostic tool in medicine; in this sense, it is essential that medical undergraduates learn how to interpret it correctly while they are still on training. Naturally, they go through classic learning (e.g., lectures and speeches. However, they are not often efficiently trained in analyzing ECG results. In this regard, methodologies such as other educational support tools in medical practice, such as educational software, should be considered a valuable approach for medical training purposes. Methods. We performed a literature review in six electronic databases, considering studies published before April 2017. The resulting set comprises 2,467 studies. From this collection, 12 studies have been selected, initially, whereby we carried out a snowballing process to identify other relevant studies through the reference lists of these studies, resulting in five relevant studies, making up a total of 17 articles that passed all stages and criteria. Results. The results show that 52.9% of software types were tutorial and 58.8% were designed to be run locally on a computer. The subjects were discussed together with a greater focus on the teaching of electrophysiology and/or cardiac physiology, identifying patterns of ECG and/or arrhythmias. Conclusions. We found positive results with the introduction of educational software for ECG teaching. However, there is a clear need for using higher quality research methodologies and the inclusion of appropriate controls, in order to obtain more precise conclusions about how beneficial the inclusion of such tools can be for the practices of ECG interpretation.

Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome

DEFF Research Database (Denmark)

Clark, Elaine N; Ripa, Maria Sejersten; Clemmensen, Peter

2010-01-01

The aims of this study were to assess the effectiveness of 2 automated electrocardiogram interpretation programs in patients with suspected acute coronary syndrome transported to hospital by ambulance in 1 rural region of Denmark with hospital discharge diagnosis used as the gold standard...... infarction with respect to discharge diagnosis were 78%, 91%, and 81% for LIFEPAK 12 and 78%, 94%, and 87% for the Glasgow program. Corresponding data for attending cardiologists were 85%, 90%, and 81%. In conclusion, the Glasgow program had significantly higher specificity than the LIFEPAK 12 program (p = 0...

A Precise Drunk Driving Detection Using Weighted Kernel Based on Electrocardiogram.

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Wu, Chung Kit; Tsang, Kim Fung; Chi, Hao Ran; Hung, Faan Hei

2016-05-09

Globally, 1.2 million people die and 50 million people are injured annually due to traffic accidents. These traffic accidents cost $500 billion dollars. Drunk drivers are found in 40% of the traffic crashes. Existing drunk driving detection (DDD) systems do not provide accurate detection and pre-warning concurrently. Electrocardiogram (ECG) is a proven biosignal that accurately and simultaneously reflects human's biological status. In this letter, a classifier for DDD based on ECG is investigated in an attempt to reduce traffic accidents caused by drunk drivers. At this point, it appears that there is no known research or literature found on ECG classifier for DDD. To identify drunk syndromes, the ECG signals from drunk drivers are studied and analyzed. As such, a precise ECG-based DDD (ECG-DDD) using a weighted kernel is developed. From the measurements, 10 key features of ECG signals were identified. To incorporate the important features, the feature vectors are weighted in the customization of kernel functions. Four commonly adopted kernel functions are studied. Results reveal that weighted feature vectors improve the accuracy by 11% compared to the computation using the prime kernel. Evaluation shows that ECG-DDD improved the accuracy by 8% to 18% compared to prevailing methods.

Case report: an electrocardiogram of spontaneous pneumothorax mimicking arm lead reversal.

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Wieters, J Scott; Carlin, Joseph P; Morris, Andrew

2014-05-01

There are several previously documented findings for electrocardiograms (ECGs) of spontaneous pneumothorax. These findings include axis deviation, T-wave inversion, and right bundle branch block. When an ECG has the arm leads incorrectly placed, the ECG will display right axis deviation and inversion of the P waves in lead I. There have been no previously published ECGs of spontaneous pneumothorax that have shown the same findings as reversal of the limb leads of an ECG. A possible finding of spontaneous pneumothorax is an identical finding to that of an ECG that has been flagged for limb lead reversal. A patient presented in the emergency setting with acute chest pain and shortness of breath caused by a tension pneumothorax. An ECG was administered; findings indicated reversal of the arm leads (right axis deviation and inverted P waves in lead I), but there was no actual limb lead reversal present. ECG findings resolved upon resolution of the pneumothorax. If a patient presents with chest pain and shortness of breath, and the patient's ECG is flagged for limb lead reversal despite being set up correctly, the physician should raise clinical suspicion for a possible spontaneous pneumothorax. Copyright © 2014 Elsevier Inc. All rights reserved.

A Precise Drunk Driving Detection Using Weighted Kernel Based on Electrocardiogram

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Chung Kit Wu

2016-05-01

Full Text Available Globally, 1.2 million people die and 50 million people are injured annually due to traffic accidents. These traffic accidents cost $500 billion dollars. Drunk drivers are found in 40% of the traffic crashes. Existing drunk driving detection (DDD systems do not provide accurate detection and pre-warning concurrently. Electrocardiogram (ECG is a proven biosignal that accurately and simultaneously reflects human’s biological status. In this letter, a classifier for DDD based on ECG is investigated in an attempt to reduce traffic accidents caused by drunk drivers. At this point, it appears that there is no known research or literature found on ECG classifier for DDD. To identify drunk syndromes, the ECG signals from drunk drivers are studied and analyzed. As such, a precise ECG-based DDD (ECG-DDD using a weighted kernel is developed. From the measurements, 10 key features of ECG signals were identified. To incorporate the important features, the feature vectors are weighted in the customization of kernel functions. Four commonly adopted kernel functions are studied. Results reveal that weighted feature vectors improve the accuracy by 11% compared to the computation using the prime kernel. Evaluation shows that ECG-DDD improved the accuracy by 8% to 18% compared to prevailing methods.

Trend Extraction in Functional Data of Amplitudes of R and T Waves in Exercise Electrocardiogram

Science.gov (United States)

Cammarota, Camillo; Curione, Mario

The amplitudes of R and T waves of the electrocardiogram (ECG) recorded during the exercise test show both large inter- and intra-individual variability in response to stress. We analyze a dataset of 65 normal subjects undergoing ambulatory test. We model the dataset of R and T series in the framework of functional data, assuming that the individual series are realizations of a non-stationary process, centered at the population trend. We test the time variability of this trend computing a simultaneous confidence band and the zero crossing of its derivative. The analysis shows that the amplitudes of the R and T waves have opposite responses to stress, consisting respectively in a bump and a dip at the early recovery stage. Our findings support the existence of a relationship between R and T wave amplitudes and respectively diastolic and systolic ventricular volumes.

Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea.

Science.gov (United States)

de Chazal, Philip; Heneghan, Conor; Sheridan, Elaine; Reilly, Richard; Nolan, Philip; O'Malley, Mark

2003-06-01

A method for the automatic processing of the electrocardiogram (ECG) for the detection of obstructive apnoea is presented. The method screens nighttime single-lead ECG recordings for the presence of major sleep apnoea and provides a minute-by-minute analysis of disordered breathing. A large independently validated database of 70 ECG recordings acquired from normal subjects and subjects with obstructive and mixed sleep apnoea, each of approximately eight hours in duration, was used throughout the study. Thirty-five of these recordings were used for training and 35 retained for independent testing. A wide variety of features based on heartbeat intervals and an ECG-derived respiratory signal were considered. Classifiers based on linear and quadratic discriminants were compared. Feature selection and regularization of classifier parameters were used to optimize classifier performance. Results show that the normal recordings could be separated from the apnoea recordings with a 100% success rate and a minute-by-minute classification accuracy of over 90% is achievable.

PROPOSED SIMPLE METHOD FOR ELECTROCARDIOGRAM RECORDING IN FREE-RANGING ASIAN ELEPHANTS (ELEPHAS MAXIMUS).

Science.gov (United States)

Chai, Norin; Pouchelon, Jean Louis; Bouvard, Jonathan; Sillero, Leonor Camacho; Huynh, Minh; Segalini, Vincent; Point, Lisa; Croce, Veronica; Rigaux, Goulven; Highwood, Jack; Chetboul, Valérie

2016-03-01

Electrocardiography represents a relevant diagnostic tool for detecting cardiac disease in animals. Elephants can present various congenital and acquired cardiovascular diseases. However, few electrophysiologic studies have been reported in captive elephants, mainly due to challenging technical difficulties in obtaining good-quality electrocardiogram (ECG) tracings, and no data are currently available for free-ranging Asian elephants (Elephas maximus). The purpose of this pilot prospective study was to evaluate the feasibility of using a simple method for recording ECG tracings in wild, apparently healthy, unsedated Asian elephants (n = 7) in the standing position. Successful six-lead recordings (I, II, III, aVR, aVL, and aVF) were obtained, with the aVL lead providing the best-quality tracings in most animals. Variables measured in the aVL lead included heart rate, amplitudes and duration of the P waves, QRS complexes, T and U waves, and duration of the PR, QT, and QU intervals. A negative deflection following positive P waves, representative of an atrial repolarization wave (Ta wave), was observed for five out of the seven elephants.

Analysis of Morphological Characteristics and Origins of Idiopathic Premature Ventricular Contractions Under a 12-Lead Electrocardiogram in Children with Structurally Normal Hearts.

Science.gov (United States)

Jiang, Jianbin; He, Yuee; Qiu, Huixian; Zhang, Yuanhai; Chu, Maoping; Li, Yuechun; Chen, Qi

2017-10-21

Up to 40% of healthy children have premature ventricular complexes or contractions (PVCs) detected with 24-hour Holter monitoring. We aimed to investigate the morphological characteristics and origins of idiopathic PVCs under a 12-lead electrocardiogram in children with structurally normal hearts. All asymptomatic monomorphic PVC patients with structurally normal hearts under 18 years of age were included in this retrospective study. Characteristics of PVCs in lead V 1 under a 12-lead electrocardiogram were classified as left bundle branch block (PVC-LBBB) or right bundle branch block (PVC-RBBB). According to limb leads, PVC-LBBB or PVC-RBBB was divided into: PVCs-LBBB type I; PVCs-LBBB type II; PVCs-RBBB type I; PVCs-RBBB type II; and PVCs-RBBB type III. Out of 178 PVC patients, 94 cases of PVCs-LBBB (PVCs-LBBB type I = 60; PVCs-LBBB type II = 34) and 84 cases of PVCs-RBBB (PVCs-RBBB type I = 3; PVCs-RBBB type II = 55; PVCs-RBBB type III = 26) were identified. The frequency of PVCs-LBBB type I increased with age and the frequency of PVCs-RBBB type II and III decreased with age. Among the children monitor tested, from 1 years old to 18 years old, PVCs originating from the left or right ventricular outflow tract gradually increased with age, while PVCs originating from the branch sources decreased with age.

Detection of coronary artery disease using 12-lead electrocardiogram and simultaneous dual myocardial imaging with iodine-123-β-methyl iodophenyl-pentadecanoic acid (BMIPP) and thallium-201 in patients with unstable angina

International Nuclear Information System (INIS)

Saitoh, Makoto; Hasegawa, Koh; Hasegawa, Kazuo; Kondoh, Teruo; Yanagawa, Tetsuo.

1995-01-01

We investigated the usefulness of 12-lead electrocardiogram and simultaneous single-photon emission computed tomography (SPECT) with 123 I-β-methyl iodophenyl-pentadecanoic acid (BMIPP) and thallium-201 ( 201 Tl) for detecting coronary artery disease (CAD) in 54 consecutive patients with unstable angina. Discordant BMIPP uptake was defined as less 123 I-BMIPP uptake than 201 Tl uptake in 123 I-BMIPP/ 201 Tl dual SPECT. In the detection of CAD, ischemic electrocardiographic change during anginal attack had high sensitivity and low specificity, while discordant BMIPP finding had low sensitivity and high specificity. In patients showing ST depression during anginal attack, discordant BMIPP uptake showed high sensitivity and high specificity for detecting CAD. In conclusion, both 12-lead electrocardiogram during anginal attack and discordant BMIPP uptake are useful in detecting CAD in patients with unstable angina. (author)

A NEW APPROACH TO DETECT CONGESTIVE HEART FAILURE USING DETRENDED FLUCTUATION ANALYSIS OF ELECTROCARDIOGRAM SIGNALS

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CHANDRAKAR KAMATH

2015-02-01

Full Text Available The aim of this study is to evaluate how far the detrended fluctuation analysis (DFA approach helps to characterize the short-term and intermediate-term fractal correlations in the raw electrocardiogram (ECG signals and thereby discriminate between normal and congestive heart failure (CHF subjects. The DFA-1 calculations were performed on normal and CHF short-term ECG segments, of the order of 20 seconds duration. Differences were found in shortterm and intermediate-term correlation properties and the corresponding scaling exponents of the two groups (normal and CHF. The statistical analyses show that short-term fractal scaling exponent alone is sufficient to distinguish between normal and CHF subjects. The receiver operating characteristic curve (ROC analysis confirms the robustness of this new approach and exhibits an average accuracy that exceeds 98.2%, average sensitivity of about 98.4%, positive predictivity of 98.00%, and average specificity of 98.00%.

Real-Time Monitoring and Analysis of Zebrafish Electrocardiogram with Anomaly Detection

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Michael Lenning

2017-12-01

Full Text Available Heart disease is the leading cause of mortality in the U.S. with approximately 610,000 people dying every year. Effective therapies for many cardiac diseases are lacking, largely due to an incomplete understanding of their genetic basis and underlying molecular mechanisms. Zebrafish (Danio rerio are an excellent model system for studying heart disease as they enable a forward genetic approach to tackle this unmet medical need. In recent years, our team has been employing electrocardiogram (ECG as an efficient tool to study the zebrafish heart along with conventional approaches, such as immunohistochemistry, DNA and protein analyses. We have overcome various challenges in the small size and aquatic environment of zebrafish in order to obtain ECG signals with favorable signal-to-noise ratio (SNR, and high spatial and temporal resolution. In this paper, we highlight our recent efforts in zebrafish ECG acquisition with a cost-effective simplified microelectrode array (MEA membrane providing multi-channel recording, a novel multi-chamber apparatus for simultaneous screening, and a LabVIEW program to facilitate recording and processing. We also demonstrate the use of machine learning-based programs to recognize specific ECG patterns, yielding promising results with our current limited amount of zebrafish data. Our solutions hold promise to carry out numerous studies of heart diseases, drug screening, stem cell-based therapy validation, and regenerative medicine.

An ontological analysis of the electrocardiogram - DOI: 10.3395/reciis.v3i1.242en

Directory of Open Access Journals (Sweden)

Bernardo Gonçalves

2009-04-01

Full Text Available Bioinformatics has been a fertile field for the application of the discipline of formal ontology. The principled representation of biomedical entities has increasingly supported biological research, with direct benefits ranging from the reformulation of medical terminologies to the introduction of new perspectives for enhanced models of Electronic Health Records (EHR. This paper introduces an application-independent ontological analysis of the electrocardiogram (ECG grounded in the Unified Foundational Ontology. With the objective of investigating the phenomena underlying this cardiological exam, we deal with the sub-domains of human heart electrophysiology and anatomy. We then outline an ECG Ontology built upon the OBO Relation Ontology. In addition, the domain ontology sketched here takes inspiration both in the Foundational Model of Anatomy and in the Ontology of Functions proposed under the auspices of the General Formal Ontology (GFO research program.

Diagnosis of silent myocardial ischemia in type 2 diabetic patients by electrocardiogram, ergometry and Gated-SPECT

International Nuclear Information System (INIS)

Penna Quian, Yamile; Fernandez-Britto Rodriguez, Jose; Bacallao Gallestey, Jorge; Batista Cuellar, Juan Felipe; Coca Perez, Marco Antonio; Toirac Garcia, Noresma; Penna Coego, Andria

2008-01-01

31 asymptomatic type 2 diabetic patients were studied by lab tests, electrocardiogram, ergometry, Gated-SPECT and coronariography to determine the relation between the atherosclerotic risk factors and the silent myocardial ischemia. Patients were classified into two groups: positive SPECT and negative SPECT. Association tests were made for each variable and ROC curves were constructed to identify risk markers. In 35.5% of the patients silent myocardial ischemia was detected with a good angiographic correlation. A significant association was evidenced between positive SPECT and the atherosclerotic risk factors, namely, low values of HDLc, family pathological history of ischemic heart disease and peripheral vascular disease. The logistic regression models showed that low values of HDLc together with family pathological history of ischemic heart disease may be strong predictors of silent myocardial ischemia in asymptomatic type 2 diabetic patients

Computer analysis of the exercise electrocardiogram and control of radionuclide ventriculography: an optimal statistical decision model for diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Hsia, P.W.E.

1987-01-01

A new automated technique for the diagnosis of coronary artery disease (CAD) by stress electrocardiography and radionuclide ventriculography (RNV) has been developed. The method employs digital signal processing of the electrocardiogram (ECG) for recognition of ischemic and arrhythmic events. On-line detection of abnormal beats is used for control image acquisition by the gamma camera resulting in improved image quality since only identical beats are included in the composite images of the cardiac cycle. A combined stress ECG analysis which measures ST changes indicative of ischemia, and radionuclide results, which reveal corresponding ejection fraction abnormalities yields greater sensitivity and specificity than either test alone. Digitized data from the electrocardiogram are analyzed in a beat-by-beat mode and a contextual diagnosis of underlying rhythm is given. Template generation, R wave detection, QRS window size, baseline correction, and continuous updating of heart rate are completely automated. A statistical model base on computerized ST segment measurements combined with radionuclide ventriculography data has been developed by using a logistic model with stepwise regression fitting. A previously acquired database of similar measurements was used for designing the model. The most significant parameters were found to be (1) ejection fraction of exercise RNV; (2) difference of ST level between exercise and resting test (stdif); and (3) ejection fraction difference between exercise and resting test. The new parameter stdif, not previously used in ECG interpretation, was found to be of great diagnostic significance

Learning electrocardiogram on YouTube: how useful is it?

Science.gov (United States)

Akgun, Taylan; Karabay, Can Yucel; Kocabay, Gonenc; Kalayci, Arzu; Oduncu, Vecih; Guler, Ahmet; Pala, Selcuk; Kirma, Cevat

2014-01-01

YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube. YouTube was searched on May 28, 2013 for the search terms "AF ecg" for atrial fibrillation, "AVNRT" for atrioventricular nodal reentrant tachycardia, "AVRT" for atrioventricular reentrant tachycardia, "AV block or heart block" for atrioventricular block, "LBBB, RBBB" for bundle branch block, "left anterior fascicular block or left posterior fascicular block" for fascicular blocks, "VT ecg" for ventricular tachycardia, "long QT" and "Brugada ecg". Non-English language, unrelated and non-educational videos were excluded. Remaining videos were assessed for usefulness, source and characteristics. Usefulness was assessed with using a checklist developed by the authors. One hundred nineteen videos were included in the analysis. Sources of the videos were as follows: individuals n=70, 58.8%, universities/hospitals n=10, 8.4% and medical organizations n=3, 2.5%, health ads n=10 8.4%, health websites n=26, 21.8%. Fifty-six (47.1%) videos were classified as very useful and 16 (13.4%) videos were misleading. 90% of the videos uploaded by universities/hospitals were grouped as very useful videos, the same ratio was 45% for the individual uploads. There were statistically significant differences in ECG diagnosis among the groups (for very useful, useful and misleading, pYouTube has a substantial amount of videos on ECG with a wide diversity from useful to misleading content. The lack of quality content relating to ECG on YouTube necessitates that videos should be selected with utmost care. © 2013 Elsevier Inc. All rights reserved.

The differences in electrocardiogram interpretation in top-level athletes.

Science.gov (United States)

Jakubiak, Agnieszka A; Burkhard-Jagodzińska, Krystyna; Król, Wojciech; Konopka, Marcin; Bursa, Dominik; Sitkowski, Dariusz; Kuch, Marek; Braksator, Wojciech

2017-01-01

The Ministry of Health in Poland recommends electrocardiogram (ECG)-based cardiovascular screening in athletes, but so far there has been a lack of guidelines on preparticipation assessment. We compared different criteria of ECG screening assessment in a group of top-level athletes. The aims were to evaluate the prevalence of ECG changes in athletes that necessitate further cardiological work-up according to three criteria in various age groups as well as to identify factors determining the occurrence of changes related and unrelated to the training. 262 high-dynamic, high-static Polish athletes (rowers, cyclists, canoeists) were divided into two age categories: young (≤ 18 years of age; n = 177, mean age 16.9 ± 0.8; 15-18 years) and elite (> 18 years of age; n = 85, mean age 22.9 ± 3.4; 19-34 years). All sports persons had a 12-lead ECG performed and evaluated according to 2010 European Society of Cardiology (ESC) recommendations, 2012 Seattle criteria, and 2014 Refined criteria. The Refined criteria reduced (p < 0.001) the number of training-unrelated ECG findings to 8.0% vs. 12.6% (Seattle criteria) and 30.5% (ESC recommendations). All three criteria revealed more training-related changes in the group of older athletes (76.5% vs. 55.9%, p = 0.001). Predictors that significantly (p < 0.005) affected the occurrence of adaptive changes were the age of the athlete, training duration (in years), and male gender. 1. The ESC criteria identified a group of athletes that was unacceptably large, as for the screening test, requiring verification with other methods (every fourth athlete). 2. The use of the Refined criteria helps to significantly reduce the frequency and necessity for additional tests. 3. The dependence of adaptive changes on training duration and athletes' age confirms the benign nature of those ECG findings.

Induction of Inflammation In Vivo by Electrocardiogram Sensor Operation Using Wireless Power Transmission.

Science.gov (United States)

Heo, Jin-Chul; Kim, Beomjoon; Kim, Yoon-Nyun; Kim, Dae-Kwang; Lee, Jong-Ha

2017-12-14

Prolonged monitoring by cardiac electrocardiogram (ECG) sensors is useful for patients with emergency heart conditions. However, implant monitoring systems are limited by lack of tissue biocompatibility. Here, we developed an implantable ECG sensor for real-time monitoring of ventricular fibrillation and evaluated its biocompatibility using an animal model. The implantable sensor comprised transplant sensors with two electrodes, a wireless power transmission system, and a monitoring system. The sensor was inserted into the subcutaneous tissue of the abdominal area and operated for 1 h/day for 5 days using a wireless power system. Importantly, the sensor was encapsulated by subcutaneous tissue and induced angiogenesis, inflammation, and phagocytosis. In addition, we observed that the levels of inflammation-related markers increased with wireless-powered transmission via the ECG sensor; in particular, levels of the Th-1 cytokine interleukin-12 were significantly increased. The results showed that induced tissue damage was associated with the use of wireless-powered sensors. We also investigated research strategies for the prevention of adverse effects caused by lack of tissue biocompatibility of a wireless-powered ECG monitoring system and provided information on the clinical applications of inflammatory reactions in implant treatment using the wireless-powered transmission system.

Corrected Integral Shape Averaging Applied to Obstructive Sleep Apnea Detection from the Electrocardiogram

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C. O'Brien

2007-01-01

Full Text Available We present a technique called corrected integral shape averaging (CISA for quantifying shape and shape differences in a set of signals. CISA can be used to account for signal differences which are purely due to affine time warping (jitter and dilation/compression, and hence provide access to intrinsic shape fluctuations. CISA can also be used to define a distance between shapes which has useful mathematical properties; a mean shape signal for a set of signals can be defined, which minimizes the sum of squared shape distances of the set from the mean. The CISA procedure also allows joint estimation of the affine time parameters. Numerical simulations are presented to support the algorithm for obtaining the CISA mean and parameters. Since CISA provides a well-defined shape distance, it can be used in shape clustering applications based on distance measures such as k-means. We present an application in which CISA shape clustering is applied to P-waves extracted from the electrocardiogram of subjects suffering from sleep apnea. The resulting shape clustering distinguishes ECG segments recorded during apnea from those recorded during normal breathing with a sensitivity of 81% and specificity of 84%.

Comparison of Electrocardiogram Signals in Men and Women during Creativity with Classification Approaches

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Sahar ZAKERI

2016-07-01

Full Text Available Electrocardiogram (ECG analysis is mostly used as a valuable tool in the evaluation of cognitive tasks. By taking and analyzing measurements in vast quantities, researchers are working toward a better understanding of how human physiological systems work. For the first time, this study investigated the function of the cardiovascular system during creative thinking. In addition, the difference between male/female and normal/creativity states from ECG signals was investigated. Overall, the purpose of this paper was to illustrate the heart working during the creativity, and discover the creative men or women subjects. For these goals, six nonlinear features of the ECG signal were extracted to detect creativity states. During the three tasks of the Torrance Tests of Creative Thinking (TTCT- Figural B, ECG signals were recorded from 52 participants (26 men and 26 women. Then, the proficiency of two kinds of classification approaches was evaluated: Artificial Neural Network (ANN and Support Vector Machine (SVM. The results indicated the high accuracy rate of discriminations between male/female (96.09% and normal/creativity states (95.84% using ANN classifier. Therefore, the proposed method can be useful to detect the creativity states.

Sequential Markov chain Monte Carlo filter with simultaneous model selection for electrocardiogram signal modeling.

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Edla, Shwetha; Kovvali, Narayan; Papandreou-Suppappola, Antonia

2012-01-01

Constructing statistical models of electrocardiogram (ECG) signals, whose parameters can be used for automated disease classification, is of great importance in precluding manual annotation and providing prompt diagnosis of cardiac diseases. ECG signals consist of several segments with different morphologies (namely the P wave, QRS complex and the T wave) in a single heart beat, which can vary across individuals and diseases. Also, existing statistical ECG models exhibit a reliance upon obtaining a priori information from the ECG data by using preprocessing algorithms to initialize the filter parameters, or to define the user-specified model parameters. In this paper, we propose an ECG modeling technique using the sequential Markov chain Monte Carlo (SMCMC) filter that can perform simultaneous model selection, by adaptively choosing from different representations depending upon the nature of the data. Our results demonstrate the ability of the algorithm to track various types of ECG morphologies, including intermittently occurring ECG beats. In addition, we use the estimated model parameters as the feature set to classify between ECG signals with normal sinus rhythm and four different types of arrhythmia.

Construction and use of a zebrafish heart voltage and calcium optical mapping system, with integrated electrocardiogram and programmable electrical stimulation

Science.gov (United States)

Lin, Eric; Craig, Calvin; Lamothe, Marcel; Sarunic, Marinko V.; Beg, Mirza Faisal

2015-01-01

Zebrafish are increasingly being used as a model of vertebrate cardiology due to mammalian-like cardiac properties in many respects. The size and fecundity of zebrafish make them suitable for large-scale genetic and pharmacological screening. In larger mammalian hearts, optical mapping is often used to investigate the interplay between voltage and calcium dynamics and to investigate their respective roles in arrhythmogenesis. This report outlines the construction of an optical mapping system for use with zebrafish hearts, using the voltage-sensitive dye RH 237 and the calcium indicator dye Rhod-2 using two industrial-level CCD cameras. With the use of economical cameras and a common 532-nm diode laser for excitation, the rate dependence of voltage and calcium dynamics within the atrial and ventricular compartments can be simultaneously determined. At 140 beats/min, the atrial action potential duration was 36 ms and the transient duration was 53 ms. With the use of a programmable electrical stimulator, a shallow rate dependence of 3 and 4 ms per 100 beats/min was observed, respectively. In the ventricle the action potential duration was 109 ms and the transient duration was 124 ms, with a steeper rate dependence of 12 and 16 ms per 100 beats/min. Synchronous electrocardiograms and optical mapping recordings were recorded, in which the P-wave aligns with the atrial voltage peak and R-wave aligns with the ventricular peak. A simple optical pathway and imaging chamber are detailed along with schematics for the in-house construction of the electrocardiogram amplifier and electrical stimulator. Laboratory procedures necessary for zebrafish heart isolation, cannulation, and loading are also presented. PMID:25740339

Proposed clinical scale for the diagnosis of acute coronary syndrome in patients with an inconclusive electrocardiogram and myocardial injury biomarkers.

Science.gov (United States)

Montero-Pérez, F J; Quero-Espinosa, F B; Clemente-Millán, M J; Castro-Giménez, J A; de Burgos-Marín, J; Romero-Moreno, M Á

2018-03-01

Acute coronary syndrome (ACS) requires improved diagnostic accuracy through useful, safe and easy-to-apply tools. To obtain an assessment scale for the diagnosis of ACS in patients with chest pain and nondiagnostic electrocardiogram and troponin concentrations. A prospective cohort study included 286 patients treated in the emergency department for chest pain, with normal electrocardiogram and troponin levels. Using multiple logistic regression, we obtained the independent predictors for the diagnosis of ACS. The assessment scale's discriminative power was assessed with the area under the ROC curve. The diagnosis of ACS was confirmed in 103 patients (36%). The final predictive model included 3 endpoints: a history of coronary artery disease, hyperlipidaemia and a score≥6 points on the Geleijnse scale. The area under the ROC curve for the final model was 0.90 (95% confidence interval [95% CI] 0.85-0.93). A threshold of 5 points achieved a sensitivity of 76.7% (95% CI 68-84), a specificity of 91.8% (95% CI 87-95), a positive likelihood ratio of 9.36 (95% CI 5.70-15.40), a negative likelihood ratio of 0.25 (95% CI 18.00-36.00) and an overall diagnostic accuracy of 86.4% (95% CI 82-90). The predictive model was superior to the Geleijnse scale alone. The final scale showed good discriminative capacity for diagnosing ACS and could therefore be of interest for identifying ACS in emergency departments. Nevertheless, the scale needs to be validated in larger multicentre studies. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Electrocardiogram Pattern Recognition and Analysis Based on Artificial Neural Networks and Support Vector Machines: A Review

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Mario Sansone

2013-01-01

Full Text Available Computer systems for Electrocardiogram (ECG analysis support the clinician in tedious tasks (e.g., Holter ECG monitored in Intensive Care Units or in prompt detection of dangerous events (e.g., ventricular fibrillation. Together with clinical applications (arrhythmia detection and heart rate variability analysis, ECG is currently being investigated in biometrics (human identification, an emerging area receiving increasing attention. Methodologies for clinical applications can have both differences and similarities with respect to biometrics. This paper reviews methods of ECG processing from a pattern recognition perspective. In particular, we focus on features commonly used for heartbeat classification. Considering the vast literature in the field and the limited space of this review, we dedicated a detailed discussion only to a few classifiers (Artificial Neural Networks and Support Vector Machines because of their popularity; however, other techniques such as Hidden Markov Models and Kalman Filtering will be also mentioned.

Correlation of Respiratory Signals and Electrocardiogram Signals via Empirical Mode Decomposition

KAUST Repository

El Fiky, Ahmed Osama

2011-05-24

Recently Electrocardiogram (ECG) signals are being broadly used as an essential diagnosing tool in different clinical applications as they carry a reliable representation not only for cardiac activities, but also for other associated biological processes, like respiration. However, the process of recording and collecting them has usually suffered from the presence of some undesired noises, which in turn affects the reliability of such representations.Therefore, de-noising ECG signals became a hot research field for signal processing experts to ensure better and clear representation of the different cardiac activities. Given the nonlinear and non-stationary properties of ECGs, it is not a simple task to cancel the undesired noise terms without affecting the biological physics of them. In this study, we are interested in correlating the ECG signals with respiratory parameters, specifically the lung volume and lung pressure. We have focused on the concept of de-noising ECG signals by means of signal decomposition using an algorithm called the Empirical Mode Decomposition (EMD) where the original ECG signals are being decomposed into a set of intrinsic mode functions (IMF). Then, we have provided criteria based on which some of these IMFs have been adapted to reconstruct de-noised ECG version. Finally, we have utilized de-noised ECGs as well as IMFs for to study the correlation with lung volume and lung pressure. These correlation studies have showed some clear resemblance especially between the oscillations of ECGs and lung pressures.

The effect of sport on computerized electrocardiogram measurements in college athletes.

Science.gov (United States)

Gademan, Maaike G J; Uberoi, Abhimanyu; Le, Vy-Van; Mandic, Sandra; van Oort, Eddy R; Myers, Jonathan; Froelicher, Victor F

2012-02-01

Broad criteria for abnormal electrocardiogram (ECG) findings, requiring additional testing, have been recommended for preparticipation exams (PPE) of athletes. As these criteria have not considered the sport in which athletes participate, we examined the effect of sports on the computerized ECG measurements obtained in college athletes. During the Stanford 2007 PPE, computerized 12-lead ECGs (Schiller AG) were obtained in 641 athletes (350 male/291 female, age 19.5 ± 2 years). Athletes were engaged in 22 different sports and were grouped into 16 categories: baseball/softball, basketball, crew, crosscountry, fencing, field events, football linemen, football other positions, golf, gymnastics, racquet sports, sailing, track/field, volleyball, water sports, and wrestling. The analysis focused on ECG leads V2, aVF and V5 which provide a three-dimensional representation of the heart's electrical activity. As marked ECG differences exist between males and females, the data are presented by gender. In males, ANOVA analysis yielded significant ECG differences between sports for heart rate, QRS duration, QTc, J-amplitude in V2 and V5, spatial vector length (SVL) of the P wave, SVL R wave, and SVL T wave, and RS(sum) (p sports were found for heart rate, QRS duration, QRS axis and SVL T wave (p sports, and these differences were more apparent in males than females. Therefore, sport-specific ECG criteria for abnormal ECG findings should be developed to obtain a more useful approach to ECG screening in athletes.

Application of artificial neural networks for versatile preprocessing of electrocardiogram recordings.

Science.gov (United States)

Mateo, J; Rieta, J J

2012-02-01

The electrocardiogram (ECG) is the most widely used method for diagnosis of heart diseases, where a good quality of recordings allows the proper interpretation and identification of physiological and pathological phenomena. However, ECG recordings often have interference from noises including thermal, muscle, baseline and powerline noises. These signals severely limit ECG recording utility and, hence, have to be removed. To deal with this problem, the present paper proposes an artificial neural network (ANN) as a filter to remove all kinds of noise in just one step. The method is based on a growing ANN which optimizes both the number of nodes in the hidden layer and the coefficient matrices, which are optimized by means of the Widrow-Hoff delta algorithm. The ANN has been trained with a database comprising all kinds of noise, both from synthesized and real ECG recordings, in order to handle any noise signal present in the ECG. The proposed system improves results yielded by conventional techniques of ECG filtering, such as FIR-based systems, adaptive filtering and wavelet filtering. Therefore, the algorithm could serve as an effective framework to substantially reduce noise in ECG recordings. In addition, the resulting ECG signal distortion is notably more reduced in comparison with conventional methodologies. In summary, the current contribution introduces a new method which is able to suppress all ECG interference signals in only one step with low ECG distortion and a high noise reduction.

ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes - A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial

NARCIS (Netherlands)

Windhausen, Fons; Hirsch, Alexander; Tijssen, Jan G. P.; Cornel, Jan Hein; Verheugt, Freek W. A.; Klees, Margriet I.; de Winter, Robbert J.

2007-01-01

Background: We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive

Wavelet transform and Huffman coding based electrocardiogram compression algorithm: Application to telecardiology

International Nuclear Information System (INIS)

Chouakri, S A; Djaafri, O; Taleb-Ahmed, A

2013-01-01

We present in this work an algorithm for electrocardiogram (ECG) signal compression aimed to its transmission via telecommunication channel. Basically, the proposed ECG compression algorithm is articulated on the use of wavelet transform, leading to low/high frequency components separation, high order statistics based thresholding, using level adjusted kurtosis value, to denoise the ECG signal, and next a linear predictive coding filter is applied to the wavelet coefficients producing a lower variance signal. This latter one will be coded using the Huffman encoding yielding an optimal coding length in terms of average value of bits per sample. At the receiver end point, with the assumption of an ideal communication channel, the inverse processes are carried out namely the Huffman decoding, inverse linear predictive coding filter and inverse discrete wavelet transform leading to the estimated version of the ECG signal. The proposed ECG compression algorithm is tested upon a set of ECG records extracted from the MIT-BIH Arrhythmia Data Base including different cardiac anomalies as well as the normal ECG signal. The obtained results are evaluated in terms of compression ratio and mean square error which are, respectively, around 1:8 and 7%. Besides the numerical evaluation, the visual perception demonstrates the high quality of ECG signal restitution where the different ECG waves are recovered correctly

Significance of screening electrocardiogram before the initiation of amitriptyline therapy in children with functional abdominal pain.

Science.gov (United States)

Patra, Kamakshya P; Sankararaman, Senthilkumar; Jackson, Robert; Hussain, Sunny Z

2012-09-01

Amitriptyline (AMT) is commonly used in the management of children with irritable bowel syndrome. AMT is pro-arrhythmogenic and increases the risk of sudden cardiac death. However, there is not enough data regarding the cardiac toxicity in therapeutic doses of AMT in children and the need for screening electrocardiogram (EKG). Errors in computer EKG interpretation are not uncommon. In a risk-prevention study, the authors sought to identify the true incidence of prolonged corrected QT (QTc) interval and other arrhythmias in children with irritable bowel syndrome before the initiation of AMT. Out of the 760 EKGs screened, 3 EKGs demonstrated a true prolonged QTc after the careful manual reading by a pediatric cardiologist and they were not picked by computer-generated reading. The authors conclude that screening EKG should always be performed on children before initiating AMT therapy. Also, the computer-generated EKG needs to be verified by a pediatric cardiologist to avoid serious misinterpretations.

Independent component analysis-based artefact reduction: application to the electrocardiogram for improved magnetic resonance imaging triggering

International Nuclear Information System (INIS)

Oster, Julien; Pietquin, Olivier; Felblinger, Jacques; Abächerli, Roger; Kraemer, Michel

2009-01-01

Electrocardiogram (ECG) is required during magnetic resonance (MR) examination for monitoring patients under anaesthesia or with heart diseases and for synchronizing image acquisition with heart activity (triggering). Accurate and fast QRS detection is therefore desirable, but this task is complicated by artefacts related to the complex MR environment (high magnetic field, radio-frequency pulses and fast switching magnetic gradients). Specific signal processing has been proposed, whether using specific MR QRS detectors or ECG denoising methods. Most state-of-the-art techniques use a connection to the MR system for achieving their task, which is a major drawback since access to the MR system is often restricted. This paper introduces a new method for on-line ECG signal enhancement, called ICARE, which takes advantage of using multi-lead ECG and does not require any connection to the MR system. It is based on independent component analysis (ICA) and applied in real time. This algorithm yields accurate QRS detection for efficient triggering

A Fixed-Lag Kalman Smoother to Filter Power Line Interference in Electrocardiogram Recordings.

Science.gov (United States)

Warmerdam, G J J; Vullings, R; Schmitt, L; Van Laar, J O E H; Bergmans, J W M

2017-08-01

Filtering power line interference (PLI) from electrocardiogram (ECG) recordings can lead to significant distortions of the ECG and mask clinically relevant features in ECG waveform morphology. The objective of this study is to filter PLI from ECG recordings with minimal distortion of the ECG waveform. In this paper, we propose a fixed-lag Kalman smoother with adaptive noise estimation. The performance of this Kalman smoother in filtering PLI is compared to that of a fixed-bandwidth notch filter and several adaptive PLI filters that have been proposed in the literature. To evaluate the performance, we corrupted clean neonatal ECG recordings with various simulated PLI. Furthermore, examples are shown of filtering real PLI from an adult and a fetal ECG recording. The fixed-lag Kalman smoother outperforms other PLI filters in terms of step response settling time (improvements that range from 0.1 to 1 s) and signal-to-noise ratio (improvements that range from 17 to 23 dB). Our fixed-lag Kalman smoother can be used for semi real-time applications with a limited delay of 0.4 s. The fixed-lag Kalman smoother presented in this study outperforms other methods for filtering PLI and leads to minimal distortion of the ECG waveform.

Envelopment filter and K-means for the detection of QRS waveforms in electrocardiogram.

Science.gov (United States)

Merino, Manuel; Gómez, Isabel María; Molina, Alberto J

2015-06-01

The electrocardiogram (ECG) is a well-established technique for determining the electrical activity of the heart and studying its diseases. One of the most common pieces of information that can be read from the ECG is the heart rate (HR) through the detection of its most prominent feature: the QRS complex. This paper describes an offline version and a real-time implementation of a new algorithm to determine QRS localization in the ECG signal based on its envelopment and K-means clustering algorithm. The envelopment is used to obtain a signal with only QRS complexes, deleting P, T, and U waves and baseline wander. Two moving average filters are applied to smooth data. The K-means algorithm classifies data into QRS and non-QRS. The technique is validated using 22 h of ECG data from five Physionet databases. These databases were arbitrarily selected to analyze different morphologies of QRS complexes: three stored data with cardiac pathologies, and two had data with normal heartbeats. The algorithm has a low computational load, with no decision thresholds. Furthermore, it does not require any additional parameter. Sensitivity, positive prediction and accuracy from results are over 99.7%. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Induction of Inflammation In Vivo by Electrocardiogram Sensor Operation Using Wireless Power Transmission

Directory of Open Access Journals (Sweden)

Jin-Chul Heo

2017-12-01

Full Text Available Prolonged monitoring by cardiac electrocardiogram (ECG sensors is useful for patients with emergency heart conditions. However, implant monitoring systems are limited by lack of tissue biocompatibility. Here, we developed an implantable ECG sensor for real-time monitoring of ventricular fibrillation and evaluated its biocompatibility using an animal model. The implantable sensor comprised transplant sensors with two electrodes, a wireless power transmission system, and a monitoring system. The sensor was inserted into the subcutaneous tissue of the abdominal area and operated for 1 h/day for 5 days using a wireless power system. Importantly, the sensor was encapsulated by subcutaneous tissue and induced angiogenesis, inflammation, and phagocytosis. In addition, we observed that the levels of inflammation-related markers increased with wireless-powered transmission via the ECG sensor; in particular, levels of the Th-1 cytokine interleukin-12 were significantly increased. The results showed that induced tissue damage was associated with the use of wireless-powered sensors. We also investigated research strategies for the prevention of adverse effects caused by lack of tissue biocompatibility of a wireless-powered ECG monitoring system and provided information on the clinical applications of inflammatory reactions in implant treatment using the wireless-powered transmission system.

Electrocardiogram ST-Segment Morphology Delineation Method Using Orthogonal Transformations.

Directory of Open Access Journals (Sweden)

Miha Amon

Full Text Available Differentiation between ischaemic and non-ischaemic transient ST segment events of long term ambulatory electrocardiograms is a persisting weakness in present ischaemia detection systems. Traditional ST segment level measuring is not a sufficiently precise technique due to the single point of measurement and severe noise which is often present. We developed a robust noise resistant orthogonal-transformation based delineation method, which allows tracing the shape of transient ST segment morphology changes from the entire ST segment in terms of diagnostic and morphologic feature-vector time series, and also allows further analysis. For these purposes, we developed a new Legendre Polynomials based Transformation (LPT of ST segment. Its basis functions have similar shapes to typical transient changes of ST segment morphology categories during myocardial ischaemia (level, slope and scooping, thus providing direct insight into the types of time domain morphology changes through the LPT feature-vector space. We also generated new Karhunen and Lo ève Transformation (KLT ST segment basis functions using a robust covariance matrix constructed from the ST segment pattern vectors derived from the Long Term ST Database (LTST DB. As for the delineation of significant transient ischaemic and non-ischaemic ST segment episodes, we present a study on the representation of transient ST segment morphology categories, and an evaluation study on the classification power of the KLT- and LPT-based feature vectors to classify between ischaemic and non-ischaemic ST segment episodes of the LTST DB. Classification accuracy using the KLT and LPT feature vectors was 90% and 82%, respectively, when using the k-Nearest Neighbors (k = 3 classifier and 10-fold cross-validation. New sets of feature-vector time series for both transformations were derived for the records of the LTST DB which is freely available on the PhysioNet website and were contributed to the LTST DB. The

Impact of teaching and assessment format on electrocardiogram interpretation skills.

Science.gov (United States)

Raupach, Tobias; Hanneforth, Nathalie; Anders, Sven; Pukrop, Tobias; Th J ten Cate, Olle; Harendza, Sigrid

2010-07-01

Interpretation of the electrocardiogram (ECG) is a core clinical skill that should be developed in undergraduate medical education. This study assessed whether small-group peer teaching is more effective than lectures in enhancing medical students' ECG interpretation skills. In addition, the impact of assessment format on study outcome was analysed. Two consecutive cohorts of Year 4 medical students (n=335) were randomised to receive either traditional ECG lectures or the same amount of small-group, near-peer teaching during a 6-week cardiorespiratory course. Before and after the course, written assessments of ECG interpretation skills were undertaken. Whereas this final assessment yielded a considerable amount of credit points for students in the first cohort, it was merely formative in nature for the second cohort. An unannounced retention test was applied 8 weeks after the end of the cardiovascular course. A significant advantage of near-peer teaching over lectures (effect size 0.33) was noted only in the second cohort, whereas, in the setting of a summative assessment, both teaching formats appeared to be equally effective. A summative instead of a formative assessment doubled the performance increase (Cohen's d 4.9 versus 2.4), mitigating any difference between teaching formats. Within the second cohort, the significant difference between the two teaching formats was maintained in the retention test (p=0.017). However, in both cohorts, a significant decrease in student performance was detected during the 8 weeks following the cardiovascular course. Assessment format appeared to be more powerful than choice of instructional method in enhancing student learning. The effect observed in the second cohort was masked by an overriding incentive generated by the summative assessment in the first cohort. This masking effect should be considered in studies assessing the effectiveness of different teaching methods.

Exercise tolerance test in patients presenting with chest pain and normal electrocardiogram

International Nuclear Information System (INIS)

Sharieff, S.; Khan, Shah-e-Zaman

2002-01-01

Objective: To report the prevalence of abnormal exercise tolerance test (ETT) responses and to assess the risk factors for ischemic heart disease (IHD) in a population referred for the evaluation of chest pain with a normal baseline electrocardiogram (ECG). Design: A prospective study. The study was conducted at the National Institute of cardiovascular Diseases (NICVD), Karachi, Pakistan between 1st January 2000 and 31 December 2000. Subjects and Methods: One thousand one hundred and twenty-seven consecutive adult patients presenting in the outpatient department (OPD) with history of chest pain and having a normal baseline ECG were the subjects of the study after excluding patients with indeterminate or inconclusive test response. All these subjects underwent ETT and were screened for risk factor for IHD. Results: Of the patients studied 56.6% had abnormal ETT response. Male to female ratio of all patients was 4.85:1 Overall mean age was 50.3 +- 8.8 years. 65.9% of diabetic patients had ETT Suggestive of silent myocardial ischemia (p=0.012). Age > 50 year (p= <0.0001), male sex (p=0.015), diabetes mellitus (p=0.0033) and positive family history of IHD (p=0.0014) were the risk factor found in patient with abnormal ETT response. Conclusion: Age of more than 50 years, male gender, diabetes mellitus and positive family history of IHD are the significant risk factors for the development of ischemic heart disease in our population. Silent myocardial ischemic is common in diabetics. (author)

Alterations in electrocardiogram of adenosine test for 99Tcm-MIBI myocardial perfusion imaging

International Nuclear Information System (INIS)

Xie Boqia; Tian Yueqin; Zheng Lihui

2011-01-01

Objective: To analyze alterations in electrocardiogram (ECG) of adenosine test in 99 Tc m -MIBI myocardial perfusion imaging(MPI)SPECT study. Methods: A total of 641 patients were included in the study. The patients each underwent 99 Tc m -MIBI MPI with adenosine test. The ECGs were taken before, during, and after adenosine infusion. Results: In all, abnormal ECGs were found in 205(32.0%) patients. During adenosine infusion, 20.6%(132/641) of patients suffered from arrhythmia, 29.5%(39/132) had atrial premature beats, 34.1% (45/132) had premature ventricular beats, and 6.1% (8/132) had sinoatrial block. In addition, 5.3% (7/132) had first-, 24.2% (32/132) had second-, and 0.8% (1/132) had third-degree atrioventricular block (AVB). After adenosine infusion, 4.4%( 28/641) of patients suffered from arrhythmia, 57.1% (16/28) had atrial premature beats, 39.3% (11/28) had premature ventricular beats, and 3.6% (1/28) had sinoatrial block. The perfusion images showed ischemia in 36 patients and infarction in 8 patients. Adenosine infusion was terminated in 39 patients (6.1%) because of poorly tolerated side effects. However, no death or acute myocardial infarction occurred in the study. Conclusions: Adenosine pharmacologic test for 99 Tc m -MIBI MPI may result in relatively high incidence of arrhythmia in ECG monitoring. (authors)

Characteristics of the reindeer electrocardiogram

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Jouni Timisjärvi

1982-05-01

Full Text Available The electrocardiogram (ECG provides reliable information about heart rate, initiation of heart beat and also, to some degree, indirect evidence on the functional state of the heart muscle. A wide range of such information is readily obtainable from conventional scalar leads, even if the records are limited to a single plane. The present investigation deals with the normal reindeer ECG in the frontal plane. The technique used is the scalar recording technique based on the Einthovenian postulates. The P wave was positive in leads II, III and aVF, negative in lead aVL and variable in leads I and aVR. The direction of the P vector was 60 to 120°. The QRS complex was variable. The most common forms of QRS complex were R and rS in leads I and aVR; R, Rs and rS in lead aVL and Qr or qR in other leads. The most common direction of the QRS vector was 240 to 300°. The T wave was variable. The duration of various intervals and deflection depended on heart rate.Elektrokardiogram på ren.Abstract in Swedish / Sammandrag: Elektrokardiogramet (EKG ger tillförlitliga uppgifter om hjärtfrekvens, retledning och, indirekt, delvis även om hjärtmuskelns funktionell tillstånd. Största delen av denna information fås med normal skalar koppling även om registrering sker i ett plan. I detta arbete har renens normala EKG i frontalplanet undersökts. Kopplingarna har baserats på Einthovs postulat. P-vågen var riktad uppåt i koppling II, III och aVF, nedåt i koppling aVL och den varierade i koppling I och aVR. P-vektorns riktning var 60 - 120°. QRS-komplexet varierade. De vanligaste formerna var R och rS i koppling I och aVR; R, Rs och rS i koppling aVL och Qr eller qR i andra kopplingar. Vanligen var QRS-vektorns riktning 240 - 300°. T-vågen varierade. Awikelserna och intervallernas längd var beroende av hiärtfrekvenssen.Poron sydänsähkökäyrän ominaisuuksia.Abstract in Finnish / Yhteenveto: Sydänsähkökäyrästä saadaan luotettavaa tietoa syd

The 12-lead electrocardiogram and risk of sudden death: current utility and future prospects.

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Narayanan, Kumar; Chugh, Sumeet S

2015-10-01

More than 100 years after it was first invented, the 12-lead electrocardiogram (ECG) continues to occupy an important place in the diagnostic armamentarium of the practicing clinician. With the recognition of relatively rare but important clinical entities such as Wolff-Parkinson-White and the long QT syndrome, this clinical tool was firmly established as a test for assessing risk of sudden cardiac death (SCD). However, over the past two decades the role of the ECG in risk prediction for common forms of SCD, for example in patients with coronary artery disease, has been the focus of considerable investigation. Especially in light of the limitations of current risk stratification approaches, there is a renewed focus on this broadly available and relatively inexpensive test. Various abnormalities of depolarization and repolarization on the ECG have been linked to SCD risk; however, more focused work is needed before they can be deployed in the clinical arena. The present review summarizes the current knowledge on various ECG risk markers for prediction of SCD and discusses some future directions in this field. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography.

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Hayashi, Risa; Nakai, Kenji; Fukushima, Akimune; Itoh, Manabu; Sugiyama, Toru

2009-03-01

Although ultrasonic diagnostic imaging and fetal heart monitors have undergone great technological improvements, the development and use of fetal electrocardiograms to evaluate fetal arrhythmias and autonomic nervous activity have not been fully established. We verified the clinical significance of the novel signal-averaged vector-projected high amplification ECG (SAVP-ECG) method in fetuses from 48 gravidas at 32-41 weeks of gestation and in 34 neonates. SAVP-ECGs from fetuses and newborns were recorded using a modified XYZ-leads system. Once noise and maternal QRS waves were removed, the P, QRS, and T wave intervals were measured from the signal-averaged fetal ECGs. We also compared fetal and neonatal heart rates (HRs), coefficients of variation of heart rate variability (CV) as a parasympathetic nervous activity, and the ratio of low to high frequency (LF/HF ratio) as a sympathetic nervous activity. The rate of detection of a fetal ECG by SAVP-ECG was 72.9%, and the fetal and neonatal QRS and QTc intervals were not significantly different. The neonatal CVs and LF/HF ratios were significantly increased compared with those in the fetus. In conclusion, we have developed a fetal ECG recording method using the SAVP-ECG system, which we used to evaluate autonomic nervous system development.

Vectorcardiographic diagnostic & prognostic information derived from the 12-lead electrocardiogram: Historical review and clinical perspective.

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Man, Sumche; Maan, Arie C; Schalij, Martin J; Swenne, Cees A

2015-01-01

In the course of time, electrocardiography has assumed several modalities with varying electrode numbers, electrode positions and lead systems. 12-lead electrocardiography and 3-lead vectorcardiography have become particularly popular. These modalities developed in parallel through the mid-twentieth century. In the same time interval, the physical concepts underlying electrocardiography were defined and worked out. In particular, the vector concept (heart vector, lead vector, volume conductor) appeared to be essential to understanding the manifestations of electrical heart activity, both in the 12-lead electrocardiogram (ECG) and in the 3-lead vectorcardiogram (VCG). Not universally appreciated in the clinic, the vectorcardiogram, and with it the vector concept, went out of use. A revival of vectorcardiography started in the 90's, when VCGs were mathematically synthesized from standard 12-lead ECGs. This facilitated combined electrocardiography and vectorcardiography without the need for a special recording system. This paper gives an overview of these historical developments, elaborates on the vector concept and seeks to define where VCG analysis/interpretation can add diagnostic/prognostic value to conventional 12-lead ECG analysis. Copyright © 2015 Elsevier Inc. All rights reserved.

The effectiveness of nurses' ability to interpret basic electrocardiogram strips accurately using different learning modalities.

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Spiva, LeeAnna; Johnson, Kimberly; Robertson, Bethany; Barrett, Darcy T; Jarrell, Nicole M; Hunter, Donna; Mendoza, Inocencia

2012-02-01

Historically, the instructional method of choice has been traditional lecture or face-to-face education; however, changes in the health care environment, including resource constraints, have necessitated examination of this practice. A descriptive pre-/posttest method was used to determine the effectiveness of alternative teaching modalities on nurses' knowledge and confidence in electrocardiogram (EKG) interpretation. A convenience sample of 135 nurses was recruited in an integrated health care system in the Southeastern United States. Nurses attended an instructor-led course, an online learning (e-learning) platform with no study time or 1 week of study time, or an e-learning platform coupled with a 2-hour post-course instructor-facilitated debriefing with no study time or 1 week of study time. Instruments included a confidence scale, an online EKG test, and a course evaluation. Statistically significant differences in knowledge and confidence were found for individual groups after nurses participated in the intervention. Statistically significant differences were found in pre-knowledge and post-confidence when groups were compared. Organizations that use various instructional methods to educate nurses in EKG interpretation can use different teaching modalities without negatively affecting nurses' knowledge or confidence in this skill. Copyright 2012, SLACK Incorporated.

Effects of exercise rehabilitation on cardiac electrical instability assessed by T-wave alternans during ambulatory electrocardiogram monitoring in coronary artery disease patients without and with diabetes mellitus.

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Kenttä, Tuomas; Tulppo, Mikko P; Nearing, Bruce D; Karjalainen, Jaana J; Hautala, Arto J; Kiviniemi, Antti M; Huikuri, Heikki V; Verrier, Richard L

2014-09-15

Effects of exercise rehabilitation on electrocardiographic markers of risk for sudden cardiac death have not been adequately studied. We examined effects of controlled exercise training on T-wave alternans (TWA) in 24-hour ambulatory electrocardiogram recordings in patients with stable coronary artery disease (CAD) without and with type 2 diabetes mellitus (DM). Consecutive patients with angiographically confirmed CAD were recruited to join the ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) study. Exercise (n = 65) and control groups (n = 65) were matched on age, sex, DM, and previous myocardial infarction. Ambulatory electrocardiograms were recorded before and after a 2-year training period. TWA was assessed using time domain-modified moving average method by an investigator blinded to patients' clinical status. Average TWA values decreased in the rehabilitation group but not in control patients (rehabilitation [mean ± SEM]: 52.8 ± 1.7 μV vs 48.7 ± 1.5 μV, p exercise versus 10% (n = 2 of 20) of controls (p = 0.020). In CAD patients, 30% (n = 8 of 27) of positive TWA cases were converted with exercise versus 4% (n = 1 of 28) of controls (p = 0.012). In conclusion, this is the first report of the effectiveness of exercise rehabilitation to reduce TWA, a marker of sudden cardiac death risk, in patients with stable CAD. Copyright © 2014 Elsevier Inc. All rights reserved.

A gender-based analysis of high school athletes using computerized electrocardiogram measurements.

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Nikhil Kumar

Full Text Available BACKGROUND: The addition of the ECG to the preparticipation examination (PPE of high school athletes has been a topic for debate. Defining the difference between the high school male and female ECG is crucial to help initiate its implementation in the High School PPE. Establishing the different parameters set for the male and female ECG would help to reduce false positives. We examined the effect of gender on the high school athlete ECG by obtaining and analyzing ECG measurements of high school athletes from Henry M. Gunn High School. METHODS: In 2011 and 2012, computerized Electrocardiograms were recorded and analyzed on 181 athletes (52.5% male; mean age 16.1 ± 1.1 years who participated in 17 different sports. ECG statistics included intervals and durations in all 3 axes (X, Y, Z to calculate 12 lead voltage sums, QRS Amplitude, QT interval, QRS Duration, and the sum of the R wave in V5 and the S Wave in V2 (RS Sum. RESULTS: By computer analysis, we demonstrated that male athletes had significantly greater QRS duration, Q-wave duration, and T wave amplitude. (P<0.05. By contrast, female athletes had a significantly greater QTc interval. (P<0.05. CONCLUSION: The differences in ECG measurements in high school athletes are strongly associated with gender. However, body size does not correlate with the aforementioned ECG measurements. Our tables of the gender-specific parameters can help facilitate the development of a more large scale and in-depth ECG analysis for screening high school athletes in the future.

Electrocardiogram pattern of some exotic breeds of trained dogs: A variation study

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Joydip Mukherjee

2015-11-01

Full Text Available Aim: The present study has been conducted to evaluate the variation in electrocardiogram (ECG parameters among different trained breeds of dogs (viz. Labrador, German Shepherd, and Golden Retriever used for security reasons. Materials and Methods: The ECG was recorded by single channel ECG at a paper speed of 25 mm/s and calibration of 10 mm=1 mV. The recordings were taken from all the standard bipolar limb leads (Lead-I, II, and III and unipolar augmented limb leads (Lead-aVR, aVL, and aVF. Results: Heart rate was found to be highest in Labrador and lowest in German Shepherd. P-wave duration was maximum in Golden Retriever breed and lowest in Labrador. Maximum amplitude of P-wave was found in Labrador followed by German Shepherd and Golden Retriever. There was significantly (p<0.05 higher values of PR interval in German Shepherd compared to other breeds. The variation in QRS duration, ST segment duration, T-wave duration, and T-wave amplitude was found to be non-significant among breeds. Inverted T-waves were most common in Golden Retriever and German Shepherd, whereas positive T-waves were found in Labrador. There was significant (p<0.05 variation in mean electrical axis of QRS complex among different breeds and it ranges from +60° to +80°. Conclusion: The present study provides the reference values for different ECG parameters to monitor the cardiac health status among Labrador, German Shepherd, and Golden Retriever breeds.

Accuracy of remote electrocardiogram interpretation with the use of Google Glass technology.

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Jeroudi, Omar M; Christakopoulos, George; Christopoulos, George; Kotsia, Anna; Kypreos, Megan A; Rangan, Bavana V; Banerjee, Subhash; Brilakis, Emmanouil S

2015-02-01

We sought to investigate the accuracy of remote electrocardiogram (ECG) interpretation using Google Glass (Google, Mountain View, California). Google Glass is an optical head mounted display device with growing applications in medicine. We compared interpretation of 10 ECGs with 21 clinically important findings by faculty and fellow cardiologists by (1) viewing the electrocardiographic image at the Google Glass screen; (2) viewing a photograph of the ECG taken using Google Glass and interpreted on a mobile device; (3) viewing the original paper ECG; and (4) viewing a photograph of the ECG taken with a high-resolution camera and interpreted on a mobile device. One point was given for identification of each correct finding. Subjective rating of the user experience was also recorded. Twelve physicians (4 faculty and 8 fellow cardiologists) participated. The average electrocardiographic interpretation score (maximum 21 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, on paper, and high-resolution photograph on a mobile device was 13.5 ± 1.8, 16.1 ± 2.6, 18.3 ± 1.7, and 18.6 ± 1.5, respectively (p = 0.0005 between Google Glass and mobile device, p = 0.0005 between Google Glass and paper, and p = 0.002 between mobile device and paper). Of the 12 physicians, 9 (75%) were dissatisfied with ECGs viewing on the prism display of Google Glass. In conclusion, further improvements are needed before Google Glass can be reliably used for remote electrocardiographic analysis. Published by Elsevier Inc.

New ideas for teaching electrocardiogram interpretation and improving classroom teaching content.

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Zeng, Rui; Yue, Rong-Zheng; Tan, Chun-Yu; Wang, Qin; Kuang, Pu; Tian, Pan-Wen; Zuo, Chuan

2015-01-01

Interpreting an electrocardiogram (ECG) is not only one of the most important parts of diagnostics but also one of the most difficult areas to teach. Owing to the abstract nature of the basic theoretical knowledge of the ECG, its scattered characteristics, and tedious and difficult-to-remember subject matter, teaching how to interpret ECGs is as difficult for teachers to teach as it is for students to learn. In order to enable medical students to master basic knowledge of ECG interpretation skills in a limited teaching time, we modified the content used for traditional ECG teaching and now propose a new ECG teaching method called the "graphics-sequence memory method." A prospective randomized controlled study was designed to measure the actual effectiveness of ECG learning by students. Two hundred students were randomly placed under a traditional teaching group and an innovative teaching group, with 100 participants in each group. The teachers in the traditional teaching group utilized the traditional teaching outline, whereas the teachers in the innovative teaching group received training in line with the proposed teaching method and syllabus. All the students took an examination in the final semester by analyzing 20 ECGs from real clinical cases and submitted their ECG reports. The average ECG reading time was 32 minutes for the traditional teaching group and 18 minutes for the innovative teaching group. The average ECG accuracy results were 43% for the traditional teaching group and 77% for the innovative teaching group. Learning to accurately interpret ECGs is an important skill in the cardiac discipline, but the ECG's mechanisms are intricate and the content is scattered. Textbooks tend to make the students feel confused owing to the restrictions of the length and the format of the syllabi, apart from many other limitations. The graphics-sequence memory method was found to be a useful method for ECG teaching.

Effect of electrocardiogram interference on cortico-cortical connectivity analysis and a possible solution.

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Govindan, R B; Kota, Srinivas; Al-Shargabi, Tareq; Massaro, An N; Chang, Taeun; du Plessis, Adre

2016-09-01

Electroencephalogram (EEG) signals are often contaminated by the electrocardiogram (ECG) interference, which affects quantitative characterization of EEG. We propose null-coherence, a frequency-based approach, to attenuate the ECG interference in EEG using simultaneously recorded ECG as a reference signal. After validating the proposed approach using numerically simulated data, we apply this approach to EEG recorded from six newborns receiving therapeutic hypothermia for neonatal encephalopathy. We compare our approach with an independent component analysis (ICA), a previously proposed approach to attenuate ECG artifacts in the EEG signal. The power spectrum and the cortico-cortical connectivity of the ECG attenuated EEG was compared against the power spectrum and the cortico-cortical connectivity of the raw EEG. The null-coherence approach attenuated the ECG contamination without leaving any residual of the ECG in the EEG. We show that the null-coherence approach performs better than ICA in attenuating the ECG contamination without enhancing cortico-cortical connectivity. Our analysis suggests that using ICA to remove ECG contamination from the EEG suffers from redistribution problems, whereas the null-coherence approach does not. We show that both the null-coherence and ICA approaches attenuate the ECG contamination. However, the EEG obtained after ICA cleaning displayed higher cortico-cortical connectivity compared with that obtained using the null-coherence approach. This suggests that null-coherence is superior to ICA in attenuating the ECG interference in EEG for cortico-cortical connectivity analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

Prospectively Electrocardiogram-Gated High-Pitch Spiral Acquisition Mode Dual-Source CT Coronary Angiography in Patients with High Heart Rates: Comparison with Retrospective Electrocardiogram-Gated Spiral Acquisition Mode

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Sun, Kai; Ma, Rui; Wang, Li Jun [Dept. of Radiology, Baotou Central Hospital, Baotou (China); Li, Li Gang; Chen, Jiu Hong [CT BM Clinic Marketing, Siemens Healthcare, Beijing (China)

2012-11-15

To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode. Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 {+-} 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed. There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 {+-} 0.306 [group A] vs. 1.084 {+-} 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 {+-} 0.16 mSv in group A and 7.1 {+-} 1.05 mSv in group B (p = 0.001). In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.

Prospectively Electrocardiogram-Gated High-Pitch Spiral Acquisition Mode Dual-Source CT Coronary Angiography in Patients with High Heart Rates: Comparison with Retrospective Electrocardiogram-Gated Spiral Acquisition Mode

International Nuclear Information System (INIS)

Sun, Kai; Ma, Rui; Wang, Li Jun; Li, Li Gang; Chen, Jiu Hong

2012-01-01

To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode. Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 ± 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed. There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 ± 0.306 [group A] vs. 1.084 ± 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 ± 0.16 mSv in group A and 7.1 ± 1.05 mSv in group B (p = 0.001). In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.

Correlations between electrocardiogram and biomarkers in acute pulmonary embolism: Analysis of ZATPOL-2 Registry.

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Kukla, Piotr; Kosior, Dariusz A; Tomaszewski, Andrzej; Ptaszyńska-Kopczyńska, Katarzyna; Widejko, Katarzyna; Długopolski, Robert; Skrzyński, Andrzej; Błaszczak, Piotr; Fijorek, Kamil; Kurzyna, Marcin

2017-07-01

Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism. We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014. Elevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S 1 Q 3 T 3 sign (p electrocardiogram" were as follows: increased heart rate (OR 1.09, 95% CI 1.02-1.17, p = .012), elevated troponin concentration (OR 3.33, 95% CI 1.94-5.72, p = .000), and right ventricular overload (OR 2.30, 95% CI 1.17-4.53, p = .016). Electrocardiographic signs of right ventricular strain are strongly related to elevated cardiac biomarkers and echocardiographic signs of right ventricular overload. ECG may be used in preliminary risk stratification of patient with intermediate- or high-risk forms of APE. © 2017 Wiley Periodicals, Inc.

A survey of paediatricians on the use of electrocardiogram for pre-participation sports screening.

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Patel, Angira; Webster, Gregory; Ward, Kendra; Lantos, John

2017-07-01

Aim The aim of the present study was to determine general paediatrician knowledge, practices, and attitudes towards electrocardiogram (ECG) screening in school athletes during pre-participation screening exam (PPSE). Paediatricians affiliated with a tertiary children's hospital completed a survey about ECGs for PPSE. In total, 205/498 (41%) responded; 92% of the paediatricians did not include an ECG as part of PPSE; 56% were aware of a case in which a student athlete in their own community had died of sudden unexplained death; 4% had an athlete in their practice die. Only 16% of paediatricians perform all 12 American Heart Association recommended elements of the PPSE. If any of these screening elements are abnormal, 69% obtain an ECG, 36% an echocardiogram, and 30% restrict patients from sports activity; 73% of them refer the patient to a cardiologist. Most of the general paediatricians surveyed did not currently perform ECGs for PPSE. In addition, there was a low rate of adherence to performing the 12 screening elements recommended by the American Heart Association. They have trouble obtaining timely, accurate ECG interpretations, worry about potential unnecessary exercise restrictions, and cost-effectiveness. The practical hurdles to ECG implementation emphasise the need for a fresh look at PPSE, and not just ECG screening. Improvements in ECG performance/interpretation would be necessary for ECGs to be a useful part of PPSE.

Altered mental status in the emergency department - Can an electrocardiogram show the right way to go?

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Dias, Andre; Franco, Emiliana; Martinez, Jasmine; Figueredo, Vincent M

A 38-year-old African American male patient with a past medical history of human immunodeficiency virus and schizophrenia who was noncompliant with medications presented to the emergency department (ED) after activation of the local crisis response center for altered mental status. Upon arrival he was lethargic and uncooperative, unable to provide any significant details apart from pleuritic chest pain. His blood pressure was 133/88 mmHg, heart rate 43 beats per minute and initial body temperature 36.1 °C which prompted an electrocardiogram (EKG). This initial EKG was compared to a prior one obtained six months earlier during an ER visit for an acute psychotic episode. Three hours of being admitted he started shivering. Patient was found to be hypothermic with a rectal temperature of 28.9 °C. He was also hypoglycemic, pancytopenic and had positive urine cultures with >100,000 CFU/ml coagulase-negative Staphylococcus. There was no evidence of medication overdose. His CT scan of the brain did not show evidence of intracranial bleeding and his serum calcium was normal. Copyright © 2017 Elsevier Inc. All rights reserved.

E-learning and near-peer teaching in electrocardiogram education: a randomised trial.

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Davies, Andrew; Macleod, Rachael; Bennett-Britton, Ian; McElnay, Philip; Bakhbakhi, Danya; Sansom, Jane

2016-06-01

Near-peer teaching and electronic learning (e-learning) are two effective modern teaching styles. Near-peer sessions provide a supportive learning environment that benefits both the students and the tutor. E-learning resources are flexible and easily distributed. Careful construction and regular editing can ensure that students receive all of the essential material. The aim of this study is to compare the efficacy of e-learning and near-peer teaching during the pre-clinical medical curriculum. Thirty-nine second-year medical students were consented and randomised into two groups. Each group received teaching on electrocardiogram (ECG) interpretation from a predefined syllabus. Eighteen students completed an e-learning module and 21 students attended a near-peer tutorial. Students were asked to complete a multiple-choice exam, scored out of 50. Each student rated their confidence in ECG interpretation before and after their allocated teaching session. The near-peer group (84%) demonstrated a significantly higher performance than the e-learning group (74.5%) on the final assessment (p = 0.002). Prior to the teaching, the students' mean confidence scores were 3/10 in both the near-peer and e-learning groups (0, poor; 10, excellent). These increased to 6/10 in both cases following the teaching session. Both teaching styles were well received by students and improved their confidence in ECG interpretation. Near-peer teaching led to superior scores in our final assessment. Given the congested nature of the modern medical curriculum, direct comparison of the efficacy of these methods may aid course design. The aim of this study is to compare the efficacy of e-learning and near-peer teaching. © 2015 John Wiley & Sons Ltd.

Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial.

Science.gov (United States)

Wachter, Rolf; Gröschel, Klaus; Gelbrich, Götz; Hamann, Gerhard F; Kermer, Pawel; Liman, Jan; Seegers, Joachim; Wasser, Katrin; Schulte, Anna; Jürries, Falko; Messerschmid, Anna; Behnke, Nico; Gröschel, Sonja; Uphaus, Timo; Grings, Anne; Ibis, Tugba; Klimpe, Sven; Wagner-Heck, Michaela; Arnold, Magdalena; Protsenko, Evgeny; Heuschmann, Peter U; Conen, David; Weber-Krüger, Mark

2017-04-01

Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. Find-AF randomised is an open-label randomised study done at four centres in Germany. We recruited patients with acute ischaemic stroke (symptoms for 7 days or less) aged 60 years or older presenting with sinus rhythm and without history of atrial fibrillation. Patients were included irrespective of the suspected cause of stroke, unless they had a severe ipsilateral carotid or intracranial artery stenosis, which were the exclusion criteria. We used a computer-generated allocation sequence to randomly assign patients in a 1:1 ratio with permuted block sizes of 2, 4, 6, and 8, stratified by centre, to enhanced and prolonged monitoring (ie, 10-day Holter-electrocardiogram [ECG]-monitoring at baseline, and at 3 months and 6 months of follow-up) or standard care procedures (ie, at least 24 h of rhythm monitoring). Participants and study physicians were not masked to group assignment, but the expert committees that adjudicated endpoints were. The primary endpoint was the occurrence of atrial fibrillation or atrial flutter (30 sec or longer) within 6 months after randomisation and before stroke recurrence. Because Holter ECG is a widely used procedure and not known to harm patients, we chose not to assess safety in detail. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01855035. Between May 8, 2013, and Aug 31, 2014, we recruited 398 patients. 200 patients were randomly assigned to the enhanced and prolonged monitoring group and 198 to the standard care group. After 6

Viability of a Web-Based Module for Teaching Electrocardiogram Reading Skills to Psychiatry Residents: Learning Outcomes and Trainee Interest.

Science.gov (United States)

DeBonis, Katrina; Blair, Thomas R; Payne, Samuel T; Wigan, Katherine; Kim, Sara

2015-12-01

Web-based instruction in post-graduate psychiatry training has shown comparable effectiveness to in-person instruction, but few topics have been addressed in this format. This study sought to evaluate the viability of a web-based curriculum in teaching electrocardiogram (EKG) reading skills to psychiatry residents. Interest in receiving educational materials in this format was also assessed. A web-based curriculum of 41 slides, including eight pre-test and eight post-test questions with emphasis on cardiac complications of psychotropic medications, was made available to all psychiatry residents via email. Out of 57 residents, 30 initiated and 22 completed the module. Mean improvement from pre-test to post-test was 25 %, and all 22 completing participants indicated interest in future web-based instruction. This pilot study suggests that web-based instruction is feasible and under-utilized as a means of teaching psychiatry residents. Potential uses of web-based instruction, such as tracking learning outcomes or patient care longitudinally, are also discussed.

Features of electrocardiogram in patients with stenosis of the proximal right coronary artery.

Science.gov (United States)

Koh, Moo Seong; Lee, Jae Hoon; Jeong, Jin Woo; Chung, Jun Young

2017-03-01

Prediction of lesions of the proximal right coronary artery (pRCA) through electrocardiogram (ECG) is very important because pRCA occlusion has many complications and a high mortality rate, which has frequently been related with right ventricular infarction. The purpose of this study was to devise a screening tool that takes into account multiple leads from a 12-lead ECG to predict the pRCA lesion. A hundred and fifty-eight patients who were diagnosed as acute coronary syndrome and had a pure lesion of RCA or left circumf lex artery (LCX) by ECGs and angiographic findings were enrolled retrospectively. Forty-eight patients with a pure pRCA occlusion were compared to a control group of 110 patients who were diagnosed as having either a pure mid to distal RCA lesion (57 patients) or a pure LCX lesion (53 patients). ECGs of patients in the pRCA group showed more prominent ST depression in lead I ( p = 0.001) and ST elevation in V1 ( p = 0.002) than in the control group. The combination of ST depression (≤ 0 mm) in I and ST elevation (> 0.5 mm) in V1 was the best diagnostic tool (area under the curve, 0.84). ST changes in leads V1 and I allow more accurate prediction of pRCA occlusion than other criteria, such as the difference between ST elevation of leads II and III or vector direction and amplitude. These variables could help to screen for right ventricular infarction before performing reverse ECG and predicting prognosis.

Ameliorative Effect of Vitamin E on Electrocardiogram of Rabbits Exposed to Cadmium Chloride

Directory of Open Access Journals (Sweden)

Baraa Najim Al-Okaily

2013-02-01

Full Text Available This study was designed to study the effect of cadmium as an oxidant agent on electrocardiogram(ECG component and the possible preventive role of vitamin E on deleterious effects of cadmium in adult male rabbits. Twenty adult male rabbits were divided randomly into 4 equal groups (5 animals /group and treated daily for 84 days. The first group were received ordinary tap water and serve as control (C; the second group (T1 received ad libitum supply of drinking water containing (50ppb cadmium chloride; the third group T2 received (50ppb of cadmium chloride in drinking water, in addition to intubation of vitamin E (40mg/Kg B.W. orally, while the fourth group (T3 were intubated daily with 40mg/Kg B.W of vitamin E. Fasting blood samples were collected at 0, 21, 42, 63 and 84 days of the experiment to determine serum calcium concentration . The ECG was also recorded in all groups at the same interval of the experiment. The results revealed that administration of 50 ppb CdCl2 in drinking water (T1 group for 84 days caused a significant decrease(p0.05 differences in this parameter as compared to control and other groups. Analysis of ECG in Cadmium treated group (T1 showed significant (p0.05 differences in ECG waves analysis. In conclusion, Cadmium effect on electrical conduction of heart was represented by abnormality in some of ECG component as well as the protective role of vitamin E as antioxidant in the cardiovascular system was also confirmed.

Left ventricular hypertrophy: The relationship between the electrocardiogram and cardiovascular magnetic resonance imaging.

Science.gov (United States)

Bacharova, Ljuba; Ugander, Martin

2014-11-01

Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH. © 2014 Wiley Periodicals, Inc.

Signal quality indices and data fusion for determining clinical acceptability of electrocardiograms

International Nuclear Information System (INIS)

Clifford, G D; Behar, J; Li, Q; Rezek, I

2012-01-01

A completely automated algorithm to detect poor-quality electrocardiograms (ECGs) is described. The algorithm is based on both novel and previously published signal quality metrics, originally designed for intensive care monitoring. The algorithms have been adapted for use on short (5–10 s) single- and multi-lead ECGs. The metrics quantify spectral energy distribution, higher order moments and inter-channel and inter-algorithm agreement. Seven metrics were calculated for each channel (84 features in all) and presented to either a multi-layer perceptron artificial neural network or a support vector machine (SVM) for training on a multiple-annotator labelled and adjudicated training dataset. A single-lead version of the algorithm was also developed in a similar manner. Data were drawn from the PhysioNet Challenge 2011 dataset where binary labels were available, on 1500 12-lead ECGs indicating whether the entire recording was acceptable or unacceptable for clinical interpretation. We re-annotated all the leads in both the training set (1000 labelled ECGs) and test dataset (500 12-lead ECGs where labels were not publicly available) using two independent annotators, and a third for adjudication of differences. We found that low-quality data accounted for only 16% of the ECG leads. To balance the classes (between high and low quality), we created extra noisy data samples by adding noise from PhysioNet’s noise stress test database to some of the clean 12-lead ECGs. No data were shared between training and test sets. A classification accuracy of 98% on the training data and 97% on the test data were achieved. Upon inspection, incorrectly classified data were found to be borderline cases which could be classified either way. If these cases were more consistently labelled, we expect our approach to achieve an accuracy closer to 100%. (paper)

Automated Detection of Obstructive Sleep Apnea Events from a Single-Lead Electrocardiogram Using a Convolutional Neural Network.

Science.gov (United States)

Urtnasan, Erdenebayar; Park, Jong-Uk; Joo, Eun-Yeon; Lee, Kyoung-Joung

2018-04-23

In this study, we propose a method for the automated detection of obstructive sleep apnea (OSA) from a single-lead electrocardiogram (ECG) using a convolutional neural network (CNN). A CNN model was designed with six optimized convolution layers including activation, pooling, and dropout layers. One-dimensional (1D) convolution, rectified linear units (ReLU), and max pooling were applied to the convolution, activation, and pooling layers, respectively. For training and evaluation of the CNN model, a single-lead ECG dataset was collected from 82 subjects with OSA and was divided into training (including data from 63 patients with 34,281 events) and testing (including data from 19 patients with 8571 events) datasets. Using this CNN model, a precision of 0.99%, a recall of 0.99%, and an F 1 -score of 0.99% were attained with the training dataset; these values were all 0.96% when the CNN was applied to the testing dataset. These results show that the proposed CNN model can be used to detect OSA accurately on the basis of a single-lead ECG. Ultimately, this CNN model may be used as a screening tool for those suspected to suffer from OSA.

The clinical factors′ prediction of increased intradialytic qt dispersion on the electrocardiograms of chronic hemodialysis patients

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Dina Oktavia

2013-01-01

Full Text Available Ventricular arrhythmias and sudden death are common in patients on maintenance hemodialysis (HD. The increase in QT dispersion (QTd on the electrocardiogram (ECG reflects increased tendency for ventricular repolarization that predisposes to arrhythmias. The purpose of the study was to identify the clinical factors that may predict the increased intradialytic QTd and to assess differences in QTd before and after HD. Each of 61 chronic HD patients underwent 12-lead ECG and blood pressure (BP measurement before and every 1 h during a single HD session. The QT intervals were corrected for heart rate using Bazett′s formula. Intradialytic QTd increased in 30 (49% patients. There was no correlation between the increased QTd and the clinical factors including hypertension, pulse pressure, intradialytic hypotension, left ventricular hypertrophy, old myocardial infarct, diabetes mellitus, and nutritional status. The means of QT interval and QTd increased after HD session (from 382 ± 29 to 444 ± 26 ms, P <0.05; and from 74 ± 21 to 114 ± 53 ms, respectively, P <0.05. We conclude that the increased intradialytic QTd could not be predicted by any of the clinical factors evaluated in this study. There was significant difference in the means of QTd before and after HD session.

Assessment of left ventricular function using 201Tl electrocardiogram-gated myocardial single photon emission computed tomography

International Nuclear Information System (INIS)

Nishikubo, Naotsugu; Tamai, Hiroyuki

2013-01-01

Advances in computed tomography (CT) technology make it possible to obtain left ventricular wall motion using 3D reconstruction. In this study, we compared the images obtained from CT and 201 Tl electrocardiogram (ECG) gated single photon emission computed tomography (SPECT). In 20 patients with ischemic heart disease, we performed 201 Tl ECG gated SPECT (GE Healthcare Millennium VG) and ECG gated CT (Philips Medical Systems Brilliance iCT) to evaluate of left ventricular wall motion during the resting phase. In SPECT, left ventricular images were reconstructed using quantitative gated SPECT (QGS) software. In CT, the images were reconstructed using Virtual Place (AZE Software). The left ventricle was classified into five regions (anterior, lateral, inferior, septal, and apical). The amplitude of the wall motion was classified into five grades according to AHA classification. The values of the wall motion were separately checked by two radiographers. Assessment of left ventricular function myocardial wall movement using the three-dimensional movie display with ECG gated myocardial SPECT data was in agreement with the evaluation by cardiac CT inspection, and corresponded with wall motion in 88 of all 100 segments. SPECT analysis has the same quantity as that of obtained from CT for evaluation of left ventricular wall motion. (author)

Experimental envenomation with Crotalus durissus terrificus venom in dogs treated with antiophidic serum - part II: laboratory aspects, electrocardiogram and histopathology

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R. M. B. Nogueira

2007-01-01

Full Text Available The present work shows laboratory aspects, electrocardiogram and histopathology results during experimental envenomation by Crotalus durissus terrificus in dogs treated with antiophidic serum. Twenty-one dogs were divided into three groups of seven animals each. Group I received 1mg/kg venom (sc; Group II received 1mg/kg venom (sc, 50mg antiophidic serum (iv and fluid therapy including 0.9% NaCl solution (iv; and Group III received 1mg/kg venom (sc, 50mg antiophidic serum (iv and fluid therapy including 0.9% NaCl solution containing sodium bicarbonate diluted to the dose of 4mEq/kg. Urinalysis showed brown urine, proteinuria, occult blood and myoglobinuria. Respiratory acidosis and hypotension were also observed. At the venom inoculation site, there was discreet edema, popliteal lymph node response, musculature presenting whitish areas and necrotic myositis with myoregenerative activity. There was not evidence of electrocardiographical and biochemical alterations.

Prognostic value of an electrocardiogram at rest and exercise test in patients admitted with suspected acute myocardial infarction, in whom the diagnosis is not confirmed

DEFF Research Database (Denmark)

Madsen, J K; Hommel, E; Hansen, J F

1987-01-01

. Impaired prognosis was found in patients with negative T waves or ST depression at rest or with ST--T abnormalities or angina pectoris during exercise. Patients with ST depression or elevation, Q wave or intraventricular block at rest. ST abnormalities during exercise or both constituted a high-risk group......The prognosis following discharge in 217 patients admitted with suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed, was related to the electrocardiogram (ECG) at rest and a symptom-limited exercise test. The patients were followed for 12 to 24 months...... in the ECG at rest and during exercise can be used to identify high and low risk patients....

Derivation of orthogonal leads from the 12-lead electrocardiogram. Performance of an atrial-based transform for the derivation of P loops.

Science.gov (United States)

Guillem, M Salud; Sahakian, Alan V; Swiryn, Steven

2008-01-01

The objective of this study was the evaluation of the accuracy of Dower inverse transform for the derivation of the P wave in orthogonal leads. We tested the accuracy of Dower transform on the P wave and compared it with a P-wave-optimized transform in a database of 123 simultaneous recordings of electrocardiograms and vectorcardiograms. This new transform achieved a lower error when we compared derived vs true measured P waves (mean +/- SD, 12.2 +/- 8.0 VRMS) than Dower transform (14.4 +/- 9.5 Root mean squared voltage) and higher correlation values (Rx, 0.93 +/- 0.12; Ry, 0.90 +/- 0.27; Rz, 0.91 +/- 0.18; vs Dower: Rx, 0.88 +/- 0.15; Ry, 0.91 +/- 0.26; Rz, 0.85 +/- 0.23). We conclude that derivation of orthogonal leads for the P wave can be improved by using an atrial-based transform matrix.

Electrocardiogram as an important tool in Preventive & Community Medicine - A rare case report of asymptomatic non paroxysmal accelerated junctional rhythm detected on routine ECG

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Raghavendra Deolalikar

2015-03-01

Full Text Available Fifty four year old asymptomatic employee was detected to have Inverted P waves with normal QRS complex on Electrocardiogram [ECG] during his Annual Medical Examination. The ECG reverted to normal after few days. Inverted P is suggestive of retrograde conduct of impulse from A-V Node. Case of Non Paroxysmal Accelerated Junctional Rhythm. Causes are inferior wall myocardial infarction, myocarditis or recent open heart surgery. Troponin T Test was negative, Treadmill test was negative, and 2D Echo showed 55 % ejection fraction with no regional wall motion abnormalities. It needs no treatment if underlying causes are ruled out. Case would have gone un-noticed as patient was asymptomatic, thus emphasizing the importance of ECG in preventive and community medicine.

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

Energy Technology Data Exchange (ETDEWEB)

Shirota, Go; Maeda, Eriko; Namiki, Yoko; Bari, Razibul; Abe, Osamu [The University of Tokyo, Department of Radiology, Graduate School of Medicine, Tokyo (Japan); Ino, Kenji [The University of Tokyo Hospital, Imaging Center, Tokyo (Japan); Torigoe, Rumiko [Toshiba Medical Systems, Tokyo (Japan)

2017-10-15

Full iterative reconstruction algorithm is available, but its diagnostic quality in pediatric cardiac CT is unknown. To compare the imaging quality of two algorithms, full and hybrid iterative reconstruction, in pediatric cardiac CT. We included 49 children with congenital cardiac anomalies who underwent cardiac CT. We compared quality of images reconstructed using the two algorithms (full and hybrid iterative reconstruction) based on a 3-point scale for the delineation of the following anatomical structures: atrial septum, ventricular septum, right atrium, right ventricle, left atrium, left ventricle, main pulmonary artery, ascending aorta, aortic arch including the patent ductus arteriosus, descending aorta, right coronary artery and left main trunk. We evaluated beam-hardening artifacts from contrast-enhancement material using a 3-point scale, and we evaluated the overall image quality using a 5-point scale. We also compared image noise, signal-to-noise ratio and contrast-to-noise ratio between the algorithms. The overall image quality was significantly higher with full iterative reconstruction than with hybrid iterative reconstruction (3.67±0.79 vs. 3.31±0.89, P=0.0072). The evaluation scores for most of the gross structures were higher with full iterative reconstruction than with hybrid iterative reconstruction. There was no significant difference between full and hybrid iterative reconstruction for the presence of beam-hardening artifacts. Image noise was significantly lower in full iterative reconstruction, while signal-to-noise ratio and contrast-to-noise ratio were significantly higher in full iterative reconstruction. The diagnostic quality was superior in images with cardiac CT reconstructed with electrocardiogram-gated full iterative reconstruction. (orig.)

Computerized analysis of the 12-lead electrocardiogram to identify epicardial ventricular tachycardia exit sites.

Science.gov (United States)

Yokokawa, Miki; Jung, Dae Yon; Joseph, Kim K; Hero, Alfred O; Morady, Fred; Bogun, Frank

2014-11-01

Twelve-lead electrocardiogram (ECG) criteria for epicardial ventricular tachycardia (VT) origins have been described. In patients with structural heart disease, the ability to predict an epicardial origin based on QRS morphology is limited and has been investigated only for limited regions in the heart. The purpose of this study was to determine whether a computerized algorithm is able to accurately differentiate epicardial vs endocardial origins of ventricular arrhythmias. Endocardial and epicardial pace-mapping were performed in 43 patients at 3277 sites. The 12-lead ECGs were digitized and analyzed using a mixture of gaussian model (MoG) to assess whether the algorithm was able to identify an epicardial vs endocardial origin of the paced rhythm. The MoG computerized algorithm was compared to algorithms published in prior reports. The computerized algorithm correctly differentiated epicardial vs endocardial pacing sites for 80% of the sites compared to an accuracy of 42% to 66% of other described criteria. The accuracy was higher in patients without structural heart disease than in those with structural heart disease (94% vs 80%, P = .0004) and for right bundle branch block (82%) compared to left bundle branch block morphologies (79%, P = .001). Validation studies showed the accuracy for VT exit sites to be 84%. A computerized algorithm was able to accurately differentiate the majority of epicardial vs endocardial pace-mapping sites. The algorithm is not region specific and performed best in patients without structural heart disease and with VTs having a right bundle branch block morphology. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Pediatric 320-row cardiac computed tomography using electrocardiogram-gated model-based full iterative reconstruction

International Nuclear Information System (INIS)

Shirota, Go; Maeda, Eriko; Namiki, Yoko; Bari, Razibul; Abe, Osamu; Ino, Kenji; Torigoe, Rumiko

2017-01-01

Full iterative reconstruction algorithm is available, but its diagnostic quality in pediatric cardiac CT is unknown. To compare the imaging quality of two algorithms, full and hybrid iterative reconstruction, in pediatric cardiac CT. We included 49 children with congenital cardiac anomalies who underwent cardiac CT. We compared quality of images reconstructed using the two algorithms (full and hybrid iterative reconstruction) based on a 3-point scale for the delineation of the following anatomical structures: atrial septum, ventricular septum, right atrium, right ventricle, left atrium, left ventricle, main pulmonary artery, ascending aorta, aortic arch including the patent ductus arteriosus, descending aorta, right coronary artery and left main trunk. We evaluated beam-hardening artifacts from contrast-enhancement material using a 3-point scale, and we evaluated the overall image quality using a 5-point scale. We also compared image noise, signal-to-noise ratio and contrast-to-noise ratio between the algorithms. The overall image quality was significantly higher with full iterative reconstruction than with hybrid iterative reconstruction (3.67±0.79 vs. 3.31±0.89, P=0.0072). The evaluation scores for most of the gross structures were higher with full iterative reconstruction than with hybrid iterative reconstruction. There was no significant difference between full and hybrid iterative reconstruction for the presence of beam-hardening artifacts. Image noise was significantly lower in full iterative reconstruction, while signal-to-noise ratio and contrast-to-noise ratio were significantly higher in full iterative reconstruction. The diagnostic quality was superior in images with cardiac CT reconstructed with electrocardiogram-gated full iterative reconstruction. (orig.)

Digitization of Electrocardiogram From Telemetry Prior to In-hospital Cardiac Arrest: A Pilot Study.

Science.gov (United States)

Attin, Mina; Wang, Lu; Soroushmehr, S M Reza; Lin, Chii-Dean; Lemus, Hector; Spadafore, Maxwell; Najarian, Kayvan

2016-03-01

Analyzing telemetry electrocardiogram (ECG) data over an extended period is often time-consuming because digital records are not widely available at hospitals. Investigating trends and patterns in the ECG data could lead to establishing predictors that would shorten response time to in-hospital cardiac arrest (I-HCA). This study was conducted to validate a novel method of digitizing paper ECG tracings from telemetry systems in order to facilitate the use of heart rate as a diagnostic feature prior to I-HCA. This multicenter study used telemetry to investigate full-disclosure ECG papers of 44 cardiovascular patients obtained within 1 hr of I-HCA with initial rhythms of pulseless electrical activity and asystole. Digital ECGs were available for seven of these patients. An algorithm to digitize the full-disclosure ECG papers was developed using the shortest path method. The heart rate was measured manually (averaging R-R intervals) for ECG papers and automatically for digitized and digital ECGs. Significant correlations were found between manual and automated measurements of digitized ECGs (p < .001) and between digitized and digital ECGs (p < .001). Bland-Altman methods showed bias = .001 s, SD = .0276 s, lower and upper 95% limits of agreement for digitized and digital ECGs = .055 and -.053 s, and percentage error = 0.22%. Root mean square (rms), percentage rms difference, and signal to noise ratio values were in acceptable ranges. The digitization method was validated. Digitized ECG provides an efficient and accurate way of measuring heart rate over an extended period of time. © The Author(s) 2015.

Compressive sensing of electrocardiogram signals by promoting sparsity on the second-order difference and by using dictionary learning.

Science.gov (United States)

Pant, Jeevan K; Krishnan, Sridhar

2014-04-01

A new algorithm for the reconstruction of electrocardiogram (ECG) signals and a dictionary learning algorithm for the enhancement of its reconstruction performance for a class of signals are proposed. The signal reconstruction algorithm is based on minimizing the lp pseudo-norm of the second-order difference, called as the lp(2d) pseudo-norm, of the signal. The optimization involved is carried out using a sequential conjugate-gradient algorithm. The dictionary learning algorithm uses an iterative procedure wherein a signal reconstruction and a dictionary update steps are repeated until a convergence criterion is satisfied. The signal reconstruction step is implemented by using the proposed signal reconstruction algorithm and the dictionary update step is implemented by using the linear least-squares method. Extensive simulation results demonstrate that the proposed algorithm yields improved reconstruction performance for temporally correlated ECG signals relative to the state-of-the-art lp(1d)-regularized least-squares and Bayesian learning based algorithms. Also for a known class of signals, the reconstruction performance of the proposed algorithm can be improved by applying it in conjunction with a dictionary obtained using the proposed dictionary learning algorithm.

Multiclass classification of obstructive sleep apnea/hypopnea based on a convolutional neural network from a single-lead electrocardiogram.

Science.gov (United States)

Urtnasan, Erdenebayar; Park, Jong-Uk; Lee, Kyoung-Joung

2018-05-24

In this paper, we propose a convolutional neural network (CNN)-based deep learning architecture for multiclass classification of obstructive sleep apnea and hypopnea (OSAH) using single-lead electrocardiogram (ECG) recordings. OSAH is the most common sleep-related breathing disorder. Many subjects who suffer from OSAH remain undiagnosed; thus, early detection of OSAH is important. In this study, automatic classification of three classes-normal, hypopnea, and apnea-based on a CNN is performed. An optimal six-layer CNN model is trained on a training dataset (45,096 events) and evaluated on a test dataset (11,274 events). The training set (69 subjects) and test set (17 subjects) were collected from 86 subjects with length of approximately 6 h and segmented into 10 s durations. The proposed CNN model reaches a mean -score of 93.0 for the training dataset and 87.0 for the test dataset. Thus, proposed deep learning architecture achieved a high performance for multiclass classification of OSAH using single-lead ECG recordings. The proposed method can be employed in screening of patients suspected of having OSAH. © 2018 Institute of Physics and Engineering in Medicine.

An obstructive sleep apnea detection approach using kernel density classification based on single-lead electrocardiogram.

Science.gov (United States)

Chen, Lili; Zhang, Xi; Wang, Hui

2015-05-01

Obstructive sleep apnea (OSA) is a common sleep disorder that often remains undiagnosed, leading to an increased risk of developing cardiovascular diseases. Polysomnogram (PSG) is currently used as a golden standard for screening OSA. However, because it is time consuming, expensive and causes discomfort, alternative techniques based on a reduced set of physiological signals are proposed to solve this problem. This study proposes a convenient non-parametric kernel density-based approach for detection of OSA using single-lead electrocardiogram (ECG) recordings. Selected physiologically interpretable features are extracted from segmented RR intervals, which are obtained from ECG signals. These features are fed into the kernel density classifier to detect apnea event and bandwidths for density of each class (normal or apnea) are automatically chosen through an iterative bandwidth selection algorithm. To validate the proposed approach, RR intervals are extracted from ECG signals of 35 subjects obtained from a sleep apnea database ( http://physionet.org/cgi-bin/atm/ATM ). The results indicate that the kernel density classifier, with two features for apnea event detection, achieves a mean accuracy of 82.07 %, with mean sensitivity of 83.23 % and mean specificity of 80.24 %. Compared with other existing methods, the proposed kernel density approach achieves a comparably good performance but by using fewer features without significantly losing discriminant power, which indicates that it could be widely used for home-based screening or diagnosis of OSA.

A novel LabVIEW-based multi-channel non-invasive abdominal maternal-fetal electrocardiogram signal generator.

Science.gov (United States)

Martinek, Radek; Kelnar, Michal; Koudelka, Petr; Vanus, Jan; Bilik, Petr; Janku, Petr; Nazeran, Homer; Zidek, Jan

2016-02-01

This paper describes the design, construction, and testing of a multi-channel fetal electrocardiogram (fECG) signal generator based on LabVIEW. Special attention is paid to the fetal heart development in relation to the fetus' anatomy, physiology, and pathology. The non-invasive signal generator enables many parameters to be set, including fetal heart rate (FHR), maternal heart rate (MHR), gestational age (GA), fECG interferences (biological and technical artifacts), as well as other fECG signal characteristics. Furthermore, based on the change in the FHR and in the T wave-to-QRS complex ratio (T/QRS), the generator enables manifestations of hypoxic states (hypoxemia, hypoxia, and asphyxia) to be monitored while complying with clinical recommendations for classifications in cardiotocography (CTG) and fECG ST segment analysis (STAN). The generator can also produce synthetic signals with defined properties for 6 input leads (4 abdominal and 2 thoracic). Such signals are well suited to the testing of new and existing methods of fECG processing and are effective in suppressing maternal ECG while non-invasively monitoring abdominal fECG. They may also contribute to the development of a new diagnostic method, which may be referred to as non-invasive trans-abdominal CTG +  STAN. The functional prototype is based on virtual instrumentation using the LabVIEW developmental environment and its associated data acquisition measurement cards (DAQmx). The generator also makes it possible to create synthetic signals and measure actual fetal and maternal ECGs by means of bioelectrodes.

Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

Science.gov (United States)

Gu, Jiwei; Andreasen, Jan J; Melgaard, Jacob; Lundbye-Christensen, Søren; Hansen, John; Schmidt, Erik B; Thorsteinsson, Kristinn; Graff, Claus

2017-02-01

To investigate if electrocardiogram (ECG) markers from routine preoperative ECGs can be used in combination with clinical data to predict new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Retrospective observational case-control study. Single-center university hospital. One hundred consecutive adult patients (50 POAF, 50 without POAF) who underwent coronary artery bypass grafting, valve surgery, or combinations. Retrospective review of medical records and registration of POAF. Clinical data and demographics were retrieved from the Western Denmark Heart Registry and patient records. Paper tracings of preoperative ECGs were collected from patient records, and ECG measurements were read by two independent readers blinded to outcome. A subset of four clinical variables (age, gender, body mass index, and type of surgery) were selected to form a multivariate clinical prediction model for POAF and five ECG variables (QRS duration, PR interval, P-wave duration, left atrial enlargement, and left ventricular hypertrophy) were used in a multivariate ECG model. Adding ECG variables to the clinical prediction model significantly improved the area under the receiver operating characteristic curve from 0.54 to 0.67 (with cross-validation). The best predictive model for POAF was a combined clinical and ECG model with the following four variables: age, PR-interval, QRS duration, and left atrial enlargement. ECG markers obtained from a routine preoperative ECG may be helpful in predicting new-onset POAF in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

An Investigation on the Effect of Extremely Low Frequency Pulsed Electromagnetic Fields on Human Electrocardiograms (ECGs).

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Fang, Qiang; Mahmoud, Seedahmed S; Yan, Jiayong; Li, Hui

2016-11-23

For this investigation, we studied the effects of extremely low frequency pulse electromagnetic fields (ELF-PEMF) on the human cardiac signal. Electrocardiograms (ECGs) of 22 healthy volunteers before and after a short duration of ELF-PEMF exposure were recorded. The experiment was conducted under single-blind conditions. The root mean square (RMS) value of the recorded data was considered as comparison criteria. We also measured and analysed four important ECG time intervals before and after ELF-PEMF exposure. Results revealed that the RMS value of the ECG recordings from 18 participants (81.8% of the total participants) increased with a mean value of 3.72%. The increase in ECG voltage levels was then verified by a second experimental protocol with a control exposure. In addition to this, we used hyperbolic T-distributions (HTD) in the analysis of ECG signals to verify the change in the RR interval. It was found that there were small shifts in the frequency-domain signal before and after EMF exposure. This shift has an influence on all frequency components of the ECG signals, as all spectrums were shifted. It is shown from this investigation that a short time exposure to ELF-PEMF can affect the properties of ECG signals. Further study is needed to consolidate this finding and discover more on the biological effects of ELF-PEMF on human physiological processes.

Evaluation of left ventricular function and volume with multidetector-row computed tomography. Comparison with electrocardiogram-gated single photon emission computed tomography

International Nuclear Information System (INIS)

Suzuki, Takeya; Yamashina, Shohei; Nanjou, Shuji; Yamazaki, Junichi

2007-01-01

This study compared left ventricular systolic function and volume determined by multidetector-row computed tomography (MDCT) and electrocardiogram-gated single photon emission computed tomography (G-SPECT) Thirty-seven patients with coronary artery disease and non-cardiovascular disease underwent MDCT. In this study, left ventricular ejection fraction (EF), left ventricular end-diastolic volume (EDV) and left ventricular end-systolic volume (ESV) were calculated using only two-phase imaging with MDCT. Left ventricular function and volume were compared using measurements from G-SPECT. We conducted MDCT and G-SPECT virtually simultaneously. Both the EF and ESV evaluated by MDCT closely correlated with G-SPECT (r=0.763, P 65 bpm) during MDCT significantly influenced the difference in EF calculated from MDCT and G-SPECT (P<0.05). Left ventricular function can be measured with MDCT as well as G-SPECT. However, a heart rate over 65 bpm during MDCT negatively affects the EF correlation between MDCT and G-SPECT. (author)

Use of concept maps to promote electrocardiogram diagnosis learning in undergraduate medical students

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Dong, Ruimin; Yang, Xiaoyan; Xing, Bangrong; Zou, Zihao; Zheng, Zhenda; Xie, Xujing; Zhu, Jieming; Chen, Lin; Zhou, Hanjian

2015-01-01

Concept mapping is an effective method in teaching and learning, however this strategy has not been evaluated among electrocardiogram (ECG) diagnosis learning. This study explored the use of concept maps to assist ECG study, and sought to analyze whether this method could improve undergraduate students’ ECG interpretation skills. There were 126 undergraduate medical students who were randomly selected and assigned to two groups, group A (n = 63) and group B (n = 63). Group A was taught to use concept maps to learn ECG diagnosis, while group B was taught by traditional methods. After the course, all of the students were assessed by having an ECG diagnostic test. Quantitative data which comprised test score and ECG features completion index was compared by using the unpaired Student’s t-test between the two groups. Further, a feedback questionnaire on concept maps used was also completed by group A, comments were evaluated by a five-point Likert scale. The test scores of ECGs interpretation was 7.36 ± 1.23 in Group A and 6.12 ± 1.39 in Group B. A significant advantage (P = 0.018) of concept maps was observed in ECG interpretation accuracy. No difference in the average ECG features completion index was observed between Group A (66.75 ± 15.35%) and Group B (62.93 ± 13.17%). According qualitative analysis, majority of students accepted concept maps as a helpful tool. Difficult to learn at the beginning and time consuming are the two problems in using this method, nevertheless most of the students indicated to continue using it. Concept maps could be a useful pedagogical tool in enhancing undergraduate medical students’ ECG interpretation skills. Furthermore, students indicated a positive attitude to it, and perceived it as a resource for learning. PMID:26221331

An assessment of algorithms to estimate respiratory rate from the electrocardiogram and photoplethysmogram.

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Charlton, Peter H; Bonnici, Timothy; Tarassenko, Lionel; Clifton, David A; Beale, Richard; Watkinson, Peter J

2016-04-01

Over 100 algorithms have been proposed to estimate respiratory rate (RR) from the electrocardiogram (ECG) and photoplethysmogram (PPG). As they have never been compared systematically it is unclear which algorithm performs the best. Our primary aim was to determine how closely algorithms agreed with a gold standard RR measure when operating under ideal conditions. Secondary aims were: (i) to compare algorithm performance with IP, the clinical standard for continuous respiratory rate measurement in spontaneously breathing patients; (ii) to compare algorithm performance when using ECG and PPG; and (iii) to provide a toolbox of algorithms and data to allow future researchers to conduct reproducible comparisons of algorithms. Algorithms were divided into three stages: extraction of respiratory signals, estimation of RR, and fusion of estimates. Several interchangeable techniques were implemented for each stage. Algorithms were assembled using all possible combinations of techniques, many of which were novel. After verification on simulated data, algorithms were tested on data from healthy participants. RRs derived from ECG, PPG and IP were compared to reference RRs obtained using a nasal-oral pressure sensor using the limits of agreement (LOA) technique. 314 algorithms were assessed. Of these, 270 could operate on either ECG or PPG, and 44 on only ECG. The best algorithm had 95% LOAs of  -4.7 to 4.7 bpm and a bias of 0.0 bpm when using the ECG, and  -5.1 to 7.2 bpm and 1.0 bpm when using PPG. IP had 95% LOAs of  -5.6 to 5.2 bpm and a bias of  -0.2 bpm. Four algorithms operating on ECG performed better than IP. All high-performing algorithms consisted of novel combinations of time domain RR estimation and modulation fusion techniques. Algorithms performed better when using ECG than PPG. The toolbox of algorithms and data used in this study are publicly available.

Comparison between exercise electrocardiogram and thallium 201 myocardial perfusion imaging during exercise, after dipyridamole and at rest, for the diagnosis of stable angina pectoris. 176 cases were studied with coronary angiography

International Nuclear Information System (INIS)

Machecourt, J.; Denis, B.; Comet, M.; Wolf, J.E.; Dimitriou, R.; Pellet, J.; Noel, P.M.

1981-01-01

The purpose of this study was to compare the diagnostic interest of the electrocardiogram stress test (EST) and the thallium myocardial imaging during exercise (TIE). For this, the cases of 176 patients with stable angina pectoris who underwent a coronary arteriogram were studied. These patients were divided into two groups: a first group of 113 patients without a previous history of myocardial infarction, nor a Q wave on their electrocardiogram and a second group of 63 patients with angina pectoris after a previous myocardial infarction. All patients underwent a combined EST and TIE. The sensitivity and the specificity of the EST and the TIE were studied, and the post-test risk after either a positive test or a negative test was calculated according to Bayes' theorem. In the first group 62 patients had a coronary stenosis and 51 had a normal arteriogram. The sensitivity of the TIE was higher than that of the EST: 80% versus 64%, p < 0.01. Even when the maximum effort was not reached during the EST, the TIE kept the same sensitivity. The diagnosis of angina pectoris cannot be absolutely established by the separate use of the TIE or the EST. However, their predictive value increases when both are correlated. Moreover, for female patients, the TIE is more specific than the EST because of the higher frequency of false positive or equivocal results of the EST in that population. (Auth.)

Impact of the 12-lead electrocardiogram on ED evaluation and management.

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Benner, John P; Borloz, Matthew P; Adams, Madeline; Brady, William J

2007-10-01

This study was conducted to assess the impact (diagnostic, therapeutic, and disposition) of the 12-lead electrocardiogram (ECG) on emergency department (ED) patient evaluation and management. This project was a prospective study of a convenience sample of 304 ED patients undergoing ECG analysis during their evaluation in the ED of a level 1 trauma center. The data collection for this study was divided into 4 parts. In part I, the treating physicians determined the specific reasons for ECG analysis; categories include complaint-based (eg, chest pain), syndrome-based (eg, overdose/poisoning), and system-based (eg, "requested by consult"). In part II, all treating physicians were surveyed before ECG interpretation regarding the future diagnostic, therapeutic, and disposition plans for the patient based only on history and physical examination. Their comments were recorded on a standardized data sheet. In part III, the physicians were surveyed after their interpretation of the ECG as to whether the results could suggest any further diagnostic information (eg, normal vs abnormal), or provide enough information for the patient care plan to be altered. In part IV of the study period, alterations to the original diagnostic, therapeutic, and disposition plans made by information provided by the ECG were obtained from the treating physician. A total of 304 patients underwent ECG examination and were used for data analysis. The average age of patients, of which 48% were men, was 60 years. The most common complaints that prompted electrocardiographic evaluation were chest pain and dyspnea. The most common reason an ECG was ordered was nursing staff protocol. Physicians determined that they were able to make a diagnosis based primarily on ECG in 33 (10.9%) cases. The total number of ECGs that were determined to be normal was 95 (31.3%), 7 (2.3%) of which allowed a rule-out diagnosis; 209 (68.7%) of total ECGs were determined to be abnormal, 72 (23.6%) of which were considered

Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram.

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Costin, Nathaniel I; Korach, Amit; Loor, Gabriel; Peterson, Mark D; Desai, Nimesh D; Trimarchi, Santi; de Vincentiis, Carlo; Ota, Takeyoshi; Reece, T Brett; Sundt, Thoralf M; Patel, Himanshu J; Chen, Edward P; Montgomery, Dan G; Nienaber, Christoph A; Isselbacher, Eric M; Eagle, Kim A; Gleason, Thomas G

2018-01-01

The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD. TAAAD patients (N = 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n = 1,094 [39.6%]) and abnormal (n = 1,671 [60.4%]) findings on presenting ECGs and further subdivided according to specific ECG findings. Time data are presented in hours as medians (quartile 1 to quartile 3). Patients with ECGs with abnormal findings presented to the hospital sooner after symptom onset than those with ECGs with normal findings (1.4 [0.8 to 3.3] vs 2.0 [1.0 to 3.3]; p = 0.005). Specifically, this was seen in patients with infarction with new Q waves or ST elevation (1.3 [0.6 to 2.7] vs 1.5 [0.8 to 3.3]; p = 0.049). Interestingly, the time between symptom onset and diagnosis was longer with infarction with old Q waves (6.7 [3.2 to 18.4] vs 5.0 [2.9 to 11.8]; p = 0.034) and nonspecific ST-T changes (5.8 [3.0 to 13.8] vs 4.5 [2.8 to 10.5]; p = 0.002). Surgical mortality was higher in patients with abnormal ECG findings (20.6% vs 11.9%, p presenting with abnormal ECG results are sicker, have more in-hospital complications, and are more likely to die. The frequency of nonspecific ST-T abnormalities and its association with delay in diagnosis and treatment presents an opportunity for practice improvement. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A comparative study of electrocardiogram multi-segment reconstruction and dual source computed tomography using a computer controlled coronary phantom

International Nuclear Information System (INIS)

Ohashi, Kazuya; Higashide, Ryo; Kunitomo, Hirosi; Ichikawa, Katsuhiro

2011-01-01

Currently, there are two main methods for improving temporal resolution of coronary computed tomography (CT): electrocardiogram-gated multi-segment reconstruction (EMR) and dual source scanning using dual source CT (DSCT). We developed a motion phantom system for image quality assessment of cardiac CT to evaluate these two methods. This phantom system was designed to move an object at arbitrary speeds during a desired phase range in cyclic motion. By using this system, we obtained coronary CT mode images for motion objects like coronary arteries. We investigated the difference in motion artifacts between EMR and the DSCT using a 3-mm-diameter acrylic rod resembling the coronary artery. EMR was evaluated using 16-row multi-slice CT (16MSCT). To evaluate the image quality, we examined the degree of motion artifacts by analyzing the profiles around the rod and the displacement of a peak pixel in the rod image. In the 16MSCT, remarkable increases of artifacts and displacement were caused by the EMR. In contrast, the DSCT presented excellent images with fewer artifacts. The results showed the validity of DSCT to improve true temporal resolution. (author)

Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

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Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

2015-01-01

The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

Property of electrocardiogram gated single photon emission tomography by 99mTc-methoxy isobutyl isonitrile

International Nuclear Information System (INIS)

Imai, Kamon; Nishio, Yukari; Araki, Yasushi; Saito, Satoshi; Ozawa, Yukio; Yasugi, Tadao; Hagiwara, Kazuo; Kamata, Rikisaburo

1992-01-01

99m Tc-methoxy isobutyl isonitrile (MIBI) is a new developed myocardial perfusion imaging agent. Because this compound has higher photon energy than thallium (Tl), electrocardiogram gated single photon emission tomography (SPECT): end-diastolic (ED) and end-systolic (ES) short axis (SA) images could be taken. To investigate property of gated MIBI SPECT, MIBI myocardial scintigraphy, Tl scintigraphy (TMS) and analysis of left ventricular wall motion were performed in 6 patients with myocardial infarction. Left ventricule was divided into 8 segments. Perfusion defect (PD) was scored: '0' (normal), '1' (hypo-perfusion), '2' (defect). Wall motion abnormality (WMA) was also scored: '0' (normo-kinesis), '1' (hypo-kinesis), '2' (a-, dys-kinesis). Severity and extent of PD and WMA were calculated. Severity of WMA was 3.0±2.0 (M±SD), severity of PD was 3.3±1.7 in TMS, 3.7±1.3 in no-gated MIBI, 5.0±0.6 in ES-MIBI, 7.3±2.0 in ED-MIBI. Extent of WMA was 2.3±1.0. Extent of PD was 2.5±1.3 in TMS, 3.0±1.6 in no-gated MIBI, 3.5±0.8 in ES-MIBI, 4.8±1.0 in ED-MIBI. Compared with wall motion abnormality, severity and extent of PD in ED-MIBI was larger. From our data, it is concluded that perfusion defect in ED-MIBI was overestimated significantly. When we evaluate gated MIBI image, we must consider this property. (author)

Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

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Carlos Manuel Teixeira

Full Text Available Abstract Background: There are currently several electrocardiographic algorithms to locate the accessory pathway (AP in patients with Wolff-Parkinson-White (WPW syndrome. Objective: To compare the ability of electrocardiographic algorithms in identifying the location of the AP in patients with WPW pattern referred for ablation. Methods: Observational, cross-sectional, retrospective study with 111 patients with WPW syndrome referred for AP ablation. The electrocardiogram (ECG obtained prior to the ablation was analyzed by an experienced observer who consecutively applied seven algorithms to identify non-invasively the AP. We then compared the location estimated with this assessment with that obtained in the electrophysiological study and calculated the agreement rates. Results: Among the APs, 59 (53.15% were distributed around the mitral annulus and the remaining 52 (46.85% were located around the tricuspid annulus. The overall absolute accuracy of the algorithms evaluated varied between 27% and 47%, increasing to between 40% and 76% when we included adjacent locations. The absolute agreement rate by AP location was 2.00-52.20% for septal APs (n = 51, increasing to 5.90-90.20% when considering adjacent locations; 7.70-69.20% for right APs (n = 13, increasing to 42.90-100% when considering adjacent locations; and 21.70-54.50% for left APs (n = 47, increasing to 50-87% when considering adjacent locations. Conclusion: The agreement rates observed for the analyzed scores indicated a low discriminative ability of the ECG in locating the AP in patients with WPW.

Parallelized computation for computer simulation of electrocardiograms using personal computers with multi-core CPU and general-purpose GPU.

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Shen, Wenfeng; Wei, Daming; Xu, Weimin; Zhu, Xin; Yuan, Shizhong

2010-10-01

Biological computations like electrocardiological modelling and simulation usually require high-performance computing environments. This paper introduces an implementation of parallel computation for computer simulation of electrocardiograms (ECGs) in a personal computer environment with an Intel CPU of Core (TM) 2 Quad Q6600 and a GPU of Geforce 8800GT, with software support by OpenMP and CUDA. It was tested in three parallelization device setups: (a) a four-core CPU without a general-purpose GPU, (b) a general-purpose GPU plus 1 core of CPU, and (c) a four-core CPU plus a general-purpose GPU. To effectively take advantage of a multi-core CPU and a general-purpose GPU, an algorithm based on load-prediction dynamic scheduling was developed and applied to setting (c). In the simulation with 1600 time steps, the speedup of the parallel computation as compared to the serial computation was 3.9 in setting (a), 16.8 in setting (b), and 20.0 in setting (c). This study demonstrates that a current PC with a multi-core CPU and a general-purpose GPU provides a good environment for parallel computations in biological modelling and simulation studies. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

The non-invasive and continuous estimation of cardiac output using a photoplethysmogram and electrocardiogram during incremental exercise

International Nuclear Information System (INIS)

Wang, L; Poon, C C Y; Zhang, Y T

2010-01-01

Cardiac output (CO) monitoring is not only essential for critically ill patients in the hospital, but also for patients at home and those undergoing cardiopulmonary exercise testing. However, CO is difficult to monitor during daily activities and exercise. In this paper, we aim at developing a novel CO estimation method that can be used under these challenging conditions. The tube model was utilized to derive a CO index, namely the pulse time reflection ratio (PTRR) from an electrocardiogram and photoplethysmogram. After calibration, the PTRR can be used to estimate beat-to-beat CO. The proposed method was verified against CO measured by impedance cardiography on 19 healthy subjects in an incremental intensity exercise test. Results showed that there were strong correlations (r) between the PTRR and reference CO in 18 subjects (mean r: 0.88, n = 245 trials). Two calibration approaches reported in the literature were applied to the proposed method and the corresponding bias ± precisions of estimation errors were 0 ± 1.89 L min −1 and −0.22 ± 2.12 L min −1 , respectively. The percent errors were 21.94% and 24.90%, smaller than the clinical acceptance limit (30%). To conclude, after calibration, this method can be used to monitor CO on healthy subjects during incremental intensity exercise

Fetal electrocardiogram (ECG) for fetal monitoring during labour.

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Neilson, James P

2015-12-21

Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electronic fetal heart rate monitoring with the aim of improving fetal outcome and minimising unnecessary obstetric interference. To compare the effects of analysis of fetal ECG waveforms during labour with alternative methods of fetal monitoring. The Cochrane Pregnancy and Childbirth Group's Trials Register (latest search 23 September 2015) and reference lists of retrieved studies. Randomised trials comparing fetal ECG waveform analysis with alternative methods of fetal monitoring during labour. One review author independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. One review author assessed the quality of the evidence using the GRADE approach. Seven trials (27,403 women) were included: six trials of ST waveform analysis (26,446 women) and one trial of PR interval analysis (957 women). The trials were generally at low risk of bias for most domains and the quality of evidence for ST waveform analysis trials was graded moderate to high. In comparison to continuous electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis made no obvious difference to primary outcomes: births by caesarean section (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.96 to 1.08; six trials, 26,446 women; high quality evidence); the number of babies with severe metabolic acidosis at birth (cord arterial pH less than 7.05 and base deficit greater than 12 mmol/L) (average RR 0.72, 95% CI 0.43 to 1.20; six trials, 25,682 babies; moderate quality evidence); or babies with neonatal encephalopathy (RR 0.61, 95% CI 0.30 to 1.22; six trials, 26,410 babies; high quality evidence). There were, however, on average

Identification of QRS complex in non-stationary electrocardiogram of sick infants.

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Kota, S; Swisher, C B; Al-Shargabi, T; Andescavage, N; du Plessis, A; Govindan, R B

2017-08-01

Due to the high-frequency of routine interventions in an intensive care setting, electrocardiogram (ECG) recordings from sick infants are highly non-stationary, with recurrent changes in the baseline, alterations in the morphology of the waveform, and attenuations of the signal strength. Current methods lack reliability in identifying QRS complexes (a marker of individual cardiac cycles) in the non-stationary ECG. In the current study we address this problem by proposing a novel approach to QRS complex identification. Our approach employs lowpass filtering, half-wave rectification, and the use of instantaneous Hilbert phase to identify QRS complexes in the ECG. We demonstrate the application of this method using ECG recordings from eight preterm infants undergoing intensive care, as well as from 18 normal adult volunteers available via a public database. We compared our approach to the commonly used approaches including Pan and Tompkins (PT), gqrs, wavedet, and wqrs for identifying QRS complexes and then compared each with manually identified QRS complexes. For preterm infants, a comparison between the QRS complexes identified by our approach and those identified through manual annotations yielded sensitivity and positive predictive values of 99% and 99.91%, respectively. The comparison metrics for each method are as follows: PT (sensitivity: 84.49%, positive predictive value: 99.88%), gqrs (85.25%, 99.49%), wavedet (95.24%, 99.86%), and wqrs (96.99%, 96.55%). Thus, the sensitivity values of the four methods previously described, are lower than the sensitivity of the method we propose; however, the positive predictive values of these other approaches is comparable to those of our method, with the exception of the wqrs approach, which yielded a slightly lower value. For adult ECG, our approach yielded a sensitivity of 99.78%, whereas PT yielded 99.79%. The positive predictive value was 99.42% for both our approach as well as for PT. We propose a novel method for

New ideas for teaching electrocardiogram interpretation and improving classroom teaching content

Directory of Open Access Journals (Sweden)

Zeng R

2015-02-01

Full Text Available Rui Zeng,1 Rong-Zheng Yue,2 Chun-Yu Tan,3 Qin Wang,4 Pu Kuang,5 Pan-Wen Tian,6 Chuan Zuo3 1Department of Cardiovascular Diseases, 2Department of Nephrology, 3Department of Rheumatology and Immunology, 4Department of Endocrinology, 5Department of Hematology, 6Department of Respiratory Diseases, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, People’s Republic of China Background: Interpreting an electrocardiogram (ECG is not only one of the most important parts of diagnostics but also one of the most difficult areas to teach. Owing to the abstract nature of the basic theoretical knowledge of the ECG, its scattered characteristics, and tedious and difficult-to-remember subject matter, teaching how to interpret ECGs is as difficult for teachers to teach as it is for students to learn. In order to enable medical students to master basic knowledge of ECG interpretation skills in a limited teaching time, we modified the content used for traditional ECG teaching and now propose a new ECG teaching method called the “graphics-sequence memory method.” Methods: A prospective randomized controlled study was designed to measure the actual effectiveness of ECG learning by students. Two hundred students were randomly placed under a traditional teaching group and an innovative teaching group, with 100 participants in each group. The teachers in the traditional teaching group utilized the traditional teaching outline, whereas the teachers in the innovative teaching group received training in line with the proposed teaching method and syllabus. All the students took an examination in the final semester by analyzing 20 ECGs from real clinical cases and submitted their ECG reports. Results: The average ECG reading time was 32 minutes for the traditional teaching group and 18 minutes for the innovative teaching group. The average ECG accuracy results were 43% for the traditional teaching group and 77% for the innovative teaching

Friend or Foe? Flipped Classroom for Undergraduate Electrocardiogram Learning: a Randomized Controlled Study.

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Rui, Zeng; Lian-Rui, Xiang; Rong-Zheng, Yue; Jing, Zeng; Xue-Hong, Wan; Chuan, Zuo

2017-03-07

Interpreting an electrocardiogram (ECG) is not only one of the most important parts of clinical diagnostics but also one of the most difficult topics to teach and learn. In order to enable medical students to master ECG interpretation skills in a limited teaching period, the flipped teaching method has been recommended by previous research to improve teaching effect on undergraduate ECG learning. A randomized controlled trial for ECG learning was conducted, involving 181 junior-year medical undergraduates using a flipped classroom as an experimental intervention, compared with Lecture-Based Learning (LBL) as a control group. All participants took an examination one week after the intervention by analysing 20 ECGs from actual clinical cases and submitting their ECG reports. A self-administered questionnaire was also used to evaluate the students' attitudes, total learning time, and conditions under each teaching method. The students in the experimental group scored significantly higher than the control group (8.72 ± 1.01 vs 8.03 ± 1.01, t = 4.549, P = 0.000) on ECG interpretation. The vast majority of the students in the flipped classroom group held positive attitudes toward the flipped classroom method and also supported LBL. There was no significant difference (4.07 ± 0.96 vs 4.16 ± 0.89, Z = - 0.948, P = 0.343) between the groups. Prior to class, the students in the flipped class group devoted significantly more time than those in the control group (42.33 ± 22.19 vs 30.55 ± 10.15, t = 4.586, P = 0.000), whereas after class, the time spent by the two groups were not significantly different (56.50 ± 46.80 vs 54.62 ± 31.77, t = 0.317, P = 0.752). Flipped classroom teaching can improve medical students' interest in learning and their self-learning abilities. It is an effective teaching model that needs to be further studied and promoted.

Value of the Signal-Averaged Electrocardiogram in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

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Kamath, Ganesh S.; Zareba, Wojciech; Delaney, Jessica; Koneru, Jayanthi N.; McKenna, William; Gear, Kathleen; Polonsky, Slava; Sherrill, Duane; Bluemke, David; Marcus, Frank; Steinberg, Jonathan S.

2011-01-01

Background Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited disease causing structural and functional abnormalities of the right ventricle (RV). The presence of late potentials as assessed by the signal averaged electrocardiogram (SAECG) is a minor Task Force criterion. Objective The purpose of this study was to examine the diagnostic and clinical value of the SAECG in a large population of genotyped ARVC/D probands. Methods We compared the SAECGs of 87 ARVC/D probands (age 37 ± 13 years, 47 males) diagnosed as affected or borderline by Task Force criteria without using the SAECG criterion with 103 control subjects. The association of SAECG abnormalities was also correlated with clinical presentation; surface ECG; VT inducibility at electrophysiologic testing; ICD therapy for VT; and RV abnormalities as assessed by cardiac magnetic resonance imaging (cMRI). Results When compared with controls, all 3 components of the SAECG were highly associated with the diagnosis of ARVC/D (p<0.001). These include the filtered QRS duration (fQRSD) (97.8 ± 8.7 msec vs. 119.6 ± 23.8 msec), low amplitude signal (LAS) (24.4 ± 9.2 msec vs. 46.2 ± 23.7 msec) and root mean square amplitude of the last 40 msec of late potentials (RMS-40) (50.4 ± 26.9 µV vs. 27.9 ± 36.3 µV). The sensitivity of using SAECG for diagnosis of ARVC/D was increased from 47% using the established 2 of 3 criteria (i.e. late potentials) to 69% by using a modified criterion of any 1 of the 3 criteria, while maintaining a high specificity of 95%. Abnormal SAECG as defined by this modified criteria was associated with a dilated RV volume and decreased RV ejection fraction detected by cMRI (p<0.05). SAECG abnormalities did not vary with clinical presentation or reliably predict spontaneous or inducible VT, and had limited correlation with ECG findings. Conclusion Using 1 of 3 SAECG criteria contributed to increased sensitivity and specificity for the diagnosis of ARVC/D. This

The value of the 12-lead electrocardiogram in localizing the scar in non-ischaemic cardiomyopathy.

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Oloriz, Teresa; Wellens, Hein J J; Santagostino, Giulia; Trevisi, Nicola; Silberbauer, John; Peretto, Giovanni; Maccabelli, Giuseppe; Della Bella, Paolo

2016-12-01

Patients with non-ischaemic cardiomyopathy (NICM) and ventricular tachycardia can be categorized as anteroseptal (AS) or inferolateral (IL) scar sub-types based on imaging and voltage mapping studies. The aim of this study was to correlate the baseline electrocardiogram (ECG) with endo-epicardial voltage maps created during ablation procedures and identify the ECG characteristics that may help to distinguish the scar as AS or IL. We assessed 108 baseline ECGs; 72 patients fulfilled criteria for dilated cardiomyopathy whereas 36 showed minimal structural abnormalities. Based on the unipolar low-voltage distribution, the scar pattern was classified as predominantly AS (n = 59) or IL (n = 49). Three ECG criteria (PR interval 230 ms or QRS > 170 ms or an r ≤ 0.3 mV in V3 having 92 and 81% of sensitivity and specificity, respectively, in predicting AS scar pattern. A significant negative correlation was found between the extension of the endocardial unipolar low voltage area and left ventricular EF (r s = -0.719, P < 0.001). The extent of endocardial AS unipolar low voltage was correlated with PR interval and QRS duration (r s = 0.583 and r s = 0.680, P < 0.001, respectively) and the IL epicardial unipolar low voltage with the mean voltage of the limb leads (r s = -0.639, P < 0.001). Baseline ECG features are well correlated with the distribution of unipolar voltage abnormalities in NICM and may help to predict the location of scar in this population. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

What adult electrocardiogram (ECG) diagnoses and/or findings do residents in emergency medicine need to know?

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Patocka, Catherine; Turner, Joel; Wiseman, Jeffrey

2015-11-01

There is no evidence-based description of electrocardiogram (ECG) interpretation competencies for emergency medicine (EM) trainees. The first step in defining these competencies is to develop a prioritized list of adult ECG findings relevant to EM contexts. The purpose of this study was to categorize the importance of various adult ECG diagnoses and/or findings for the EM trainee. We developed a list of potentially important adult ECG diagnoses/findings and conducted a Delphi opinion-soliciting process. Participants used a 4-point Likert scale to rate the importance of each diagnosis for EM trainees. Consensus was defined as a minimum of 75% agreement at the second round or later. In the absence of consensus, stability was defined as a shift of 20% or less after successive rounds. A purposive sampling of 22 emergency physicians participated in the Delphi process, and 16 (72%) completed the process. Of those, 15 were from 11 different EM training programs across Canada and one was an expert in EM electrocardiography. Overall, 78 diagnoses reached consensus, 42 achieved stability and one diagnosis achieved neither consensus nor stability. Out of 121 potentially important adult ECG diagnoses, 53 (44%) were considered "must know" diagnoses, 61 (50%) "should know" diagnoses, and 7 (6%) "nice to know" diagnoses. We have categorized adult ECG diagnoses within an EM training context, knowledge of which may allow clinical EM teachers to establish educational priorities. This categorization will also facilitate the development of an educational framework to establish EM trainee competency in ECG interpretation.

Detection of premature ventricular contractions on a ventricular electrocardiogram for patients with left ventricular assist devices.

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Park, Sung Min; Lee, Jin Hong; Choi, Seong Wook

2014-12-01

The ventricular electrocardiogram (v-ECG) was developed for long-term monitoring of heartbeats in patients with a left ventricular assist device (LVAD) and does not normally have the functionality necessary to detect additional heart irregularities that can progress to critical arrhythmias. Although the v-ECG has the benefits of physiological optimization and counterpulsation control, when abnormal heartbeats occur, the v-ECG does not show the distinct abnormal waveform that enables easy detection of an abnormal heartbeat among normal heartbeats on the conventional ECG. In this study, the v-ECGs of normal and abnormal heartbeats are compared with each other with respect to peak-to-peak voltage, area, and maximal slopes, and a new method to detect abnormal heartbeats is suggested. In a series of animal experiments with three porcine models (Yorkshire pigs weighing 30-40 kg), a v-ECG and conventional ECG were taken simultaneously during LVAD perfusion. Clinical experts found 104 abnormal heartbeats from the saved conventional ECG data and confirmed that the other 3159 heartbeats were normal. Almost all of the abnormal heartbeats were premature ventricular contractions (PVCs), and there was short-term tachycardia for 3 s. A personal computer was used to automatically detect abnormal heartbeats with the v-ECG according to the new method, and its results were compared with the clinicians' results. The new method found abnormal heartbeats with 90% accuracy, and less than 15% of the total PVCs were missed. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

An Energy efficient application specific integrated circuit for electrocardiogram feature detection and its potential for ambulatory cardiovascular disease detection.

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Jain, Sanjeev Kumar; Bhaumik, Basabi

2016-03-01

A novel algorithm based on forward search is developed for real-time electrocardiogram (ECG) signal processing and implemented in application specific integrated circuit (ASIC) for QRS complex related cardiovascular disease diagnosis. The authors have evaluated their algorithm using MIT-BIH database and achieve sensitivity of 99.86% and specificity of 99.93% for QRS complex peak detection. In this Letter, Physionet PTB diagnostic ECG database is used for QRS complex related disease detection. An ASIC for cardiovascular disease detection is fabricated using 130-nm CMOS high-speed process technology. The area of the ASIC is 0.5 mm(2). The power dissipation is 1.73 μW at the operating frequency of 1 kHz with a supply voltage of 0.6 V. The output from the ASIC is fed to their Android application that generates diagnostic report and can be sent to a cardiologist through email. Their ASIC result shows average failed detection rate of 0.16% for six leads data of 290 patients in PTB diagnostic ECG database. They also have implemented a low-leakage version of their ASIC. The ASIC dissipates only 45 pJ with a supply voltage of 0.9 V. Their proposed ASIC is most suitable for energy efficient telemetry cardiovascular disease detection system.

Clinical evaluation of the use of an intracardiac electrocardiogram to guide the tip positioning of peripherally inserted central catheters.

Science.gov (United States)

Zhao, Ruiyi; Chen, Chunfang; Jin, Jingfen; Sharma, Komal; Jiang, Nan; Shentu, Yingqin; Wang, Xingang

2016-06-01

The use of peripherally inserted central catheters (PICCs) provides important central venous accesses for clinical treatments, tests and monitoring. Compared with the traditional methods, intracardiac electrocardiogram (ECG)-guided method has the potential to guide more accurate tip positioning of PICCs. This study aimed to clinically evaluate the effectiveness of an intracardiac ECG to guide the tip positioning by monitoring characteristic P-wave changes. In this study, eligible patients enrolled September 2011 to May 2012 according to the inclusion and exclusion criteria received the catheterization monitored by intracardiac ECG. Then chest radiography was performed to check the catheter position. The results revealed that, with 117 eligible patients, all bar one patient who died (n = 116) completed the study, including 60 males and 56 females aged 51.2 ± 15.1 years. Most (n = 113, > 97%) had characteristic P-wave changes. The intracardiac ECG-guided positioning procedure achieved correct placement for 112 patients (96.56%), demonstrating 99.12% sensitivity and 100% specificity. In conclusion, the intracardiac ECG can be a promising technique to guide tip positioning of PICCs. However, since the sample size in this study is limited, more experience and further study during clinical practice are needed to demonstrate achievement of optimal catheterization outcomes. © 2015 John Wiley & Sons Australia, Ltd.

A new method for measuring temporal resolution in electrocardiogram-gated reconstruction image with area-detector computed tomography

International Nuclear Information System (INIS)

Kaneko, Takeshi; Takagi, Masachika; Kato, Ryohei; Anno, Hirofumi; Kobayashi, Masanao; Yoshimi, Satoshi; Sanda, Yoshihiro; Katada, Kazuhiro

2012-01-01

The purpose of this study was to design and construct a phantom for using motion artifact in the electrocardiogram (ECG)-gated reconstruction image. In addition, the temporal resolution under various conditions was estimated. A stepping motor was used to move the phantom over an arc in a reciprocating manner. The program for controlling the stepping motor permitted the stationary period and the heart rate to be adjusted as desired. Images of the phantom were obtained using a 320-row area-detector computed tomography (ADCT) system under various conditions using the ECG-gated reconstruction method. For estimation, the reconstruction phase was continuously changed and the motion artifacts were quantitatively assessed. The temporal resolution was calculated from the number of motion-free images. Changes in the temporal resolution according to heart rate, rotation time, the number of reconstruction segments and acquisition position in z-axis were also investigated. The measured temporal resolution of ECG-gated half reconstruction is 180 ms, which is in good agreement with the nominal temporal resolution of 175 ms. The measured temporal resolution of ECG-gated segmental reconstruction is in good agreement with the nominal temporal resolution in most cases. The estimated temporal resolution improved to approach the nominal temporal resolution as the number of reconstruction segments was increased. Temporal resolution in changing acquisition position is equal. This study shows that we could design a new phantom for estimating temporal resolution. (author)

Validity of computational hemodynamics in human arteries based on 3D time-of-flight MR angiography and 2D electrocardiogram gated phase contrast images

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Yu, Huidan (Whitney); Chen, Xi; Chen, Rou; Wang, Zhiqiang; Lin, Chen; Kralik, Stephen; Zhao, Ye

2015-11-01

In this work, we demonstrate the validity of 4-D patient-specific computational hemodynamics (PSCH) based on 3-D time-of-flight (TOF) MR angiography (MRA) and 2-D electrocardiogram (ECG) gated phase contrast (PC) images. The mesoscale lattice Boltzmann method (LBM) is employed to segment morphological arterial geometry from TOF MRA, to extract velocity profiles from ECG PC images, and to simulate fluid dynamics on a unified GPU accelerated computational platform. Two healthy volunteers are recruited to participate in the study. For each volunteer, a 3-D high resolution TOF MRA image and 10 2-D ECG gated PC images are acquired to provide the morphological geometry and the time-varying flow velocity profiles for necessary inputs of the PSCH. Validation results will be presented through comparisons of LBM vs. 4D Flow Software for flow rates and LBM simulation vs. MRA measurement for blood flow velocity maps. Indiana University Health (IUH) Values Fund.

Puzzle based teaching versus traditional instruction in electrocardiogram interpretation for medical students--a pilot study.

Science.gov (United States)

Rubinstein, Jack; Dhoble, Abhijeet; Ferenchick, Gary

2009-01-13

Most medical professionals are expected to possess basic electrocardiogram (EKG) interpretation skills. But, published data suggests that residents' and physicians' EKG interpretation skills are suboptimal. Learning styles differ among medical students; individualization of teaching methods has been shown to be viable and may result in improved learning. Puzzles have been shown to facilitate learning in a relaxed environment. The objective of this study was to assess efficacy of teaching puzzle in EKG interpretation skills among medical students. This is a reader blinded crossover trial. Third year medical students from College of Human Medicine, Michigan State University participated in this study. Two groups (n = 9) received two traditional EKG interpretation skills lectures followed by a standardized exam and two extra sessions with the teaching puzzle and a different exam. Two other groups (n = 6) received identical courses and exams with the puzzle session first followed by the traditional teaching. EKG interpretation scores on final test were used as main outcome measure. The average score after only traditional teaching was 4.07 +/- 2.08 while after only the puzzle session was 4.04 +/- 2.36 (p = 0.97). The average improvement after the traditional session was followed up with a puzzle session was 2.53 +/- 1.94 while the average improvement after the puzzle session was followed with the traditional session was 2.08 +/- 1.73 (p = 0.67). The final EKG exam score for this cohort (n = 15) was 84.1 compared to 86.6 (p = 0.22) for a comparable sample of medical students (n = 15) at a different campus. Teaching EKG interpretation with puzzles is comparable to traditional teaching and may be particularly useful for certain subgroups of students. Puzzle session are more interactive and relaxing, and warrant further investigations on larger scale.

Usefulness of simultaneous and sequential monitoring of glucose level and electrocardiogram in monkeys treated with gatifloxacin under conscious and nonrestricted conditions.

Science.gov (United States)

Yoshimatsu, Yu; Ishizaka, Tomomichi; Chiba, Katsuyoshi; Mori, Kazuhiko

2018-05-10

Drug-induced cardiac electrophysiological abnormalities accompanied by hypoglycemia or hyperglycemia increase the risk for life-threatening arrhythmia. To assess the drug-induced cardiotoxic potential associated with extraordinary blood glucose (GLU) levels, the effect of gatifloxacin (GFLX) which was frequently associated with GLU abnormality and QT/QTc prolongations in the clinic on blood GLU and electrocardiogram (ECG) parameters was investigated in cynomolgus monkeys (n=4) given GFLX orally in an ascending dose regimen (10, 30, 60 and 100 mg/kg). Simultaneous and sequential GLU and ECG monitoring with a continuous GLU monitoring system and Holter ECG, respectively, were conducted for 24 h under free-moving conditions. Consequently, GFLX at 30 and 60 mg/kg dose-dependently induced a transient decrease in GLU without any ECG abnormality 2-4 h postdose. Highest dose of 100 mg/kg caused severe hypoglycemia with a mean GLU of sequential GLU monitoring data clearly distinguished between GFLX-induced GLU abnormality and physiological GLU changes influenced by feeding throughout the day. In conclusion, the combined assessment of continuous GLU and ECG monitoring is valuable in predicting the drug-induced cardio-electrophysiological risk associated with both GLU and ECG abnormalities.

Is 10-second electrocardiogram recording enough for accurately estimating heart rate in atrial fibrillation.

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Shuai, Wei; Wang, Xi-Xing; Hong, Kui; Peng, Qiang; Li, Ju-Xiang; Li, Ping; Chen, Jing; Cheng, Xiao-Shu; Su, Hai

2016-07-15

At present, the estimation of rest heart rate (HR) in atrial fibrillation (AF) is obtained by apical auscultation for 1min or on the surface electrocardiogram (ECG) by multiplying the number of RR intervals on the 10second recording by six. But the reasonability of 10second ECG recording is controversial. ECG was continuously recorded at rest for 60s to calculate the real rest HR (HR60s). Meanwhile, the first 10s and 30s ECG recordings were used for calculating HR10s (sixfold) and HR30s (twofold). The differences of HR10s or HR30s with the HR60s were compared. The patients were divided into three sub-groups on the HR60s 100bpm. No significant difference among the mean HR10s, HR30s and HR60s was found. A positive correlation existed between HR10s and HR60s or HR30s and HR60s. Bland-Altman plot showed that the 95% reference limits were high as -11.0 to 16.0bpm for HR10s, but for HR30s these values were only -4.5 to 5.2bpm. Among the three subgroups with HR60s 100bpm, the 95% reference limits with HR60s were -8.9 to 10.6, -10.5 to 14.0 and -11.3 to 21.7bpm for HR10s, but these values were -3.9 to 4.3, -4.1 to 4.6 and -5.3 to 6.7bpm for HR30s. As 10s ECG recording could not provide clinically accepted estimation HR, ECG should be recorded at least for 30s in the patients with AF. It is better to record ECG for 60s when the HR is rapid. Copyright © 2016. Published by Elsevier Ireland Ltd.

Is there evidence for mandating electrocardiogram as part of the pre-participation examination?

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Borjesson, Mats; Dellborg, Mikael

2011-01-01

The risk of sudden cardiac death may be increased up to 2.8 times in competitive athletes compared with nonathletes. The majority of sudden cardiac death cases are caused by an underlying abnormality that potentially may be identified on cardiovascular screening, depending on the specific abnormality and the content of the cardiovascular screening applied. Indeed, today, cardiac screening is universally recommended by the cardiac societies [European Society of Cardiology (ESC) and American Heart Association (AHA)] and required by the sporting bodies [Fédération Internationale de Football Association (FIFA) and Union of European Football Associations (UEFA)]. Pre-participation examination is by consensus understood to include personal history and physical examination; controversy exists regarding the usefulness and appropriateness of screening using resting 12-lead electrocardiogram (ECG), with an apparent transatlantic difference. The ESC recommends screening consisting of personal history, physical examination, and 12-lead resting ECG, whereas recommendations from the AHA includes only personal history and physical examination. There is firm scientific ground to state that the sensitivity of screening with ECG is vastly superior to, and the cost-effectiveness significantly better than, screening without ECG. Cardiac screening of elite athletes with personal history, physical examination, and ECG is cost-effective also in comparison with other well-accepted procedures of modern health care, such as dialysis and implantable cardiac defibrillators. Newly published recommendations for the interpretation of the ECG in athletes (ESC) and future studies on ECGs in athletes of different ethnicity, gender, and age may further increase the specificity of ECG in cardiac screening, refining the screening procedure and lowering the costs for additional follow-up testing. Cardiac screening without ECG is not cost-effective and may be only marginally better than no screening

Assessment of left ventricular function by electrocardiogram-gated myocardial single photon emission computed tomography using quantitative gated single photon emission computed tomography software

International Nuclear Information System (INIS)

Morita, Koichi; Adachi, Itaru; Konno, Masanori

1999-01-01

Electrocardiogram (ECG)-gated myocardial single photon emission computed tomography (SPECT) can assess left ventricular (LV) perfusion and function easily using quantitative gated SPECT (QGS) software. ECG-gated SPECT was performed in 44 patients with coronary artery disease under post-stress and resting conditions to assess the values of LV functional parameters, by comparison to LV ejection fraction derived from gated blood pool scan and myocardial characteristics. A good correlation was obtained between ejection fraction using QGS and that using cardiac blood pool scan (r=0.812). Some patients with myocardial ischemia had lower ejection fraction under post-stress compared to resting conditions, indicating post-stress LV dysfunction. LV wall motion and wall thickening were significantly impaired in ischemic and infarcted myocardium, and the degree of abnormality in the infarcted areas was greater than in the ischemia area. LV functional parameters derived using QGS were useful to assess post-stress LV dysfunction and myocardial viability. In conclusion, ECG-gated myocardial SPECT permits simultaneous quantitative assessment of myocardial perfusion and function. (author)

Evaluation of an exposed-radiation dose on a dual-source cardiac computed tomography examination with a prospective electrocardiogram-gated fast dual spiral scan

International Nuclear Information System (INIS)

Matsubara, Kosuke; Koshida, Kichiro; Koshida, Haruka; Sakuta, Keita; Hayashi, Hiroyuki; Takata, Tadanori; Horii, Junsei; Kawai, Keiichi; Yamamoto, Tomoyuki

2012-01-01

We evaluated exposed-radiation doses on dual-source cardiac computed tomography (CT) examinations with prospective electrocardiogram (ECG)-gated fast dual spiral scans. After placing dosimeters at locations corresponding to each of the thoracic organs, prospective ECG-gated fast dual spirals and retrospective ECG-gated dual spiral scans were performed to measure the absorbed dose of each organ. In the prospective ECG-gated fast dual spiral scans, the average absorbed doses were 5.03 mGy for the breast, 9.96 mGy for the heart, 6.60 mGy for the lung, 6.48 mGy for the bone marrow, 9.73 mGy for the thymus, and 4.58 mGy for the skin. These values were about 5% of the absorbed doses for the retrospective ECG-gated dual spiral scan. However, the absorbed dose differed greatly at each scan, especially in the external organs such as the breast. For effective and safe use of the prospective ECG-gated fast dual spiral scan, it is necessary to understand these characteristics sufficiently. (author)

Electrocardiogram score for the selection of reperfusion strategy in early latecomers with ST-segment elevation myocardial infarction.

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Zhang, Yu-Jiao; Zheng, Wen; Sun, Jian; Li, Guo-Li; Chi, Bao-Rong

2015-01-01

The clinical benefit of percutaneous coronary intervention (PCI) is controversial in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset. Several studies suggested this conflicting result was associated with myocardial area at risk (MaR) of enrolled patients. MaR could be estimated by the electrocardiogram (ECG) score. Our objective was to evaluate the benefits of PCI in STEMI latecomers with different MaR. We constructed a prospective cohort involving 436 patients presenting 12-72 hours after STEMI onset and who met an inclusion criteria. 218 underwent PCI and 218 received the optimal medical therapy (OMT) alone. Individual MaR was quantified by the combined Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction or revascularization within two years. The 2-year cumulative primary endpoint rate was respectively 9.2% in PCI group and 5.3% in OMT group when MaR<35% (adjusted hazard ratio for PCI vs. OMT, 1.855; 95% confidence interval [CI], 0.617-5.575; P=0.271), and was 12.8% in PCI group and 23.1% in OMT group when MaR ≥35% (adjusted hazard ratio for PCI vs. OMT, 0.448; 95% CI, 0.228-0.884; P=0.021). The benefit of PCI for the STEMI latecomers was associated with the MaR. PCI, compared with OMT, could significantly reduce the 2-year primary outcomes in patients with MaR≥35%, but not in ones with MaR<35%. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN® for intrapartum monitoring

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Rijnders Robbert JP

2007-07-01

Full Text Available Abstract Background Cardiotocography (CTG is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS, it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour. Two clinical trials have shown that a combination of CTG and ST-analysis of the fetal electrocardiogram (ECG reduces the rates of metabolic acidosis and instrumental delivery. However, in both trials FBS was still performed in the ST-analysis arm, and it is therefore still unknown if the observed results were indeed due to the ST-analysis or to the use of FBS in combination with ST-analysis. Methods/Design We aim to evaluate the effectiveness of non-invasive monitoring (CTG + ST-analysis as compared to normal care (CTG + FBS, in a multicentre randomised clinical trial setting. Secondary aims are: 1 to judge whether ST-analysis of fetal electrocardiogram can significantly decrease frequency of performance of FBS or even replace it; 2 perform a cost analysis to establish the economic impact of the two treatment options. Women in labour with a gestational age ≥ 36 weeks and an indication for CTG-monitoring can be included in the trial. Eligible women will be randomised for fetal surveillance with CTG and, if necessary, FBS or CTG combined with ST-analysis of the fetal ECG. The primary outcome of the study is the incidence of serious metabolic acidosis (defined as pH ecf > 12 mmol/L in the umbilical cord artery. Secondary outcome measures are: instrumental delivery, neonatal outcome (Apgar score, admission to a neonatal ward, incidence of performance of FBS in both arms and cost-effectiveness of both monitoring strategies across hospitals. The analysis will follow the intention to treat principle. The incidence of metabolic acidosis will be compared across both groups

Puzzle based teaching versus traditional instruction in electrocardiogram interpretation for medical students – a pilot study

Science.gov (United States)

Rubinstein, Jack; Dhoble, Abhijeet; Ferenchick, Gary

2009-01-01

Background Most medical professionals are expected to possess basic electrocardiogram (EKG) interpretation skills. But, published data suggests that residents' and physicians' EKG interpretation skills are suboptimal. Learning styles differ among medical students; individualization of teaching methods has been shown to be viable and may result in improved learning. Puzzles have been shown to facilitate learning in a relaxed environment. The objective of this study was to assess efficacy of teaching puzzle in EKG interpretation skills among medical students. Methods This is a reader blinded crossover trial. Third year medical students from College of Human Medicine, Michigan State University participated in this study. Two groups (n = 9) received two traditional EKG interpretation skills lectures followed by a standardized exam and two extra sessions with the teaching puzzle and a different exam. Two other groups (n = 6) received identical courses and exams with the puzzle session first followed by the traditional teaching. EKG interpretation scores on final test were used as main outcome measure. Results The average score after only traditional teaching was 4.07 ± 2.08 while after only the puzzle session was 4.04 ± 2.36 (p = 0.97). The average improvement after the traditional session was followed up with a puzzle session was 2.53 ± 1.94 while the average improvement after the puzzle session was followed with the traditional session was 2.08 ± 1.73 (p = 0.67). The final EKG exam score for this cohort (n = 15) was 84.1 compared to 86.6 (p = 0.22) for a comparable sample of medical students (n = 15) at a different campus. Conclusion Teaching EKG interpretation with puzzles is comparable to traditional teaching and may be particularly useful for certain subgroups of students. Puzzle session are more interactive and relaxing, and warrant further investigations on larger scale. PMID:19144134

Puzzle based teaching versus traditional instruction in electrocardiogram interpretation for medical students – a pilot study

Directory of Open Access Journals (Sweden)

Dhoble Abhijeet

2009-01-01

Full Text Available Abstract Background Most medical professionals are expected to possess basic electrocardiogram (EKG interpretation skills. But, published data suggests that residents' and physicians' EKG interpretation skills are suboptimal. Learning styles differ among medical students; individualization of teaching methods has been shown to be viable and may result in improved learning. Puzzles have been shown to facilitate learning in a relaxed environment. The objective of this study was to assess efficacy of teaching puzzle in EKG interpretation skills among medical students. Methods This is a reader blinded crossover trial. Third year medical students from College of Human Medicine, Michigan State University participated in this study. Two groups (n = 9 received two traditional EKG interpretation skills lectures followed by a standardized exam and two extra sessions with the teaching puzzle and a different exam. Two other groups (n = 6 received identical courses and exams with the puzzle session first followed by the traditional teaching. EKG interpretation scores on final test were used as main outcome measure. Results The average score after only traditional teaching was 4.07 ± 2.08 while after only the puzzle session was 4.04 ± 2.36 (p = 0.97. The average improvement after the traditional session was followed up with a puzzle session was 2.53 ± 1.94 while the average improvement after the puzzle session was followed with the traditional session was 2.08 ± 1.73 (p = 0.67. The final EKG exam score for this cohort (n = 15 was 84.1 compared to 86.6 (p = 0.22 for a comparable sample of medical students (n = 15 at a different campus. Conclusion Teaching EKG interpretation with puzzles is comparable to traditional teaching and may be particularly useful for certain subgroups of students. Puzzle session are more interactive and relaxing, and warrant further investigations on larger scale.

A Combined Linkage and Exome Sequencing Analysis for Electrocardiogram Parameters in the Erasmus Rucphen Family Study.

Science.gov (United States)

Silva, Claudia T; Zorkoltseva, Irina V; Amin, Najaf; Demirkan, Ayşe; van Leeuwen, Elisabeth M; Kors, Jan A; van den Berg, Marten; Stricker, Bruno H; Uitterlinden, André G; Kirichenko, Anatoly V; Witteman, Jacqueline C M; Willemsen, Rob; Oostra, Ben A; Axenovich, Tatiana I; van Duijn, Cornelia M; Isaacs, Aaron

2016-01-01

Electrocardiogram (ECG) measurements play a key role in the diagnosis and prediction of cardiac arrhythmias and sudden cardiac death. ECG parameters, such as the PR, QRS, and QT intervals, are known to be heritable and genome-wide association studies of these phenotypes have been successful in identifying common variants; however, a large proportion of the genetic variability of these traits remains to be elucidated. The aim of this study was to discover loci potentially harboring rare variants utilizing variance component linkage analysis in 1547 individuals from a large family-based study, the Erasmus Rucphen Family Study (ERF). Linked regions were further explored using exome sequencing. Five suggestive linkage peaks were identified: two for QT interval (1q24, LOD = 2.63; 2q34, LOD = 2.05), one for QRS interval (1p35, LOD = 2.52) and two for PR interval (9p22, LOD = 2.20; 14q11, LOD = 2.29). Fine-mapping using exome sequence data identified a C > G missense variant (c.713C > G, p.Ser238Cys) in the FCRL2 gene associated with QT (rs74608430; P = 2.8 × 10 -4 , minor allele frequency = 0.019). Heritability analysis demonstrated that the SNP explained 2.42% of the trait's genetic variability in ERF ( P = 0.02). Pathway analysis suggested that the gene is involved in cytosolic Ca 2+ levels ( P = 3.3 × 10 -3 ) and AMPK stimulated fatty acid oxidation in muscle ( P = 4.1 × 10 -3 ). Look-ups in bioinformatics resources showed that expression of FCRL2 is associated with ARHGAP24 and SETBP1 expression. This finding was not replicated in the Rotterdam study. Combining the bioinformatics information with the association and linkage analyses, FCRL2 emerges as a strong candidate gene for QT interval.

A combined linkage and exome sequencing analysis for electrocardiogram parameters in the Erasmus Rucphen Family study

Directory of Open Access Journals (Sweden)

Claudia Tamar Silva

2016-11-01

Full Text Available Electrocardiogram (ECG measurements play a key role in the diagnosis and prediction of cardiac arrhythmias and sudden cardiac death. ECG parameters, such as the PR, QRS, and QT intervals, are known to be heritable and genome-wide association studies (GWAS of these phenotypes have been successful in identifying common variants; however, a large proportion of the genetic variability of these traits remains to be elucidated. The aim of this study was to discover loci potentially harboring rare variants utilizing variance component linkage analysis in 1547 individuals from a large family-based study, the Erasmus Rucphen Family Study (ERF. Linked regions were further explored using exome sequencing. Five suggestive linkage peaks were identified: two for QT interval (1q24, LOD = 2.63; 2q34, LOD = 2.05, one for QRS interval (1p35, LOD = 2.52 and two for PR interval (9p22, LOD = 2.20; 14q11, LOD = 2.29. Fine-mapping using exome sequence data identified a C > G missense variant (c.713C>G, p.Ser238Cys in the FCRL2 gene associated with QT (rs74608430; P = 2.8 ×10-4, minor allele frequency = 0.019. Heritability analysis demonstrated that the SNP explained 2.42% of the trait’s genetic variability in ERF (P = 0.02. Pathway analysis suggested that the gene is involved in cytosolic Ca2+ levels (P = 3.3 × 10-3 and AMPK stimulated fatty acid oxidation in muscle (P = 4.1 ×10-3. Look-ups in bioinformatics resources showed that expression of FCRL2 is associated with ARHGAP24 and SETBP1 expression. This finding was not replicated in the Rotterdam study. Combining the bioinformatics information with the association and linkage analyses, FCRL2 emerges as a strong candidate gene for QT interval.

Effect of ventricular size and function on exercise performance and the electrocardiogram in repaired tetralogy of Fallot with pure pulmonary regurgitation

International Nuclear Information System (INIS)

Menon, Shaji C; Kaza, Aditya K; Puchalski, Michael D

2012-01-01

In repaired tetralogy of Fallot (TOF), exercise test parameters like peak oxygen uptake and ventilatory efficiency predict mortality. Studies have also suggested cardiac magnetic resonance (CMR)-derived right ventricular (RV) size threshold values for pulmonary valve replacement in repaired TOF. However, effects of proposed RV size on exercise capacity and morbidity are not known. The relationship between CMR-derived ventricular size, function, and pulmonary regurgitation (PR) and NYHA class, exercise performance, and electrocardiogram (ECG) was studied in patients of repaired TOF with pure PR in a retrospective review of records. 46 patients (22 females), mean age 14 years (8–30.8), were studied. There was no relationship between CMR-derived ventricular size, function, or PR and exercise test parameters, or NYHA class. RV end systolic and end diastolic volume correlated positively with the degree of PR. QRS duration on ECG correlated positively with RV end-diastolic volume (P < 0.01, r 2 = 0.34) and PR (P < 0.01, r 2 = 0.52). In repaired TOF and pure PR, there is no correlation between ventricular size or function and exercise performance. RV size increases with increasing PR. Timing of pulmonary valve replacement in TOF with pure PR needs further prospective evaluation for its effect on morbidity and mortality

The Effect of Creative Tasks on Electrocardiogram: Using Linear and Nonlinear Features in Combination with Classification Approaches

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Sahar Zakeri

2017-02-01

Full Text Available Objective: Interest in the subject of creativity and its impacts on human life is growing extensively. However, only a few surveys pay attention to the relation between creativity and physiological changes. This paper presents a novel approach to distinguish between creativity states from electrocardiogram signals. Nineteen linear and nonlinear features of the cardiac signal were extracted to detect creativity states. Method: ECG signals of 52 participants were recorded while doing three tasks of Torrance Tests of Creative Thinking (TTCT/ figural B. To remove artifacts, notch filter 50 Hz and Chebyshev II were applied. According to TTCT scores, participants were categorized into the high and low creativity groups: Participants with scores higher than 70 were assigned into the high creativity group and those with scores less than 30 were considered as low creativity group. Some linear and nonlinear features were extracted from the ECGs. Then, Support Vector Machine (SVM and Adaptive Neuro-Fuzzy Inference System (ANFIS were used to classify the groups.Results: Applying the Wilcoxon test, significant differences were observed between rest and each three tasks of creativity. However, better discrimination was performed between rest and the first task. In addition, there were no statistical differences between the second and third task of the test. The results indicated that the SVM effectively detects all the three tasks from the rest, particularly the task 1 and reached the maximum accuracy of 99.63% in the linear analysis. In addition, the high creative group was separated from the low creative group with the accuracy of 98.41%.Conclusion: the combination of SVM classifier with linear features can be useful to show the relation between creativity and physiological changes.

Assessment of residual tissue viability by exercise testing in recent myocardial infarction: comparison of the electrocardiogram and myocardial perfusion scintigraphy.

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Margonato, A; Ballarotto, C; Bonetti, F; Cappelletti, A; Sciammarella, M; Cianflone, D; Chierchia, S L

1992-04-01

The assessment of residual myocardial viability in infarcted areas is relevant for subsequent management and prognosis but requires expensive technology. To evaluate the possibility that simple, easily obtainable clinical markers may detect the presence of within-infarct viable tissue, the significance of exercise-induced ST elevation occurring in leads exploring the area of a recent Q wave myocardial infarction was assessed. Twenty-five patients with recent (less than 6 months) myocardial infarction were studied. All had angiographically documented coronary artery disease, diagnostic Q waves (n = 24) or negative T waves (n = 25) on the rest 12-lead electrocardiogram and exhibited during exercise greater than or equal to 1.5 mm ST segment elevation (n = 17) or isolated T wave pseudonormalization (n = 8) in the infarct-related leads. ST-T wave changes were reproduced in all patients during thallium-201 exercise myocardial scintigraphy. A fixed perfusion defect was observed in 24 of the 25 patients. A reversible defect was seen in 16 (94%) of 17 patients who exhibited transient ST elevation during exercise but in only 4 (50%) of the 8 patients who had only T wave pseudonormalization. In conclusion, in patients with recent myocardial infarction, analysis of simple ST segment variables obtained during exercise testing may allow a first-line discrimination of those who may potentially benefit from a revascularization procedure.

128-slice Dual-source Computed Tomography Coronary Angiography in Patients with Atrial Fibrillation: Image Quality and Radiation Dose of Prospectively Electrocardiogram-triggered Sequential Scan Compared with Retrospectively Electrocardiogram-gated Spiral Scan.

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Lin, Lu; Wang, Yi-Ning; Kong, Ling-Yan; Jin, Zheng-Yu; Lu, Guang-Ming; Zhang, Zhao-Qi; Cao, Jian; Li, Shuo; Song, Lan; Wang, Zhi-Wei; Zhou, Kang; Wang, Ming

2013-01-01

Objective To evaluate the image quality (IQ) and radiation dose of 128-slice dual-source computed tomography (DSCT) coronary angiography using prospectively electrocardiogram (ECG)-triggered sequential scan mode compared with ECG-gated spiral scan mode in a population with atrial fibrillation. Methods Thirty-two patients with suspected coronary artery disease and permanent atrial fibrillation referred for a second-generation 128-slice DSCT coronary angiography were included in the prospective study. Of them, 17 patients (sequential group) were randomly selected to use a prospectively ECG-triggered sequential scan, while the other 15 patients (spiral group) used a retrospectively ECG-gated spiral scan. The IQ was assessed by two readers independently, using a four-point grading scale from excel-lent (grade 1) to non-assessable (grade 4), based on the American Heart Association 15-segment model. IQ of each segment and effective dose of each patient were compared between the two groups. Results The mean heart rate (HR) of the sequential group was 96±27 beats per minute (bpm) with a variation range of 73±25 bpm, while the mean HR of the spiral group was 86±22 bpm with a variationrange of 65±24 bpm. Both of the mean HR (t=1.91, P=0.243) and HR variation range (t=0.950, P=0.350) had no significant difference between the two groups. In per-segment analysis, IQ of the sequential group vs. spiral group was rated as excellent (grade 1) in 190/244 (78%) vs. 177/217 (82%) by reader1 and 197/245 (80%) vs. 174/214 (81%) by reader2, as non-assessable (grade 4) in 4/244 (2%) vs. 2/217 (1%) by reader1 and 6/245 (2%) vs. 4/214 (2%) by reader2. Overall averaged IQ per-patient in the sequential and spiral group showed equally good (1.27±0.19 vs. 1.25±0.22, Z=-0.834, P=0.404). The effective radiation dose of the sequential group reduced significantly compared with the spiral group (4.88±1.77 mSv vs. 10.20±3.64 mSv; t=-5.372, P=0.000). Conclusion Compared with retrospectively

Time interval between maternal electrocardiogram and venous Doppler waves in normal pregnancy and preeclampsia: a pilot study.

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Tomsin, K; Mesens, T; Molenberghs, G; Peeters, L; Gyselaers, W

2012-12-01

To evaluate the time interval between maternal electrocardiogram (ECG) and venous Doppler waves at different stages of uncomplicated pregnancy (UP) and in preeclampsia (PE). Cross-sectional pilot study in 40 uncomplicated singleton pregnancies, categorized in four groups of ten according to gestational age: 10 - 14 weeks (UP1), 18 - 23 weeks (UP2), 28 - 33 weeks (UP3) and ≥ 37 weeks (UP4) of gestation. A fifth group of ten women with PE was also included. A Doppler flow examination at the level of renal interlobar veins (RIV) and hepatic veins (HV) was performed according to a standard protocol, in association with a maternal ECG. The time interval between the ECG P-wave and the corresponding A-deflection of the venous Doppler waves was measured (PA), and expressed relative to the duration of the cardiac cycle (RR), and labeled PA/RR. In hepatic veins, the PA/RR is longer in UP 4 than in UP 1 (0.48 ± 0.15 versus 0.29 ± 0.09, p ≤ 0.001). When all UP groups were compared, the PA/RR increased gradually with gestational age. In PE, the HV PA/RR is shorter than in UP 3 (0.25 ± 0.09 versus 0.42 ± 0.14, p advanced gestational stages are consistent with known features of maternal cardiovascular adaptation. Shorter values in preeclampsia are consistent with maternal cardiovascular maladaptation mechanisms. Our pilot study invites more research of the relevance of the time interval between maternal ECG and venous Doppler waves as a new parameter for studying the gestational cardiovascular (patho)physiology of the maternal venous compartment by duplex sonography. © Georg Thieme Verlag KG Stuttgart · New York.

Clinical and Financial Impact of Ordering an Echocardiogram in Children with Left Axis Deviation on Their Electrocardiogram.

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Ravi, Prasad; Ashwath, Ravi; Strainic, James; Li, Hong; Steinberg, Jon; Snyder, Christopher

2016-01-01

Left axis deviation (LAD) on the electrocardiogram (ECG) is associated with congenital heart disease (CHD), prompting the clinician to order further testing when evaluating a patient with this finding. The purpose is to (1) compare the physical examination (PE) by a pediatric cardiologist to echocardiogram (ECHO) findings in patients with LAD on resting ECG and (2) assess cost of performing ECHO on all patients with LAD on ECG. An IRB approved, retrospective cohort study was performed on patients with LAD (QRS axis ≥0° to -90°) on ECG between 01/02 and 12/12. age >0.25 and <18 years, non-postoperative, and PE and ECHO by pediatric cardiologist. A decision tree model analyzed cost of ECHO in patients with LAD and normal/abnormal PE. Cost of complete ECHO ($239.00) was obtained from 2014 Medicare reimbursement rates. A total of 146 patients met inclusion criteria with 46.5% (68) having normal PE and ECHO, 1.4% (2) having normal PE and abnormal ECHO, 47.3% (69) having abnormal PE and ECHO, and 4.8% (7) having an abnormal PE and normal ECHO. Sensitivity and specificity of PE for detecting abnormalities in this population was 97% and 90%. Positive and negative predictive value of PE was 91% and 97.5%. In patients with normal PE, the cost to identify an ECHO abnormality was $8365, and $263 for those with abnormal PE. In presence of LAD on ECG, the sensitivity, specificity, and positive and negative predictive values of PE by a pediatric cardiologist are excellent at identifying CHD. Performing an ECHO on patients with LAD on ECG is only cost effective in the presence of an abnormal PE. In the presence of normal PE, there is a possibility of missing incidental structural cardiac disease in approximately 2% if an ECHO is not performed. © 2015 Wiley Periodicals, Inc.

Impact of the dynamic and static component of the sport practised for electrocardiogram analysis in screening athletes.

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Maillot, N; Guenancia, C; Yameogo, N V; Gudjoncik, A; Garnier, F; Lorgis, L; Chagué, F; Cottin, Y

2018-02-01

To interpret the electrocardiogram (ECG) of athletes, the recommendations of the ESC and the Seattle criteria define type 1 peculiarities, those induced by training, and type 2, those not induced by training, to rule out cardiomyopathy. The specificity of the screening was improved by Sheikh who defined "Refined Criteria," which includes a group of intermediate peculiarities. The aim of our study was to investigate the influence of static and dynamic components on the prevalence of different types of abnormalities. The ECGs of 1030 athletes performed during preparticipation screening were interpreted using these three classifications. Our work revealed 62/16%, 69/13%, and 71/7% of type 1 peculiarities and type 2 abnormalities for the ESC, Seattle, and Refined Criteria algorithms, respectively(P<.001). For type 2 abnormalities, three independent factors were found for the ESC and Seattle criteria: age, Afro-Caribbean origin, and the dynamic component with, for the latter, an OR[95% CI] of 2.35[1.28-4.33] (P=.006) and 1.90[1.03-3.51] (P=.041), respectively. In contrast, only the Afro-Caribbean origin was associated with type 2 abnormalities using the Refined Criteria: OR[95% CI] 2.67[1.60-4.46] (P<.0001). The Refined Criteria classified more athletes in the type 1 category and fewer in the type 2 category compared with the ESC and Seattle algorithms. Contrary to previous studies, a high dynamic component was not associated with type 2 abnormalities when the Refined Criteria were used; only the Afro-Caribbean origin remained associated. Further research is necessary to better understand adaptations with regard to duration and thus improve the modern criteria for ECG screening in athletes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A three-lead, programmable, and microcontroller-based electrocardiogram generator with frequency domain characteristics of heart rate variability.

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Wei, Ying-Chieh; Wei, Ying-Yu; Chang, Kai-Hsiung; Young, Ming-Shing

2012-04-01

The objective of this study is to design and develop a programmable electrocardiogram (ECG) generator with frequency domain characteristics of heart rate variability (HRV) which can be used to test the efficiency of ECG algorithms and to calibrate and maintain ECG equipment. We simplified and modified the three coupled ordinary differential equations in McSharry's model to a single differential equation to obtain the ECG signal. This system not only allows the signal amplitude, heart rate, QRS-complex slopes, and P- and T-wave position parameters to be adjusted, but can also be used to adjust the very low frequency, low frequency, and high frequency components of HRV frequency domain characteristics. The system can be tuned to function with HRV or not. When the HRV function is on, the average heart rate can be set to a value ranging from 20 to 122 beats per minute (BPM) with an adjustable variation of 1 BPM. When the HRV function is off, the heart rate can be set to a value ranging from 20 to 139 BPM with an adjustable variation of 1 BPM. The amplitude of the ECG signal can be set from 0.0 to 330 mV at a resolution of 0.005 mV. These parameters can be adjusted either via input through a keyboard or through a graphical user interface (GUI) control panel that was developed using LABVIEW. The GUI control panel depicts a preview of the ECG signal such that the user can adjust the parameters to establish a desired ECG morphology. A complete set of parameters can be stored in the flash memory of the system via a USB 2.0 interface. Our system can generate three different types of synthetic ECG signals for testing the efficiency of an ECG algorithm or calibrating and maintaining ECG equipment. © 2012 American Institute of Physics

Detection and assessment of unstable angina using myocardial perfusion imaging: Comparison between technetium-99m sestamibi SPECT and 12-lead electrocardiogram

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Gregoire, J.; Theroux, P.

1990-01-01

Forty-five studies using technetium-99m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) were performed on patients hospitalized for spontaneous chest pain suggestive of myocardial ischemia. The studies were done after an injection during an episode of chest pain and a repeated injection when the patients were free of pain. All patients were hospitalized with a presumed diagnosis of unstable angina, and none had evidence of a previous myocardial infarction. The presence of a perfusion defect observed with Tc-99m sestamibi injected during chest pain had a 96% sensitivity and a 79% specificity for the detection of significant coronary artery disease (stenosis greater than or equal to 50%) on subsequent angiography. When the criterion of a larger perfusion defect during pain compared to absence of pain was used, the sensitivity was 81% and the specificity was 84%. In contrast, transient electrocardiographic ischemic changes during pain had a sensitivity of 35% and a specificity of 68%; electrocardiographic changes during or outside episodes of chest pain had a sensitivity of 65% and a specificity of 63% for the diagnosis. Tc-99m sestamibi SPECT represents a reliable noninvasive diagnostic tool that could aid in the diagnosis of myocardial ischemia in patients with spontaneous chest pain and provide additional information to that provided by the electrocardiogram

Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the CardShock Study.

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Javanainen, Tuija; Tolppanen, Heli; Lassus, Johan; Nieminen, Markku S; Sionis, Alessandro; Spinar, Jindrich; Silva-Cardoso, José; Greve Lindholm, Matias; Banaszewski, Marek; Harjola, Veli-Pekka; Jurkko, Raija

2018-05-30

The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but even up to 20%-50% of CS is caused by other disorders. ST-segment deviations in the electrocardiogram (ECG) have been investigated in patients with ACS-related CS, but not in those with other CS aetiologies. We set out to explore the prevalence of different ST-segment patterns and their associations with the CS aetiology, clinical findings and 90-day mortality. We analysed the baseline ECG of 196 patients who were included in a multinational prospective study of CS. The patients were divided into 3 groups: (a) ST-segment elevation (STE). (b) ST-segment depression (STDEP). (c) No ST-segment deviation or ST-segment impossible to analyse (NSTD). A subgroup analysis of the ACS patients was conducted. ST-segment deviations were present in 80% of the patients: 52% had STE and 29% had STDEP. STE was associated with the ACS aetiology, but one-fourth of the STDEP patients had aetiology other than ACS. The overall 90-day mortality was 41%: in STE 47%, STDEP 36% and NSTD 33%. In the multivariate mortality analysis, only STE predicted mortality (HR 1.74, CI 95 1.07-2.84). In the ACS subgroup, the patients were equally effectively revascularized, and no differences in the survival were noted between the study groups. ST-segment elevation is associated with the ACS aetiology and high mortality in the unselected CS population. If STE is not present, other aetiologies must be considered. When effectively revascularized, the prognosis is similar regardless of the ST-segment pattern in ACS-related CS. © 2018 Wiley Periodicals, Inc.

Preparation and Property Evaluation of Conductive Hydrogel Using Poly (Vinyl Alcohol/Polyethylene Glycol/Graphene Oxide for Human Electrocardiogram Acquisition

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Xueliang Xiao

2017-06-01

Full Text Available Conductive hydrogel combined with Ag/AgCl electrode is widely used in the acquisition of bio-signals. However, the high adhesiveness of current commercial hydrogel causes human skin allergies and pruritus easily after wearing hydrogel for electrodes for a long time. In this paper, a novel conductive hydrogel with good mechanical and conductive performance was prepared using polyvinyl alcohol (PVA, polyethylene glycol (PEG, and graphene oxide (GO nanoparticles. A cyclic freezing–thawing method was employed under processing conditions of −40 °C (8 h and 20 °C (4 h separately for three cycles in sequence until a strong conductive hydrogel, namely, PVA/PEG/GO gel, was obtained. Characterization (Fourier transform infrared spectroscopy, nuclear magnetic resonance, scanning electron microscopy results indicated that the assembled hydrogel was successfully prepared with a three-dimensional network structure and, thereafter, the high strength and elasticity due to the complete polymeric net formed by dense hydrogen bonds in the freezing process. The as-made PVA/PEG/GO hydrogel was then composited with nonwoven fabric for electrocardiogram (ECG electrodes. The ECG acquisition data indicated that the prepared hydrogel has good electro-conductivity and can obtain stable ECG signals for humans in a static state and in motion (with a small amount of drift. A comparison of results indicated that the prepared PVA/PEG/GO gel obtained the same quality of ECG signals with commercial conductive gel with fewer cases of allergies and pruritus in volunteer after six hours of wear.

Diagnostic Accuracy of a New Cardiac Electrical Biomarker for Detection of Electrocardiogram Changes Suggestive of Acute Myocardial Ischemic Injury

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Schreck, David M; Fishberg, Robert D

2014-01-01

Objective A new cardiac “electrical” biomarker (CEB) for detection of 12-lead electrocardiogram (ECG) changes indicative of acute myocardial ischemic injury has been identified. Objective was to test CEB diagnostic accuracy. Methods This is a blinded, observational retrospective case-control, noninferiority study. A total of 508 ECGs obtained from archived digital databases were interpreted by cardiologist and emergency physician (EP) blinded reference standards for presence of acute myocardial ischemic injury. CEB was constructed from three ECG cardiac monitoring leads using nonlinear modeling. Comparative active controls included ST voltage changes (J-point, ST area under curve) and a computerized ECG interpretive algorithm (ECGI). Training set of 141 ECGs identified CEB cutoffs by receiver-operating-characteristic (ROC) analysis. Test set of 367 ECGs was analyzed for validation. Poor-quality ECGs were excluded. Sensitivity, specificity, and negative and positive predictive values were calculated with 95% confidence intervals. Adjudication was performed by consensus. Results CEB demonstrated noninferiority to all active controls by hypothesis testing. CEB adjudication demonstrated 85.3–94.4% sensitivity, 92.5–93.0% specificity, 93.8–98.6% negative predictive value, and 74.6–83.5% positive predictive value. CEB was superior against all active controls in EP analysis, and against ST area under curve and ECGI by cardiologist. Conclusion CEB detects acute myocardial ischemic injury with high diagnostic accuracy. CEB is instantly constructed from three ECG leads on the cardiac monitor and displayed instantly allowing immediate cost-effective identification of patients with acute ischemic injury during cardiac rhythm monitoring. PMID:24118724

Prospective Electrocardiogram-Gated Multidetector Row Computed Tomography Coronary Angiography. Analysis of Quality Image and Radiation Dose

International Nuclear Information System (INIS)

Carrascosa, P.; Capunay, C.; Deviggiano, A.; Tajer, C.D.; Vallejos, J.; Goldsmit, A.; Garcia, M.J.

2009-01-01

Multidetector row computed tomography coronary angiography (MDCT-CA) has become a useful diagnostic tool for the direct quantification of coronary stenosis, for identifying coronary anomalies and for the assessment of coronary artery bypass grafts. Despite its clinical value has been questioned due to the effective radiation dose (ERD) received by each patient, radiation exposure is similar to other studies. However, different strategies are permanently tested in order to reduce the ERD maintaining adequate and diagnostic image quality. Objectives: To determine the image quality and effective radiation dose (ERD) of prospective electrocardiogram-gated multidetector row computed tomography coronary angiography (PMDCTCA) (the x-ray beam is turned on for only a short portion of diastole) compared to retrospective ECG gating (RMDCTCA) (the x-ray beam is turned on throughout the cardiac cycle) and a preliminary approach of its diagnostic accuracy compared to digital invasive coronary angiography (CA). Material and Methods: Fifty consecutive patients with suspected coronary artery disease and sinus rhythm were evaluated with PMDCT-CA and compared to a control group who underwent RMDCTCA. Image quality was analyzed by two reviewers. Interobserver concordance and ERD were determined. The diagnostic accuracy of PMDCT-CA compared to CA to detect coronary artery stenosis > 50% was assessed in 30 patients. Results: There were no significant differences in the image quality between both groups. Agreement between the reviewers for segment image quality scores was k = 0.92. Mean ERD was 3.5 mSv for PMDCT-CA compared to 9.7 and 12.9 mSv for RMDCT-CA with and without tube current modulation, respectively. Individual analysis including all segments showed that the sensitivity, specificity, positive predictive value and negative predictive value of PMDCT-CA for the detection of coronary stenosis were 94.74%, 81.82%, 90% and 90%, respectively. Conclusion: Our initial experience

Addition of the electrocardiogram to the preparticipation examination of college athletes.

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Le, Vy-Van; Wheeler, Matthew T; Mandic, Sandra; Dewey, Frederick; Fonda, Holly; Perez, Marco; Sungar, Gannon; Garza, Daniel; Ashley, Euan A; Matheson, Gordon; Froelicher, Victor

2010-03-01

Although the use of standardized cardiovascular (CV) system-focused history and physical examination is recommended for the preparticipation examination (PPE) of athletes, the addition of the electrocardiogram (ECG) has been controversial. Because the impact of ECG screening on college athletes has rarely been reported, we analyzed the findings of adding the ECG to the PPE of Stanford athletes. For the past 15 years, the Stanford Sports Medicine program has mandated a PPE questionnaire and physical examination by Stanford physicians for participation in intercollegiate athletics. In 2007, computerized ECGs with digital measurements were recorded on athletes and entered into a database. Although the use of standardized CV-focused history and physical examination are recommended for the PPE of athletes, the addition of the ECG has been controversial. Because the feasibility and outcomes of ECG screening on college athletes have rarely been reported, we present findings derived from the addition of the ECG to the PPE of Stanford athletes. For the past 15 years, the Stanford Sports Medicine program has mandated a PPE questionnaire and physical examination by Stanford physicians for participation in intercollegiate athletics. In 2007, computerized ECGs with digital measurements were recorded on athletes and entered into a database. Six hundred fifty-eight recordings were obtained (54% men, 10% African-American, mean age 20 years) representing 24 sports. Although 68% of the women had normal ECGs, only 38% of the men did so. Incomplete right bundle branch block (RBBB) (13%), right axis deviation (RAD) (10%), and atrial abnormalities (3%) were the 3 most common minor abnormalities. Sokolow-Lyon criteria for left ventricular hypertrophy (LVH) were found in 49%; however, only 27% had a Romhilt-Estes score of >or=4. T-wave inversion in V2 to V3 occurred in 7%, and only 5 men had abnormal Q-waves. Sixty-three athletes (10%) were judged to have distinctly abnormal ECG findings

Prevalence of Chagas Disease in a U.S. Population of Latin American Immigrants with Conduction Abnormalities on Electrocardiogram.

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Mahmoud I Traina

2017-01-01

Full Text Available Chagas disease (CD affects over six million people and is a leading cause of cardiomyopathy in Latin America. Given recent migration trends, there is a large population at risk in the United States (US. Early stage cardiac involvement from CD usually presents with conduction abnormalities on electrocardiogram (ECG including right bundle branch block (RBBB, left anterior or posterior fascicular block (LAFB or LPFB, respectively, and rarely, left bundle branch block (LBBB. Identification of disease at this stage may lead to early treatment and potentially delay the progression to impaired systolic function. All ECGs performed in a Los Angeles County hospital and clinic system were screened for the presence of RBBB, LAFB, LPFB, or LBBB. Patients were contacted and enrolled in the study if they had previously resided in Latin America for at least 12 months and had no history of cardiac disease. Enzyme-linked immunosorbent assay (ELISA and immunofluorescence assay (IFA tests were utilized to screen for Trypanosoma cruzi seropositivity. A total of 327 consecutive patients were screened for CD from January 2007 to December 2010. The mean age was 46.3 years and the mean length of stay in the US was 21.2 years. Conduction abnormalities were as follows: RBBB 40.4%, LAFB 40.1%, LPFB 2.8%, LBBB 5.5%, RBBB and LAFB 8.6%, and RBBB and LPFB 2.8%. Seventeen patients were positive by both ELISA and IFA (5.2%. The highest prevalence rate was among those with RBBB and LAFB (17.9%. There is a significant prevalence of CD in Latin American immigrants residing in Los Angeles with conduction abnormalities on ECG. Clinicians should consider evaluating all Latin American immigrant patients with unexplained conduction disease for CD.

Non-invasive prediction of catheter ablation outcome in persistent atrial fibrillation by fibrillatory wave amplitude computation in multiple electrocardiogram leads.

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Zarzoso, Vicente; Latcu, Decebal G; Hidalgo-Muñoz, Antonio R; Meo, Marianna; Meste, Olivier; Popescu, Irina; Saoudi, Nadir

2016-12-01

Catheter ablation (CA) of persistent atrial fibrillation (AF) is challenging, and reported results are capable of improvement. A better patient selection for the procedure could enhance its success rate while avoiding the risks associated with ablation, especially for patients with low odds of favorable outcome. CA outcome can be predicted non-invasively by atrial fibrillatory wave (f-wave) amplitude, but previous works focused mostly on manual measures in single electrocardiogram (ECG) leads only. To assess the long-term prediction ability of f-wave amplitude when computed in multiple ECG leads. Sixty-two patients with persistent AF (52 men; mean age 61.5±10.4years) referred for CA were enrolled. A standard 1-minute 12-lead ECG was acquired before the ablation procedure for each patient. F-wave amplitudes in different ECG leads were computed by a non-invasive signal processing algorithm, and combined into a mutivariate prediction model based on logistic regression. During an average follow-up of 13.9±8.3months, 47 patients had no AF recurrence after ablation. A lead selection approach relying on the Wald index pointed to I, V1, V2 and V5 as the most relevant ECG leads to predict jointly CA outcome using f-wave amplitudes, reaching an area under the curve of 0.854, and improving on single-lead amplitude-based predictors. Analysing the f-wave amplitude in several ECG leads simultaneously can significantly improve CA long-term outcome prediction in persistent AF compared with predictors based on single-lead measures. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Quantitative performance of E-Scribe warehouse in detecting quality issues with digital annotated ECG data from healthy subjects.

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Sarapa, Nenad; Mortara, Justin L; Brown, Barry D; Isola, Lamberto; Badilini, Fabio

2008-05-01

The US Food and Drug Administration recommends submission of digital electrocardiograms in the standard HL7 XML format into the electrocardiogram warehouse to support preapproval review of new drug applications. The Food and Drug Administration scrutinizes electrocardiogram quality by viewing the annotated waveforms and scoring electrocardiogram quality by the warehouse algorithms. Part of the Food and Drug Administration warehouse is commercially available to sponsors as the E-Scribe Warehouse. The authors tested the performance of E-Scribe Warehouse algorithms by quantifying electrocardiogram acquisition quality, adherence to QT annotation protocol, and T-wave signal strength in 2 data sets: "reference" (104 digital electrocardiograms from a phase I study with sotalol in 26 healthy subjects with QT annotations by computer-assisted manual adjustment) and "test" (the same electrocardiograms with an intentionally introduced predefined number of quality issues). The E-Scribe Warehouse correctly detected differences between the 2 sets expected from the number and pattern of errors in the "test" set (except for 1 subject with QT misannotated in different leads of serial electrocardiograms) and confirmed the absence of differences where none was expected. E-Scribe Warehouse scores below the threshold value identified individual electrocardiograms with questionable T-wave signal strength. The E-Scribe Warehouse showed satisfactory performance in detecting electrocardiogram quality issues that may impair reliability of QTc assessment in clinical trials in healthy subjects.

Effect of alectinib on cardiac electrophysiology: results from intensive electrocardiogram monitoring from the pivotal phase II NP28761 and NP28673 studies.

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Morcos, Peter N; Bogman, Katrijn; Hubeaux, Stanislas; Sturm-Pellanda, Carolina; Ruf, Thorsten; Bordogna, Walter; Golding, Sophie; Zeaiter, Ali; Abt, Markus; Balas, Bogdana

2017-03-01

Alectinib, a central nervous system (CNS)-active ALK inhibitor, has demonstrated efficacy and safety in ALK+ non-small-cell lung cancer that has progressed following crizotinib treatment. Other ALK inhibitors have shown concentration-dependent QTc prolongation and treatment-related bradycardia. Therefore, this analysis evaluated alectinib safety in terms of electrophysiologic parameters. Intensive triplicate centrally read electrocardiogram (ECG) and matched pharmacokinetic data were collected across two alectinib single-arm trials. Analysis of QTcF included central tendency analysis [mean changes from baseline with one-sided upper 95% confidence intervals (CIs)], categorical analyses, and relationship between change in QTcF and alectinib plasma concentrations. Alectinib effects on other ECG parameters (heart rate, PR interval and QRS duration) were also evaluated. Alectinib did not cause a clinically relevant change in QTcF. The maximum mean QTcF change from baseline was 5.3 ms observed pre-dose at week 2. The upper one-sided 95% CI was exposure-dependent decrease in mean heart rate of ~11 to 13 beats per minute at week 2. No clinically relevant effects were seen on other ECG parameters. Approximately 5% of patients reported cardiac adverse events of bradycardia or sinus bradycardia; however, these were all grade 1-2. Alectinib does not prolong the QTc interval or cause changes in cardiac function to a clinically relevant extent, with the exception of a decrease in heart rate which was generally asymptomatic.

Evaluation of a Chest Circumference-Adapted Protocol for Low-Dose 128-Slice Coronary CT Angiography with Prospective Electrocardiogram Triggering

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Lu, Chenying; Wang, Zufei; Ji, Jiansong; Wang, Hailin; Hu, Xianghua; Chen, Chunmiao [Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang 323000 (China)

2015-11-01

To assess the effect of chest circumference-adapted scanning protocol on radiation exposure and image quality in patients undergoing prospective electrocardiogram (ECG)-triggered coronary CT angiography (CCTA). One hundred-eighty-five consecutive patients, who had undergone prospective ECG triggering CCTA with a 128-slice CT, were included in the present study. Nipple-level chest circumference, body weight and height were measured before CT examinations. Patients were divided into four groups based on kV/ref·mAs = 100/200, 100/250, 120/200, and 120/250, when patient's chest circumference was ≤ 85.0 (n = 56), 85.0-90.0 (n = 53), 90.0-95.0 (n = 44), and > 95.0 (n = 32), respectively. Image quality per-segment was independently assessed by two experienced observers. Image noise and attenuation were also measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The effective radiation dose was calculated using CT dose volume index and the dose-length product. A significant correlation was observed between patients' chest circumference and body mass index (r = 0.762, p < 0.001). Chest circumference ranged from 74 to 105 cm, and the mean effective radiation dose was 1.9-3.8 mSv. Diagnostic image quality was obtained in 98.5% (2440/2478) of all evaluated coronary segments without any significant differences among the four groups (p = 0.650). No significant difference in image noise was observed among the four groups (p = 0.439), thus supporting the validity of the chest circumference-adapted scanning protocol. However, vessel attenuation, SNR and CNR were significantly higher in the 100 kV groups than in the 120 kV groups (p < 0.05). A measure of chest circumference can be used to adapt tube voltage and current for individualized radiation dose control, with resultant similar image noise and sustained diagnostic image quality.

The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.

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Novotny, Tomas; Bond, Raymond; Andrsova, Irena; Koc, Lumir; Sisakova, Martina; Finlay, Dewar; Guldenring, Daniel; Spinar, Jindrich; Malik, Marek

2017-05-01

Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters. Copyright © 2017 Elsevier B.V. All rights reserved.

Pharmacokinetics of intravenously and orally administered sotalol hydrochloride in horses and effects on surface electrocardiogram and left ventricular systolic function.

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Broux, B; De Clercq, D; Decloedt, A; De Baere, S; Devreese, M; Van Der Vekens, N; Ven, S; Croubels, S; van Loon, G

2016-02-01

Arrhythmias are common in horses. Some, such as frequent atrial or ventricular premature beats, may require long-term anti-arrhythmic therapy. In humans and small animals, sotalol hydrochloride (STL) is often used for chronic oral anti-arrhythmic therapy. STL prolongs repolarization and the effective refractory period in all cardiac tissues. No information on STL pharmacokinetics or pharmacodynamics in horses is available and the aim of this study was to evaluate the pharmacokinetics of intravenously (IV) and orally (PO) administered STL and the effects on surface electrocardiogram and left ventricular systolic function. Six healthy horses were given 1 mg STL/kg bodyweight either IV or PO. Blood samples to determine plasma STL concentrations were taken before and at several time points after STL administration. Electrocardiography and echocardiography were performed at different time points before and after IV STL administration. Mean peak plasma concentrations after IV and PO administration of STL were 1624 ng/mL and 317 ng/mL, respectively. The oral bioavailability was intermediate (48%) with maximal absorption after 0.94 h, a moderate distribution and a mean elimination half-life of 15.24 h. After IV administration, there was a significant increase in QT interval, but no significant changes in other electrocardiographic and echocardiographic parameters. Transient transpiration was observed after IV administration, but no adverse effects were noted after a single oral dose of 1 mg/kg STL in any of the horses. It was concluded that STL has an intermediate oral bioavailability in the horse and might be useful in the treatment of equine arrhythmias. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Integrated Approach Using Chaotic Map & Sample Value Difference Method for Electrocardiogram Steganography and OFDM Based Secured Patient Information Transmission.

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Pandey, Anukul; Saini, Barjinder Singh; Singh, Butta; Sood, Neetu

2017-10-18

This paper presents a patient's confidential data hiding scheme in electrocardiogram (ECG) signal and its subsequent wireless transmission. Patient's confidential data is embedded in ECG (called stego-ECG) using chaotic map and the sample value difference approach. The sample value difference approach effectually hides the patient's confidential data in ECG sample pairs at the predefined locations. The chaotic map generates these predefined locations through the use of selective control parameters. Subsequently, the wireless transmission of the stego-ECG is analyzed using the Orthogonal Frequency Division Multiplexing (OFDM) system in a Rayleigh fading scenario for telemedicine applications. Evaluation of proposed method on all 48 records of MIT-BIH arrhythmia ECG database demonstrates that the embedding does not alter the diagnostic features of cover ECG. The secret data imperceptibility in stego-ECG is evident through the statistical and clinical performance measures. Statistical measures comprise of Percentage Root-mean-square Difference (PRD), Peak Signal to Noise Ratio (PSNR), and Kulback-Leibler Divergence (KL-Div), etc. while clinical metrics includes wavelet Energy Based Diagnostic Distortion (WEDD) and Wavelet based Weighted PRD (WWPRD). The various channel Signal-to-Noise Ratio scenarios are simulated for wireless communication of stego-ECG in OFDM system. The proposed method over all the 48 records of MIT-BIH arrhythmia database resulted in average, PRD = 0.26, PSNR = 55.49, KL-Div = 3.34 × 10 -6 , WEDD = 0.02, and WWPRD = 0.10 with secret data size of 21Kb. Further, a comparative analysis of proposed method and recent existing works was also performed. The results clearly, demonstrated the superiority of proposed method.

Beat-ID: Towards a computationally low-cost single heartbeat biometric identity check system based on electrocardiogram wave morphology

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Paiva, Joana S.; Dias, Duarte

2017-01-01

In recent years, safer and more reliable biometric methods have been developed. Apart from the need for enhanced security, the media and entertainment sectors have also been applying biometrics in the emerging market of user-adaptable objects/systems to make these systems more user-friendly. However, the complexity of some state-of-the-art biometric systems (e.g., iris recognition) or their high false rejection rate (e.g., fingerprint recognition) is neither compatible with the simple hardware architecture required by reduced-size devices nor the new trend of implementing smart objects within the dynamic market of the Internet of Things (IoT). It was recently shown that an individual can be recognized by extracting features from their electrocardiogram (ECG). However, most current ECG-based biometric algorithms are computationally demanding and/or rely on relatively large (several seconds) ECG samples, which are incompatible with the aforementioned application fields. Here, we present a computationally low-cost method (patent pending), including simple mathematical operations, for identifying a person using only three ECG morphology-based characteristics from a single heartbeat. The algorithm was trained/tested using ECG signals of different duration from the Physionet database on more than 60 different training/test datasets. The proposed method achieved maximal averaged accuracy of 97.450% in distinguishing each subject from a ten-subject set and false acceptance and rejection rates (FAR and FRR) of 5.710±1.900% and 3.440±1.980%, respectively, placing Beat-ID in a very competitive position in terms of the FRR/FAR among state-of-the-art methods. Furthermore, the proposed method can identify a person using an average of 1.020 heartbeats. It therefore has FRR/FAR behavior similar to obtaining a fingerprint, yet it is simpler and requires less expensive hardware. This method targets low-computational/energy-cost scenarios, such as tiny wearable devices (e.g., a

A decision support system and rule-based algorithm to augment the human interpretation of the 12-lead electrocardiogram.

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Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Guldenring, Daniel; Badilini, Fabio; Libretti, Guido; Peace, Aaron J; Leslie, Stephen J

The 12-lead Electrocardiogram (ECG) has been used to detect cardiac abnormalities in the same format for more than 70years. However, due to the complex nature of 12-lead ECG interpretation, there is a significant cognitive workload required from the interpreter. This complexity in ECG interpretation often leads to errors in diagnosis and subsequent treatment. We have previously reported on the development of an ECG interpretation support system designed to augment the human interpretation process. This computerised decision support system has been named 'Interactive Progressive based Interpretation' (IPI). In this study, a decision support algorithm was built into the IPI system to suggest potential diagnoses based on the interpreter's annotations of the 12-lead ECG. We hypothesise semi-automatic interpretation using a digital assistant can be an optimal man-machine model for ECG interpretation. To improve interpretation accuracy and reduce missed co-abnormalities. The Differential Diagnoses Algorithm (DDA) was developed using web technologies where diagnostic ECG criteria are defined in an open storage format, Javascript Object Notation (JSON), which is queried using a rule-based reasoning algorithm to suggest diagnoses. To test our hypothesis, a counterbalanced trial was designed where subjects interpreted ECGs using the conventional approach and using the IPI+DDA approach. A total of 375 interpretations were collected. The IPI+DDA approach was shown to improve diagnostic accuracy by 8.7% (although not statistically significant, p-value=0.1852), the IPI+DDA suggested the correct interpretation more often than the human interpreter in 7/10 cases (varying statistical significance). Human interpretation accuracy increased to 70% when seven suggestions were generated. Although results were not found to be statistically significant, we found; 1) our decision support tool increased the number of correct interpretations, 2) the DDA algorithm suggested the correct

Application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization

International Nuclear Information System (INIS)

Klausner, S.C.; Botvinick, E.H.; Shames, D.; Ullyot, D.J.; Fishman, N.H.; Roe, B.B.; Ebert, P.A.; Chatterjee, K.; Parmley, W.W.

1977-01-01

To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electrocardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release

Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch

International Nuclear Information System (INIS)

May, Matthias S.; Kuettner, Axel; Lell, Michael M.; Wuest, Wolfgang; Scharf, Michael; Uder, Michael; Deak, Paul; Kalender, Willi A.; Keller, Andrea K.; Haeberle, Lothar; Achenbach, Stephan; Seltmann, Martin

2012-01-01

To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine. Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation. Estimates for mean relative ED was 7.1 ± 2.1 mSv/100 mAs for TCM and 12.5 ± 5.3 mSv/100 mAs for CTC (P 70 bpm, 29 ± 12%). However lowest ED is achieved at high HR (5.2 ± 1.5 mSv/100 mAs), compared with intermediate (6.7 ± 1.6 mSv/100 mAs) and low (8.3 ± 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied. Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM. circle Monte Carlo simulations allow for individual radiation dose calculations. (orig.)

Cadmium stress assessment based on the electrocardiogram characteristics of zebra fish (Danio rerio): QRS complex could play an important role.

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Xing, Na; Ji, Lizhen; Song, Jie; Ma, Jingchun; Li, Shangge; Ren, Zongming; Xu, Fei; Zhu, Jianping

2017-10-01

The electrocardiogram (ECG) of zebra fish (Danio rerio) expresses cardiac features that are similar to humans. Here we use sharp microelectrode measurements to obtain ECG characteristics in adult zebra fish and analyze the effects of cadmium chloride (CdCl 2 ) on the heart. We observe the overall changes of ECG parameters in different treatments (0.1 TU, 0.5 TU and 1.0 TU CdCl 2 ), including P wave, Q wave, R wave, S wave, T wave, PR interval (atrial contraction), QRS complex (ventricular depolarization), ST segment, and QT interval (ventricular repolarization). The trends of the ECG parameters showed some responses to the concentration and exposure time of CdCl 2 , but it was difficult to obtain more information about the useful indicators in water quality assessment depending on tendency analysis alone. A self-organizing map (SOM) showed that P values, R values, and T values were similar; R wave and T wave amplitude were similar; and most important, QRS value was similar to the CdCl 2 stress according to the classified data patterns including CdCl 2 stress (E) and ECG components based on the Ward linkage. It suggested that the duration of QRS complex was related to environmental stress E directly. The specification and evaluation of ECG parameters in Cd 2+ pollution suggested that there is a markedly significant correlation between QRS complex and CdCl 2 stress with the highest r (0.729) and the smallest p (0.002) among all ECG characteristics. In this case, it is concluded that QRS complex can be used as an indicator in the CdCl 2 stress assessment due to the lowest AIC data abased on the linear regression model between the CdCl 2 stress and ECG parameters. Copyright © 2017 Elsevier B.V. All rights reserved.

Removing ECG Artifact from the Surface EMG Signal Using Adaptive Subtraction Technique

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Abbaspour, S; Fallah, A

2014-01-01

Background: The electrocardiogram artifact is a major contamination in the electromyogram signals when electromyogram signal is recorded from upper trunk muscles and because of that the contaminated electromyogram is not useful. Objective: Removing electrocardiogram contamination from electromyogram signals. Methods: In this paper, the clean electromyogram signal, electrocardiogram artifact and electrocardiogram signal were recorded from leg muscles, the pectoralis major muscle of the left side and V4, respectively. After the pre-processing, contaminated electromyogram signal is simulated with a combination of clean electromyogram and electrocardiogram artifact. Then, contaminated electromyogram is cleaned using adaptive subtraction method. This method contains some steps; (1) QRS detection, (2) formation of electrocardiogram template by averaging the electrocardiogram complexes, (3) using low pass filter to remove undesirable artifacts, (4) subtraction. Results: Performance of our method is evaluated using qualitative criteria, power spectrum density and coherence and quantitative criteria signal to noise ratio, relative error and cross correlation. The result of signal to noise ratio, relative error and cross correlation is equal to 10.493, 0.04 and %97 respectively. Finally, there is a comparison between proposed method and some existing methods. Conclusion: The result indicates that adaptive subtraction method is somewhat effective to remove electrocardiogram artifact from contaminated electromyogram signal and has an acceptable result. PMID:25505766

Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting.

Science.gov (United States)

Desteghe, Lien; Raymaekers, Zina; Lutin, Mark; Vijgen, Johan; Dilling-Boer, Dagmara; Koopman, Pieter; Schurmans, Joris; Vanduynhoven, Philippe; Dendale, Paul; Heidbuchel, Hein

2017-01-01

To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA 2 DS 2 -VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting

Trends in coronary risk factors and electrocardiogram findings from 1977 to 2009 with 10-year mortality in Japanese elderly males - The Tanushimaru Study.

Science.gov (United States)

Nakamura, Sachiko; Adachi, Hisashi; Enomoto, Mika; Fukami, Ako; Kumagai, Eita; Nohara, Yume; Kono, Shoko; Nakao, Erika; Sakaue, Akiko; Tsuru, Tomoko; Morikawa, Nagisa; Fukumoto, Yoshihiro

2017-10-01

An understanding of the trends in regard to coronary risk factors and electrocardiogram (ECG) findings has an important role in public health. We investigated the trends in coronary risk factors and main ECG findings in 1977, 1989, 1999, and 2009 in the Japanese cohort of the Seven Countries Study, in Tanushimaru, a typical farming town on Kyushu Island. A total of 1397 subjects (231 in 1977, 332 in 1989, 389 in 1999, and 445 in 2009) were enrolled in this study, and all of them were males aged over 65 years. In coronary risk factors, total cholesterol levels, diastolic blood pressure, body mass index, and uric acid significantly increased during these 3 decades. The prevalence of smokers markedly decreased from 56.7% in 1977 to 16.8% in 2009. ECG changes during 3 decades were wider QRS interval, increased prevalence of major abnormality, reduced heart rate, shortened PR interval and corrected QT, and decreased prevalence of left ventricular hypertrophy. Age, smoking habits, major and minor abnormalities in ECG were associated with mortality in 1977-1987. Age, total cholesterol levels (inversely) and corrected QT were associated with mortality in 1989-1999. Age, smoking habits, heart rate, and systolic blood pressure were associated with mortality in 1999-2009. Predictors of mortality have changed with the times. Coronary risk factors such as smoking, increased heart rate, and elevated blood pressure have been recently associated with mortalities in elderly male Japanese general population. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch

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May, Matthias S.; Kuettner, Axel; Lell, Michael M.; Wuest, Wolfgang; Scharf, Michael; Uder, Michael [University of Erlangen, Department of Radiology, Erlangen (Germany); Deak, Paul; Kalender, Willi A. [University of Erlangen, Department of Medical Physics, Erlangen (Germany); Keller, Andrea K.; Haeberle, Lothar [University of Erlangen, Department of Medical Informatics, Biometry and Epidemiology, Erlangen (Germany); Achenbach, Stephan; Seltmann, Martin [University of Erlangen, Department of Cardiology, Erlangen (Germany)

2012-03-15

To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine. Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation. Estimates for mean relative ED was 7.1 {+-} 2.1 mSv/100 mAs for TCM and 12.5 {+-} 5.3 mSv/100 mAs for CTC (P < 0.001). Relative dose reduction at low HR ({<=}60 bpm) was highest (49 {+-} 5%) compared to intermediate (60-70 bpm, 33 {+-} 12%) and high HR (>70 bpm, 29 {+-} 12%). However lowest ED is achieved at high HR (5.2 {+-} 1.5 mSv/100 mAs), compared with intermediate (6.7 {+-} 1.6 mSv/100 mAs) and low (8.3 {+-} 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied. Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM. circle Monte Carlo simulations allow for individual radiation dose calculations. (orig.)

Potenciais tardios ao eletrocardiograma de alta resolução no domínio do tempo em portadores de insuficiência cardíaca de diferentes etiologias Time domain analysis of the signal averaged electrocardiogram to detect late potentials in heart failure patients with different etiologies

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Ernani de Sousa Grell

2006-09-01

Full Text Available OBJETIVO: Avaliar freqüência, correlações clínicas e influência prognóstica do potencial tardio no eletrocardiograma de alta resolução, em portadores de insuficiência cardíaca de diferentes etiologias. MÉTODOS: Foi estudado o eletrocardiograma de alta resolução, durante 42 meses, em 288 portadores de insuficiência cardíaca de diferentes etiologias, 215 homens (74,65% e 73 mulheres (25,35, de idades entre 16 e 70 anos (média 51,5, desvio-padrão 11,24. As etiologias da insuficiência cardíaca foram: cardiomiopatia hipertensiva, 78(27,1%; cardiomiopatia dilatada idiopática, 73(25,4%; cardiomiopatia isquêmica, 65(22,6%; cardiomiopatia da doença de Chagas, 42(14,6%; cardiomiopatia alcoólica, 9(3,1%; cardiomiopatia periparto, 6(2,1%; valvopatias em 2(4,2% e miocardite viral, 3(1,04%. Foram avaliadas a duração do QRS Standard, duração do QRS filtrado, duração do sinal abaixo de 40µV e a raiz quadrada nos últimos 40ms quanto a idade, sexo, etiologia, achados do eletrocardiograma de repouso de 12 derivações, do ecocardiograma, do eletrocardiograma de longa duração e mortalidade. Para a análise estatística, foram utilizados os testes: exato de Fisher, t de Student, de Man-Whitney, análise de variância, Log-HanK e o método de Kaplan-Meyer. RESULTADOS: O potencial tardio foi diagnosticado em 90 (31,3% pacientes e não houve correlação com as etiologias. Sua presença associou-se a: menor consumo máximo de oxigênio a cicloergoespirometria (p=0,001; taquicardia ventricular sustentada e não sustentada ao Holter (p=0,001, morte súbita e mortalidade (pOBJECTIVE: To evaluate the frequency, clinical correlations and prognosis influence of late potentials on the of heart failure patients with different etiologies using the signal averaged electrocardiogram. METHODS: A 42 month study of the signal averaged electrocardiograms of 288 heart failure patients with different etiologies was conducted. The group of patients

Screening of young competitive athletes for the prevention of sudden cardiac death with a wireless electrocardiographic transmission device: a pilot study.

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Cho, Jae Hyung; Selen, Mats A; Kocheril, Abraham G

2015-08-11

The 12-lead electrocardiographic screening for the prevention of sudden cardiac death in young competitive athletes is not cost-effective and thus not routinely recommended. We investigate whether a less expensive wireless electrocardiographic transmission device can be used to screen for the prevention of sudden cardiac death in this population. During pre-participation screening, twenty college football players underwent two electrocardiograms: a conventional 12-lead electrocardiogram and a wireless 9-lead electrocardiogram. We compared several electrocardiographic parameters (QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow-Lyon criteria, ST deviation and corrected QT interval) to determine the correlation. The QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow-Lyon criteria and corrected QT interval exhibited significant correlation between the two types of electrocardiograms (correlation coefficient 0.878, 0.630, 0.770 and 0.847, respectively with P values of 0.01, 0.003, 0.01 and 0.01, respectively). ST deviation in V1 was weakly correlated between the two types of electrocardiograms without statistical significance (correlation coefficient 0.360 with a P value of 0.119). Our newly developed wireless 9-lead electrocardiogram demonstrated significant correlations with a conventional 12-lead electrocardiogram in terms of QRS duration, left ventricular hypertrophy and corrected QT interval.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography.

Science.gov (United States)

Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

2017-04-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1year after BPA. Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prospective electrocardiogram-gated axial 64-detector computed tomographic angiography vs retrospective gated helical technique to assess coronary artery bypass graft anastomosis. Comparison of image quality and patient radiation dose

International Nuclear Information System (INIS)

Machida, Haruhiko; Masukawa, Ai; Tanaka, Isao; Fukui, Rika; Suzuki, Kazufumi; Ueno, Eiko; Kodera, Kojiro; Nakano, Kiyoharu; Shen, Y.

2010-01-01

In the present study the effective dose and image quality at distal anastomoses were retrospectively compared between prospective electrocardiogram (ECG)-gated axial and retrospective ECG-gated helical techniques on 64-detector computed tomographic (CT) angiography following coronary artery bypass graft surgery. Following bypass surgery, 52 patients with a heart rate <65 beats/min underwent CT angiography: 26 patients each with prospective and retrospective ECG gating techniques. The effective dose was compared between the 2 groups using a 4-point scale (4, excellent; 1, poor) to grade the quality of curved multiplanar reformation images at distal anastomoses. Patient characteristics of the 2 groups were well matched, and the same CT scan parameters were used for both, except for the interval between surgery and CT examination, tube current, and image noise index. Image quality scores did not differ significantly (3.26±0.95 vs 3.35±0.87; P=0.63), but the effective dose was significantly lower in the prospective (7.3±1.8 mSv) than in the retrospective gating group (23.6±4.5 mSv) (P<0.0001). Following bypass surgery, 64-detector CT angiography using prospective ECG gating is superior to retrospective gating in limiting the radiation dose and maintaining the image quality of distal anastomoses. (author)

Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

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James J McCarthy

2011-05-01

Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Science.gov (United States)

Shiomi, Hiroki; Kosuge, Masami; Morimoto, Takeshi; Watanabe, Hiroki; Taniguchi, Tomohiko; Nakatsuma, Kenji; Toyota, Toshiaki; Yamamoto, Erika; Shizuta, Satoshi; Tada, Tomohisa; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Kazuo; Kimura, Takeshi

2017-07-25

In ST-segment elevation myocardial infarction (STEMI), QRS score at presentation ECG may reflect the progression of infarction and facilitate prediction of the degree of myocardial salvage achieved by reperfusion therapy.Methods and Results:Admission electrocardiogram (ECG) was studied in 2,607 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptom onset. Patients were classified into 3 groups according to QRS score: low (0-3, n=1,227), intermediate (4-7, n=810), and high (≥8, n=570). An increase of infarct size estimated by median peak creatine phosphokinase was observed as QRS score increased (low score, 1,836 IU/L; inter-quartile range (IQR), 979-3,190 IU/L; intermediate score, 2,488 IU/L; IQR, 1,126-4,640 IU/L; high score, 3,454 IU/L; IQR, 1,759-5,639 IU/L; P<0.001). Higher QRS score was associated with higher long-term mortality (low, intermediate, and high score, 15.6%, 19.7%, and 23.7% at 5 years, respectively; log-rank P<0.001). The positive relationship of QRS score with mortality was consistently seen when stratified by infarct location. The association of high QRS score with increased mortality was most remarkably seen in patients with early (≤2 h) presentation (low, intermediate, and high score: 16.7%, 16.6%, and 28.1% at 5 years, respectively; log-rank P<0.001). Higher QRS score at presentation ECG was associated with larger infarct size, and higher long-term mortality in patients with STEMI undergoing primary PCI. QRS score appears to be important in the early risk stratification for STEMI.

The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period.

Science.gov (United States)

Kim, Youn-Jung; Min, Sun-Yang; Lee, Dong Hun; Lee, Byung Kook; Jeung, Kyung Woon; Lee, Hui Jai; Shin, Jonghwan; Ko, Byuk Sung; Ahn, Shin; Nam, Gi-Byoung; Lim, Kyoung Soo; Kim, Won Young

2017-03-13

The authors aimed to evaluate the role of post-resuscitation electrocardiogram (ECG) in patients showing significant ST-segment changes on the initial ECG and to provide useful diagnostic indicators for physicians to determine in which out-of-hospital cardiac arrest (OHCA) patients brain computed tomography (CT) should be performed before emergency coronary angiography. The usefulness of immediate brain CT and ECG for all resuscitated patients with nontraumatic OHCA remains controversial. Between January 2010 and December 2014, 1,088 consecutive adult nontraumatic patients with return of spontaneous circulation who visited the emergency department of 3 tertiary care hospitals were enrolled. After excluding 245 patients with obvious extracardiac causes, 200 patients were finally included. The patients were categorized into 2 groups: those with ST-segment changes with spontaneous subarachnoid hemorrhage (SAH) (n = 50) and those with OHCA of suspected cardiac origin group (n = 150). The combination of 4 ECG characteristics including narrow QRS (<120 ms), atrial fibrillation, prolonged QTc interval (≥460 ms), and ≥4 ST-segment depressions had a 66.0% sensitivity, 80.0% specificity, 52.4% positive predictive value, and 87.6% negative predictive value for predicting SAH. The area under the receiver-operating characteristic curves in the post-resuscitation ECG findings was 0.816 for SAH. SAH was observed in a substantial number of OHCA survivors (25.0%) with significant ST-segment changes on post-resuscitation ECG. Resuscitated patients with narrow QRS complex and any 2 ECG findings of atrial fibrillation, QTc interval prolongation, or ≥4 ST-segment depressions may help identify patients who need brain CT as the next diagnostic work-up. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A comparative study of two techniques (electrocardiogram- and landmark-guided for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery

Directory of Open Access Journals (Sweden)

Neeraj Kumar Barnwal

2016-01-01

Full Text Available Background and Aims: The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG or landmark as guides, for assessing correct depth of central venous catheter (CVC placement. Methods: In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark. After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data. Results: In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001. Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056. Conclusion: Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group.

Analysis of Long-Term Electrocardiographic Data in a Rabbit Model of Heart Failure

National Research Council Canada - National Science Library

Schuckers, Stephanie

2001-01-01

... the electrocardiogram signal, can be captured, processed, quantified and stored, A new experimental model was developed such that the electrocardiogram can be monitored continuously over thirteen weeks, Cardiotoxicity...

Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction.

Science.gov (United States)

Scott, Peter J; Navarro, Cesar; Stevenson, Mike; Murphy, John C; Bennett, Johan R; Owens, Colum; Hamilton, Andrew; Manoharan, Ganesh; Adgey, A A Jennifer

2011-01-01

For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). We analyzed 528 (38% anterior [200], 44% inferior [233], and 18% lateral [95]) patients with STEMI with both a 12-lead ECG and an 80-lead body surface map (BSM) ECG (Prime ECG, Heartscape Technologies, Bangor, Northern Ireland). Body surface map was recorded within 15 minutes of the 12-lead ECG during the acute event and before revascularization. ST-segment elevation of each lead on the BSM was compared with the corresponding 12-lead precordial leads (V(1)-V(6)) for anterior STEMI. In addition, for lateral STEMI, leads I and aVL of the BSM were also compared; and limb leads II, III, aVF of the BSM were compared with inferior unipolar BSM leads for inferior STEMI. Leads with the greatest mean ST-segment elevation were selected, and significance was determined by analysis of variance of the mean ST segment. For anterior STEMI, leads V(1), V(2), 32, 42, 51, and 57 had the greatest mean ST elevation. These leads are located in the same horizontal plane as that of V(1) and V(2). Lead 32 had a significantly greater mean ST elevation than the corresponding precordial lead V(3) (P = .012); and leads 42, 51, and 57 were also significantly greater than corresponding leads V(4), V(5), V(6), respectively (P mean ST-segment elevation; and lead III was significantly superior to the inferior unipolar leads (7, 17, 27, 37, 47, 55, and 61) of the BSM (P optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and

Telecardiology

DEFF Research Database (Denmark)

Sørensen, Jacob Thorsted; Clemmensen, Peter; Sejersten, Maria

2013-01-01

use of transportable electrocardiogram machines as well as implantable devices for arrhythmia monitoring and therapy. The impact of prehospital electrocardiogram recording and interpretation in patients suspected of acute myocardial infarction should not be underestimated. It enables a more widespread...... access to rapid reperfusion therapy, thereby reducing treatment delay, morbidity and mortality. Further, continuous electrocardiogram monitoring has improved arrhythmia diagnosis and dynamic ST-segment changes have been shown to provide important prognostic information in patients with acute ST...

Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

DEFF Research Database (Denmark)

Greve, Anders M; Gerdts, Eva; Boman, Kurt

2011-01-01

Electrocardiograms are routinely obtained in clinical follow-up of patients with asymptomatic aortic stenosis (AS). The association with aortic valve, left ventricular (LV) response to long-term pressure load, and clinical covariates is unclear and the clinical value is thus uncertain. Data from...... clinical examination, electrocardiogram, and echocardiogram in 1,563 patients in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study were used. Electrocardiograms were Minnesota coded for arrhythmias and atrioventricular and intraventricular blocks; LV hypertrophy was assessed by Sokolow...

United in prevention-electrocardiographic screening for chronic obstructive pulmonary disease.

Science.gov (United States)

Lazovic, Biljana; Mazic, Sanja; Stajic, Zoran; Djelic, Marina; Zlatkovic-Svenda, Mirjana; Putnikovic, Biljana

2013-01-01

NONE DECLARED. P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, "Gothic" P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Low-dose prospectively electrocardiogram-gated axial dual-source CT angiography in patients with pulsatile bilateral bidirectional Glenn Shunt: an alternative noninvasive method for postoperative morphological estimation.

Directory of Open Access Journals (Sweden)

Xiaopeng Ji

Full Text Available To explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG as an alternative noninvasive method for postoperative morphological estimation.Twenty patients with pulsatile bBDG (mean age 4.2±1.6 years underwent both low-dose PGA scanning and conventional cardiac angiography (CCA for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC and pulmonary artery (PA, the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland-Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated.The CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P0.The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively.CT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

Energy Technology Data Exchange (ETDEWEB)

Ogo, Takeshi, E-mail: ogo.takeshi.hp@mail.ncvc.go.jp [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Department of Advanced Mediccal Research for Pulmonary Hypertension, National Cerebral and Cardiovascular Centre, Osaka (Japan); Fukuda, Tetsuya [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Sanda, Yoshihiro [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Morita, Yoshiaki [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Asano, Ryotaro; Konagai, Nao [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Yasuda, Satoshi [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan)

2017-04-15

Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

International Nuclear Information System (INIS)

Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

2017-01-01

Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

Multiscale entropy based study of the pathological time series

International Nuclear Information System (INIS)

Wang Jun; Ma Qianli

2008-01-01

This paper studies the multiscale entropy (MSE) of electrocardiogram's ST segment and compares the MSE results of ST segment with that of electrocardiogram in the first time. Electrocardiogram complexity changing characteristics has important clinical significance for early diagnosis. Study shows that the average MSE values and the varying scope fluctuation could be more effective to reveal the heart health status. Particularly the multiscale values varying scope fluctuation is a more sensitive parameter for early heart disease detection and has a clinical diagnostic significance. (general)

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status

International Nuclear Information System (INIS)

Behcet, A.; Zengin, S.; Yildirim, C.; Ercan, S.; Davutoglu, V.

2014-01-01

Objective: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes. Methods: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parameters were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis. Results: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22+-17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parameters of the patients in electrocardiogram were higher (p 0.05). Conclusion: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parameters warrant further study in terms of potential serious arrhythmias in scorpionism. (author)

Artifactual ECG changes induced by electrocautery in a patient with coronary artery disease.

Science.gov (United States)

Naik, B Naveen; Luthra, Ankur; Dwivedi, Ashish; Jafra, Anudeep

Continuous monitoring of 5-lead electrocardiogram is a basic standard of care (included under standard ASA monitor) in the operating room and electrocautery interference is a common phenomenon. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters may provide us clues to differentiate artifacts from true changes on the electrocardiogram. An improved understanding of the artifacts generated by electrocautery and their identifying characteristics is important to avoid misinterpretation, misdiagnosis, and hence mismanagement. This case report highlights the artifacts in electrocardiogram induced by electrocautery. Copyright © 2017 Elsevier Inc. All rights reserved.

Primary prevention of sudden cardiac death of the young athlete: the controversy about the screening electrocardiogram and its innovative artificial intelligence solution.

Science.gov (United States)

Chang, Anthony C

2012-03-01

The preparticipation screening for athlete participation in sports typically entails a comprehensive medical and family history and a complete physical examination. A 12-lead electrocardiogram (ECG) can increase the likelihood of detecting cardiac diagnoses such as hypertrophic cardiomyopathy, but this diagnostic test as part of the screening process has engendered considerable controversy. The pro position is supported by argument that international screening protocols support its use, positive diagnosis has multiple benefits, history and physical examination are inadequate, primary prevention is essential, and the cost effectiveness is justified. Although the aforementioned myriad of justifications for routine ECG screening of young athletes can be persuasive, several valid contentions oppose supporting such a policy, namely, that the sudden death incidence is very (too) low, the ECG screening will be too costly, the false-positive rate is too high, resources will be allocated away from other diseases, and manpower is insufficient for its execution. Clinicians, including pediatric cardiologists, have an understandable proclivity for avoiding this prodigious national endeavor. The controversy, however, should not be focused on whether an inexpensive, noninvasive test such as an ECG should be mandated but should instead be directed at just how these tests for young athletes can be performed in the clinical imbroglio of these disease states (with variable genetic penetrance and phenotypic expression) with concomitant fiscal accountability and logistical expediency in this era of economic restraint. This monumental endeavor in any city or region requires two crucial elements well known to business scholars: implementation and execution. The eventual solution for the screening ECG dilemma requires a truly innovative and systematic approach that will liberate us from inadequate conventional solutions. Artificial intelligence, specifically the process termed "machine

Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program.

Science.gov (United States)

Shavadia, Jay S; French, William; Hellkamp, Anne S; Thomas, Laine; Bates, Eric R; Manoukian, Steven V; Kontos, Michael C; Suter, Robert; Henry, Timothy D; Dauerman, Harold L; Roe, Matthew T

2018-03-01

Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3). Patient-specific time-to-treatment categories were converted to minutes ahead of or behind their group-specific mean; average time-to-treatment difference for all patients at a given hospital was termed comprehensive ECG-to-device time. Hospitals were then stratified into tertiles based on their comprehensive ECG-to-device times with negative values below the mean representing shorter (faster) time intervals. Of 117,857 patients, the proportion in Groups 1, 2, and 3 were 42%, 33%, and 25%, respectively. Lower rates of heart failure and cardiac arrest at presentation are noted within patients presenting to high-performing hospitals. Median comprehensive ECG-to-device time was shortest at -9 minutes (25th, 75th percentiles: -13, -6) for the high-performing hospital tertile, 1 minute (-1, 3) for middle-performing, and 11 minutes (7, 16) for low-performing. Unadjusted rates of in-hospital mortality were 2.3%, 2.6%, and 2.7%, respectively, but the adjusted risk of in-hospital mortality was similar across tertiles. Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

Opportunistic screening for atrial fibrillation in a real-life setting in general practice in Denmark-The Atrial Fibrillation Found On Routine Detection (AFFORD) non-interventional study

DEFF Research Database (Denmark)

Hald, Jonas; Poulsen, Peter Bo; Qvist, Ina

2017-01-01

underwent pulse palpation followed by 12-led electrocardiogram in case of irregular pulse. Two cardiologists validated all electrocardiogram examinations. Forty-nine general practice clinics recruited in total 970 patients split into three age groups; 480 patients (65-74 years), 372 (75-84 years), and 118...... patients ≥85 years of age. Co-morbidities increased by age with hypertension being most frequent. Eighty-seven patients (9%) were detected with an irregular pulse, representing 4.4%, 10.5% and 22.9%, respectively in the three age groups. Assessment of electrocardiograms by the GP showed suspicion of AF...... in 13 patients with final verification of electrocardiograms by cardiologists revealing 10 AF-patients. The highest detection rate of AF was found in the ≥85 age group (3.39%) followed by the 65-74 age group (0.83%) and the 75-84 age group (0.54%). Opportunistic screening of AF in primary care...

United in Prevention–Electrocardiographic Screening for Chronic Obstructive Pulmonary Disease

Science.gov (United States)

Mazic, Sanja; Stajic, Zoran; Djelic, Marina; Zlatkovic-Svenda, Mirjana; Putnikovic, Biljana

2013-01-01

CONFLICT OF INTEREST: NONE DECLARED Introduction P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, “Gothic” P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. Aim We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. Material and method 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. Conclusion Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema. PMID:24058253

Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram.

Science.gov (United States)

Sotomi, Yohei; Okamura, Atsunori; Iwakura, Katsuomi; Date, Motoo; Nagai, Hiroyuki; Yamasaki, Tomohiro; Koyama, Yasushi; Inoue, Koichi; Sakata, Yasushi; Fujii, Kenshi

2017-06-01

The present study aimed to assess the mechanisms of effects of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from two different aspects: left ventricular (LV) systolic function assessed by two-dimensional speckle tracking echocardiography (2D-STE) and electrical stability evaluated by late potential on signal-averaged electrocardiogram (SAECG). We conducted a prospective observational study with consecutive CTO-PCI patients. 2D-STE and SAECG were performed before PCI, and after 1-day and 3-months of procedure. 2D-STE computed global longitudinal strain (GLS) and regional longitudinal strain (RLS) in CTO area, collateral blood-supplying donor artery area, and non-CTO/non-donor area. A total of 37 patients (66 ± 11 years, 78% male) were analyzed. RLS in CTO and donor areas and GLS were significantly improved 1-day after the procedure, but these improvements diminished during 3 months. The improvement of RLS in donor area remained significant after 3-months the index procedure (pre-PCI -13.4 ± 4.8% vs. post-3M -15.1 ± 4.5%, P = 0.034). RLS in non-CTO/non-donor area and LV ejection fraction were not influenced. Mitral annulus velocity was improved at 3-month follow-up (5.0 ± 1.4 vs. 5.6 ± 1.7 cm/s, P = 0.049). Before the procedure, 12 patients (35%) had a late potential. All components of the late potential (filtered QRS duration, root-mean-square voltage in the terminal 40 ms, and duration of the low amplitude signal <40 μV) were not improved. CTO-PCI improved RLS in the donor area at 3-month follow-up without changes of LV ejection fraction. Although higher prevalence of late potential in the current population compared to healthy population was observed, late potential as a surrogate of arrhythmogenic substrate was not influenced by CTO-PCI.

Artifact reduction in maternal abdominal ECG recordings for fetal ECG estimation.

NARCIS (Netherlands)

Vullings, R.; Peters, C.H.L.; Mischi, M.; Sluijter, R.J.; Oei, S.G.; Bergmans, J.W.M.

2010-01-01

Monitoring the fetal electrocardiogram (1ECG) is currently one of the most promising methods to assess fetal health. However, the main problem associated with this method is that the signals recorded from the maternal abdomen are affected by noise and interferences: the maternal electrocardiogram

A multichannel portable ECG system with capacitive sensors

International Nuclear Information System (INIS)

Oehler, M; Schilling, M; Ling, V; Melhorn, K

2008-01-01

Capacitive sensors can be employed for measuring the electrocardiogram of a human heart without electric contact with the skin. This configuration avoids contact problems experienced by conventional electrocardiography. In our studies, we integrated these capacitive electrocardiogram electrodes in a 15-sensor array and combined this array with a tablet personal computer. By placing the system on the patient's body, we can measure a 15-channel electrocardiogram even through clothes and without any preparation. The goal of this development is to provide a new diagnostic tool that offers the user a reproducible, easy access to a fast and spatially resolved diagnostic 'heart view'

A brief review: history to understand fundamentals of electrocardiography

Directory of Open Access Journals (Sweden)

Joseph Lindsay

2012-04-01

Full Text Available The last decade of the 19th century witnessed the rise of a new era in which physicians used technology along with classical history taking and physical examination for the diagnosis of heart disease. The introduction of chest x-rays and the electrocardiograph (electrocardiogram provided objective information about the structure and function of the heart. In the first half of the 20th century, a number of innovative individuals set in motion a fascinating sequence of discoveries and inventions that led to the 12-lead electrocardiogram, as we know it now. Electrocardiography, nowadays, is an essential part of the initial evaluation for patients presenting with cardiac complaints. As a first line diagnostic tool, health care providers at different levels of training and expertise frequently find it imperative to interpret electrocardiograms. It is likely that an understanding of the electrical basis of electrocardiograms would reduce the likelihood of error. An understanding of the disorders behind electrocardiographic phenomena could reduce the need for memorizing what may seem to be an endless list of patterns. In this article, we will review the important steps in the evolution of electrocardiogram. As is the case in most human endeavors, an understanding of history enables one to deal effectively with the present.

Exercise electrocardiogram in middle-aged and older leisure time sportsmen: 100 exercise tests would be enough to identify one silent myocardial ischemia at risk for cardiac event.

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Hupin, David; Edouard, Pascal; Oriol, Mathieu; Laukkanen, Jari; Abraham, Pierre; Doutreleau, Stéphane; Guy, Jean-Michel; Carré, François; Barthélémy, Jean-Claude; Roche, Frédéric; Chatard, Jean-Claude

2018-04-15

The importance of exercise electrocardiogram (ECG) has been controversial in the prevention of cardiac events among sportsmen. The aim of this study was to determine the frequency of silent myocardial ischemia (SMI) from an exercise ECG and its relationship with induced coronary angiographic assessment and potentially preventable cardiac events. This prospective cohort study included leisure time asymptomatic sportsmen over 35years old, referred from 2011 to 2014 in the Sports Medicine Unit of the University Hospital of Saint-Etienne. Of the cohort of 1500 sportsmen (1205 men; mean age 50.7±9.4years; physical activity level 32.8±26.8MET-h/week), 951 (63%) had at least one cardiovascular disease (CVD) risk factor. Family history, medical examination and standard resting 12-lead were collected. A total of 163 exercise ECGs (10.9%) were defined as positive, most of them due to SMI (n=129, 8.6%). SMI was an indication for coronary angiography in 23 cases, leading to 17 documented SMIs (1.1%), including 11 significant stenoses requiring revascularization. In multivariate logistic regression analysis, a high risk of CVD (OR=2.65 [CI 95%: 1.33-5.27], p=0.005) and an age >50years (OR=2.71 [CI 95%: 1.65-4.44], p<0.0001) were independently associated with confirmed SMI. The association of positive exercise ECG with significant coronary stenosis was stronger among sportsmen with CVD risk factors and older than 50years. Screening by exercise ECG can lower the risk of cardiac events in middle-aged and older sportsmen. One hundred tests would be enough to detect one silent myocardial ischemia at risk for cardiac event. Copyright © 2017 Elsevier B.V. All rights reserved.

Investigation of influence of 16-slice spiral CT electrocardiogram-controlled dose modulation on exposure dosage and image quality of cardiac CT imaging under simulated fluctuant heart rate

International Nuclear Information System (INIS)

Yin Yan; Chen Jie; Chai Weiming; Hua Jia; Gao Na; Xu Jianrong; Shen Yun

2008-01-01

Objective: To investigate the influence of electrocardiogram (ECG)-controlled dose modulation on exposure dosage and image quality of cardiac CT imaging in a cardiac phantom with simulated fluctuant heart rate. Methods: The basal heart rate of the cardiac pulsating phantom was set as 60 bpm, the experimental situations were divided as 6 groups according to different heart rates. The cardiac imaging was performed on the cardiac phantom when the ECG-controlled dose modulation was firstly turned off. The exposure dosage of each scan sequence was documented. The standard deviation of the CT values of the phantom was measured on the central slice after coronal reformation of the raw data. The quality of 2D and 3D images were scored. Then cardiac imaging was performed when ECG modulation was on and set as four groups according to different modulation parameters. All the data were documented as before. The results from the five groups with and without ECG modulation current were analyzed by F test and comparative rank sum test using the statistical software SPSS 10.0. Results: Statistical analysis showed no significant difference (P>0.05) between the SNR of images (SD value was 27.78 and 26.30) from the groups that full mA output at wide reconstruction phase (69%-99%) when the heart rate was fluctuant(≥7.5 bpm). There was also no significant difference (P>0.05) between the quality of the 2D and 3D images. But there was a significant difference (P 12.5 bpm, the exposure dosage would increase obviously (from 0.6 to 1.7 mSv). Conclusion: For cardiac imaging with 16-slice row CT, the application of ECG modulated current can effectively reduce the exposure dosage without compromising the image quality even if heart rate was fluctuant. (authors)

Detection of Acute Myocardial Infarction in a Pig Model Using the SAN-Atrial-AVN-His (SAAH) Electrocardiogram (ECG), Model PHS-A10, an Automated and Integrated Signals Recognition System.

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Zhao, Wenjiao; Lu, Guihua; Liu, Li; Sun, Zhishan; Wu, Mingxin; Yi, Wenyan; Chen, Haiyan; Li, Yanhui; Tang, Lilong; Zeng, Jianping

2018-03-04

BACKGROUND The aim of this study was to compare the use of the standard 12-lead electrocardiogram (ECG) with the SAN-Atrial-AVN-His (SAAH) ECG (Model PHS-A10), a new automated and integrated signals recognition system that detects micro-waveforms within the P, QRS, and T-wave, in a pig model of acute myocardial infarction (MI). MATERIAL AND METHODS Six medium-sized domestic Chinese pigs underwent general anesthesia, and an angioplasty balloon was placed and dilated for 120 minutes in the first diagonal coronary artery arising from the left anterior descending (LAD) coronary artery. A standard ECG and a SAAH ECG (Model PHS-A10) were used to evaluate: 1) the number of wavelets in ST-T segment in lead V5; 2) the duration of the repolarization initial (Ri), or duration of the wavelets starting from the J-point to the endpoint of the wavelets in the ST interval; 3) the duration of the repolarization terminal (Rt), of the wavelets, starting from the endpoint of the wavelets in the ST interval to the cross-point of the T-wave and baseline; 4) the ratio Ri: Rt. RESULTS Following coronary artery occlusion, duration of Ri and Ri/Rt increased, and Rt decreased, which was detected by the SAAH ECG (Model PHS-A10) within 12 seconds, compared with standard ECG that detected ST segment depression at 24 seconds following coronary artery occlusion. CONCLUSIONS The findings from this preliminary study in a pig model of acute MI support the need for clinical studies to evaluate the SAAH ECG (Model PHS-A10) for the early detection of acute MI.

Wolff-Parkinson-White Syndrome: Electrocardiogram

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Brianna Miner

2016-09-01

Full Text Available History of present illness: A 26-year-old male with no significant past medical history presented to the emergency department with palpitations. The patient experienced these symptoms five times before in his life, but they had self-resolved with squatting or raising his arms. He denied chest pain, shortness of breath, dizziness, syncope, or pre-syncope symptoms. He denied any recent illnesses, cough, chest pain, drug use, or infections. Significant findings: The initial EKG showed wide complex, irregular tachycardia > 200 bpm (EKG 1. Given the possibility of Wolff-Parkinson-White (WPW, procainamide was given to the patient. The patient’s heart rate responded and decreased to 120-140 bpm with narrowing of the QRS complex. A repeat EKG showed narrow complex tachycardia without P waves approximately 120 bpm (EKG 2. Once the procainamide infusion was complete, the patient had converted to sinus rhythm with a delta wave now apparent, consistent with WPW (EKG 3. Discussion: Wolff-Parkinson-White syndrome is a combination of the presence of a certain congenital accessory pathway (Bundle of Kent and episodes of tachyarrhythmia.1 The incidence is less than one percent of the general population,2 but it is associated with the risk of sudden cardiac death, making the diagnosis imperative. When examining a wide-based tachycardia, it is important to consider WPW when choosing medications for rate control or chemical cardioversion. The first EKG shows an example of atrial fibrillation with WPW. While procainamide blocks the accessory pathway, other drugs such as beta blockers and calcium channel blockers can inhibit the AV node resulting in increased use of the accessory pathway. This can worsen the tachyarrhythmia and potentially lead to ventricular fibrillation, ventricular tachycardia, or asystole.

Problems in Recording the Electrocardiogram.

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Webster, John G.

The unwanted signals that arise in electrocardiography are discussed. A technical background of electrocardiography is given, along with teaching techniques that educate students of medical instrumentation to solve the problems caused by these signals. (MJH)

Computers in Cardiology.

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Feldman, Charles L.

The utilization of computers in the interpretation of electrocardiograms (EKG's) and vectorcardiograms is the subject of this report. A basic introduction into the operations of the electrocardiograms and vectorcardiograms is provided via an illustrated text. A historical development of the EKG starts with the 1950's with the first attempts to use…

Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium.

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Vandael, Eline; Vandenberk, Bert; Vandenberghe, Joris; Spriet, Isabel; Willems, Rik; Foulon, Veerle

2016-04-01

Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. Management of the risk of QTc-prolongation. Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.

[Successful transcatheter ablation of fascicular potential in pediatric patients with left posterior fascicular tachycardia].

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Zeng, Shao-ying; Shi, Ji-jun; Li, Hong; Zhang, Zhi-wei; Li, Yu-fen

2010-08-01

To simplify the methods of transcatheter mapping and ablation in the pediatric patients with left posterior fascicular tachycardia. While in sinus rhythm, the fascicular potential can be mapped at the posterior septal region (1 - 2 cm below inferior margin of orifice of coronary sinus vein), which display a biphasic wave before ventricular wave, and exist equipotential lines between them. When the fascicular potential occurs 20 ms later than the bundle of His' potential, radiofrequency was applied. Before applying radiofrequency, catheter position must be observed using double angle viewing (LAO 45°RAO 30°), and it should be made sure that the catheter is not at His' bundle. If the electrocardiogram displays left posterior fascicular block, the correct region is identified and ablation can continue for 60 s. Electrocardiogram monitoring should continue for 24 - 48 hours after operation, and notice abnormal repolarization after termination of ventricular tachycardia. Aspirin [2 - 3 mg/(kg·d)] was used for 3 months, and antiarrhythmic drug was discontinued. Surface electrocardiogram, chest X-ray and ultrasound cardiography were rechecked 1 d after operation. Follow-up was made at 1 month and 3 months post-discharge. Recheck was made half-yearly or follow-up was done by phone from then on. Fifteen pediatric patients were ablated successfully, and their electrocardiograms all displayed left posterior fascicular block after ablation. None of the patients had recurrences during the 3 to 12 months follow-up period. In one case, the electrocardiogram did not change after applying radiofrequency ablation and the ventricular tachycardia remained; however, on second attempt after remapping, the electrocardiogram did change. The radiofrequency lasted for 90 seconds and ablation was successful. This case had no recurrences at 6 months follow-up. Transcatheter ablation of the fascicular potential in pediatric patients with left posterior fascicular tachycardia can simplify

Avaliando a atividade vagal cardíaca na eletrocardiografia convencional Evaluating cardiac vagal activity on a conventional electrocardiogram

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Flávia P. Teixeira

2007-04-01

Full Text Available OBJETIVO: Determinar a viabilidade da utilização de traçado convencional de eletrocardiografia (ECG para avaliação da atividade vagal cardíaca (AVC. MÉTODOS: Foram analisados, retrospectivamente, 1.395 indivíduos (995 homens, na faixa de idade de 46 + 17,2 anos (média ± desvio padrão, com traçados de ECG convencional para medida do Delta RR, que representa a diferença, em ms, entre o maior e o menor intervalo RR, e com resultados da avaliação autonômica parassimpática, o teste de exercício de quatro segundos (T4s, que quantifica a AVC por meio do índice vagal cardíaco (IVC. Foram obtidas curvas ROC para determinar os valores de Delta RR com melhor relação entre sensibilidade e especificidade para os pontos de corte de baixa e alta AVC, respectivamente, de 1,20 e 1,95. RESULTADOS: Os valores de delta RR correlacionaram-se significativamente com os de IVC (r = 0,40; p 120 ms como os melhores pontos de corte para baixa e alta AVC, com sensibilidade de 75% e 57%, especificidade de 62% e 79% e áreas das curvas ROC de 0,76 e 0,74, respectivamente. CONCLUSÃO: A medida visual do delta RR em um traçado de ECG parece ser válida para a avaliação clínica preliminar e rápida da AVC, podendo ser útil em consultórios, emergências ou situações nas quais o uso de métodos mais sofisticados de avaliação autonômica não seja viável, oportuno ou conveniente.OBJECTIVE: To determine the viability of using a conventional electrocardiogram (ECG tracing for assessment of CVA. METHODS: We retrospectively analyzed 1395 individuals (995 males, aged 46 ± 17.2 years (mean ± standard deviation with conventional ECG tracings to measure the delta RR (which represents the difference in milliseconds (ms between the greatest and smallest RR interval and results of a second autonomic parasympathetic evaluation, the 4-second exercise test (T4s, that quantifies CVA by the cardiac vagal index (CVI. ROC curves were obtained to determine the

Myocardial perfusion assessed by contrast echocardiography and single photon emission computed tomography in the evaluation of patients with acute chest pain and normal electrocardiogram

International Nuclear Information System (INIS)

Soares, J. Jr.; Ferreira, S.M.A.; Matias, W. Jr.; Giorgi, M.C.P.; Izaki, M.; Luz, P.L.; Ramires, J.A.F.; Meneghetti, J.C.

2002-01-01

Aim : Evaluation of diagnostic accuracy of myocardial contrast echocardiography (MCE) in comparison with single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia in patients with acute chest pain. Material and Methods : Eighteen patients (pts) with chest pain lasting ≥30 minutes, occurring within 6 hours of emergency room presentation and a normal or no diagnostic electrocardiogram were studied. Pts underwent rest MCE and SPECT. For both exams myocardial perfusion was assessed in the same 7 segments (apical, anterior, inferior, anteroseptal, inferoseptal, lateral and posterior) of left ventricle. A total of 126 segments were analyzed. Images were classified as positive for ischemia if they had a perfusion defect. Coronary angiography was performed if MCE or SPECT images were classified as positive for ischemia or by clinical indication. Otherwise the patients underwent stress SPECT. Significant coronary artery disease (CAD) was defined as ≥70% stenosis in a major coronary artery or its branches. Final diagnosis of an acute coronary event (ACE) was established in the presence of positive findings in MCE or SPECT in addition to significant CAD in the corresponding territory. Kappa statistics were calculated to evaluate the concordance between MCE and SPECT. κ values of ≤0.4, >0.4 and >0.7 indicate fair, good and excellent agreement, respectively. Results: Thirteen out of 18 pts underwent coronary angiography (seven pts had positive findings on SPECT, 2 on MCE, 2 on both exams and 1 had clinical indication). Significant CAD was detected on six. Five pts underwent stress SPECT and no perfusion defect was detected. Therefore, six pts (33.3%) had an ACE and 12 (66.6%) had not. There were no statistical differences between groups according to age, gender, duration of pain, free pain interval, presence of risk factors and antecedents. Concordance between MCE and SPECT for evaluation of perfusion defects showed a ? coefficient of 0

Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain

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Linde, Jesper J; Hove, Jens D; Sørgaard, Mathias

2015-01-01

. BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS: Patients with acute chest pain but normal electrocardiograms and troponin values were randomized...... to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint...... electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000)....

Online or face-to-face instruction? A qualitative study on the electrocardiogram course at the University of Ulm to examine why students choose a particular format.

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Keis, Oliver; Grab, Claudia; Schneider, Achim; Öchsner, Wolfgang

2017-11-09

Since the introduction of the e-learning electrocardiogram (ECG) course 'ECG Online' into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other. In a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course. Interestingly, the very factors associated with e-learning - and always praised as advantages of it - are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date) was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction. Even though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students' needs could be better met if measures were included to strengthen extrinsic and intrinsic motivation and formats were favoured that enable students to have a minimum level

Alterações contráteis segmentares e sua associação com arritmias ventriculares complexas, em pacientes chagásicos com eletrocardiograma normal ou borderline Regional left ventricular dysfunction and its association with complex ventricular arrhythmia, in chagasic patients with normal or borderline electrocardiogram

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Flavia Vernin de Oliveira Terzi

2010-10-01

Full Text Available INTRODUÇÃO: Morte súbita representa a principal causa de óbito em chagásicos. Eventos fatais em pacientes saudáveis, com anormalidades contráteis, foram documentados. O objetivo deste trabalho é determinar a associação entre alteração contrátil e arritmias ventriculares complexas em pacientes chagásicos, classe funcional I, eletrocardiograma normal ou borderline e função ventricular preservada. MÉTODOS: Quarenta e nove pacientes com doença de Chagas e eletrocardiograma normal ou borderline realizaram ecocardiograma, teste ergométrico e Holter. Avaliou-se a contratilidade global e segmentar dos ventrículos e a presença de arritmias ventriculares complexas induzidas no esforço e espontâneas, respectivamente. A análise estatística foi feita pelo modelo Log-Linear geral. RESULTADOS: Idade média de 56 anos; 55% mulheres. Alterações contráteis segmentares em 24,5% dos pacientes; 12% dos Holter e 18% dos testes ergométricos positivos. Houve associação entre arritmia e alteração segmentar condicionada à presença da disfunção sistólica leve do ventrículo esquerdo. CONCLUSÕES: Alterações contráteis, na presença de disfunção global leve, indicam pacientes sob maior risco de arritmias complexas.INTRODUCTION: Sudden death is the major cause of death among chagasic patients. A significant number of fatal events in patients without apparent heart disease and borderline electrocardiogram, but with contractile ventricular dysfunction, have been documented. This work aimed to determine the association between regional dysfunction and the presence of ventricular arrhythmia in chagasic patients without apparent heart disease. METHODS: Forty-nine patients with normal or borderline electrocardiogram were submitted to echocardiogram, exercise stress test and Holter. The presence of cardiac contractile alterations and complex ventricular arrhythmia was analyzed. Statistic analysis used the general Log-Linear model. RESULTS

J-shaped association between QTc interval duration and the risk of atrial fibrillation

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Nielsen, Jonas Bille; Graff, Claus; Pietersen, Adrian

2013-01-01

The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF).......The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF)....

Thallium-201 scintigraphy in diagnosis of coronary stenosis

International Nuclear Information System (INIS)

Corne, R.A.; Gotsman, M.S.; Weiss, A.; Enlander, D.; Samuels, L.D.; Salomon, J.A.; Warshaw, B.; Atlan, H.

1979-01-01

The sensitivity of rest and exercise thallium-201 scintigraphy for the detection of significant coronary artery disease and myocardial ischaemia was compared with rest and exercise electrocardiography in 46 patients with chest pain. Of 26 patients with greater that 70 per cent coronary stenosis, 16 had abnormal rest thallium-201 scintigrams and 13 had Q waves. Myocardial perfusion defects in the resting scintigram correlated very well with evidence of previous myocardial infarction (16 of 17 patients, 94%) significant Q waves were present in 13 of these 17 patients (76%). After exercise, abnormal thallium-201 scintigrams consistent with ischaemia were found in 21 patients (81%). Abnormal exercise electrocardiograms were present in 15 patients (58%). The combination of abnormal exercise thallium-201 scintigrams or exercise electrocardiograms (23/26, 88%) exceeded abnormal exercise electrocardiograms alone (15/26, 58%). The two procedures were thus complementary. Abnormal rest or exercise thallium-201 scintigrams were obtained in 25/26 patients (96%) compared with abnormal rest or exercise electrocardiograms in 21/26 patients (84%). Twenty patients with less than 50 per cent coronary stenosis had normal rest thallium-201 scintigrams and no Q waves. Two had abnormal exercise thallium-201 scintigrams and 7 had abnormal exercise electrocardiograms. Thus,exercise thallium scintigraphy has higher sensitivity than exercise electrocardiography in detecting exercise induced ischaemia and is more specific. Scintigraphy appears to have a higher sensitivity than electrocardiography in detecting coronary artery disease. (author)

Temporally resolved electrocardiogram-triggered diffusion-weighted imaging of the human kidney: correlation between intravoxel incoherent motion parameters and renal blood flow at different time points of the cardiac cycle.

Science.gov (United States)

Wittsack, Hans-Jörg; Lanzman, Rotem S; Quentin, Michael; Kuhlemann, Julia; Klasen, Janina; Pentang, Gael; Riegger, Caroline; Antoch, Gerald; Blondin, Dirk

2012-04-01

To evaluate the influence of pulsatile blood flow on apparent diffusion coefficients (ADC) and the fraction of pseudodiffusion (F(P)) in the human kidney. The kidneys of 6 healthy volunteers were examined by a 3-T magnetic resonance scanner. Electrocardiogram (ECG)-gated and respiratory-triggered diffusion-weighted imaging (DWI) and phase-contrast flow measurements were performed. Flow imaging of renal arteries was carried out to quantify the dependence of renal blood flow on the cardiac cycle. ECG-triggered DWI was acquired in the coronal plane with 16 b values in the range of 0 s/mm(2) and 750 s/mm(2) at the time of minimum (MIN) (20 milliseconds after R wave) and maximum renal blood flow (MAX) (197 ± 24 milliseconds after R wave). The diffusion coefficients were calculated using the monoexponential approach as well as the biexponential intravoxel incoherent motion model and correlated to phase-contrast flow measurements. Flow imaging showed pulsatile renal blood flow depending on the cardiac cycle. The mean flow velocity at MIN was 45 cm/s as compared with 61 cm/s at MAX. F(p) at MIN (0.29) was significantly lower than at MAX (0.40) (P = 0.001). Similarly, ADC(mono), derived from the monoexponential model, also showed a significant difference (P renal blood flow and F(p) (r = 0.85) as well as ADC(mono) (r = 0.67) was statistically significant. Temporally resolved ECG-gated DWI enables for the determination of the diffusion coefficients at different time points of the cardiac cycle. ADC(mono) and FP vary significantly among acquisitions at minimum (diastole) and maximum (systole) renal blood flow. Temporally resolved ECG-gated DWI might therefore serve as a novel technique for the assessment of pulsatility in the human kidney.

Gated single photon emission computer tomography for the detection of silent myocardial ischemia

International Nuclear Information System (INIS)

Pena Q, Yamile; Coca P, Marco Antonio; Batista C, Juan Felipe; Fernandez-Britto, Jose; Quesada P, Rodobaldo; Pena C; Andria

2009-01-01

Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Material and methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60 ± 8 years without cardiovascular symptoms. All subjects were also subjected to a coronary angiography, whose results were used as gold standard. Results: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity, accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT. There was a good agreement between the results of gated-SPECT and coronary angiography (k =0.873). Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia

Dispersion durations of P-wave and QT interval in children treated with a ketogenic diet.

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Doksöz, Önder; Güzel, Orkide; Yılmaz, Ünsal; Işgüder, Rana; Çeleğen, Kübra; Meşe, Timur

2014-04-01

Limited data are available on the effects of a ketogenic diet on dispersion duration of P-wave and QT-interval measures in children. We searched for the changes in these measures with serial electrocardiograms in patients treated with a ketogenic diet. Twenty-five drug-resistant patients with epilepsy treated with a ketogenic diet were enrolled in this study. Electrocardiography was performed in all patients before the beginning and at the sixth month after implementation of the ketogenic diet. Heart rate, maximum and minimum P-wave duration, P-wave dispersion, and maximum and minimum corrected QT interval and QT dispersion were manually measured from the 12-lead surface electrocardiogram. Minimum and maximum corrected QT and QT dispersion measurements showed nonsignificant increase at month 6 compared with baseline values. Other previously mentioned electrocardiogram parameters also showed no significant changes. A ketogenic diet of 6 months' duration has no significant effect on electrocardiogram parameters in children. Further studies with larger samples and longer duration of follow-up are needed to clarify the effects of ketogenic diet on P-wave dispersion and corrected QT and QT dispersion. Copyright © 2014 Elsevier Inc. All rights reserved.

Evaluation of proportional health impairment due to occupationally related myocardial infarction

International Nuclear Information System (INIS)

Szozda, R.; Schneiberg, P.

1995-01-01

The authors propose the principles how to calculate a proportional health impairment due to myocardial infarction. The proposals are based on own experience, literature and regulations. It is suggested that the following should be taken into account for the calculation purposes: case history, resting electrocardiogram, postexercise electrocardiogram, results of Holter's examination, chest X-ray including evaluation of the heart silhouette and UCG. (author). 8 refs, 3 tabs

Hyperthyroidism with dome-and-dart T wave: A case report: A care-compliant article.

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Lai, Ping; Yuan, Jing-Ling; Xue, Jin-Hua; Qiu, Yue-Qun

2017-02-01

Dome-and-dart T waves (or bifid T waves) are a rare phenomenon in the surface electrocardiogram. These wave forms are mainly observed in patients with congenital heart disease such as atrial septal defect and ventricular septal defect. And hyperthyroidism who presented with an electrocardiogram that had dome-and-dart T waves in a precordial lead is never been reported. The patient presented with continuous tachycardia, palpitations, chest tightness, and headache for 4 days, and aggravated for 1 day. Hyperthyroidism. Methimazole. All symptoms were alleviated. Dome-and-dart or bifid T waves have been reported in the conventional 12-lead electrocardiograms in some patients with congenital heart disease. The case illustrated here, to the best of our knowledge, dome-and-dart or bifid T waves may associate with hyperthyroidism patients.

Online or face-to-face instruction? A qualitative study on the electrocardiogram course at the University of Ulm to examine why students choose a particular format

Directory of Open Access Journals (Sweden)

Oliver Keis

2017-11-01

Full Text Available Abstract Background Since the introduction of the e-learning electrocardiogram (ECG course ‘ECG Online’ into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other. Methods In a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course. Results Interestingly, the very factors associated with e-learning – and always praised as advantages of it – are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction. Conclusions Even though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students’ needs could be better met if measures were included to strengthen extrinsic and intrinsic

Electrocardiography may be a useful tool in the diagnosis of early mild canine heartworm disease

Directory of Open Access Journals (Sweden)

Edward M. Onyango

2011-01-01

Full Text Available This study was carried out to determine the usefulness of standard electrocardiography for the diagnosis of early canine heartworm disease. Baseline electrocardiograms were recorded in 12 dogs. Thirty artificial Dirofilaria immitis worms were inserted in the pulmonary artery of each dog. New electrocardiograms were recorded on days 1-4, 7, 14, 21, 28 and 35 after insertion of worms. A significant attenuation of amplitude of Q wave in lead I was recorded on days 1-4, 7, 14, 21, 28 and 35; of R wave in lead II on days 21, 28 and 35; and of S wave in lead aVR on days 7, 14, 21, 28 and 35. Duration of the QRS complex in lead AVF was significantly prolonged on day 14. In 41.6% of the dogs, right axis deviation was recorded. These results suggest that for a dog whose normal baseline standard electrocardiogram is known, a comparison of the QRS complex of the baseline with those of subsequent standard electrocardiograms may suggest early canine heartworm disease when there is an attenuation of amplitude of Q wave in lead I, R wave in lead II and S wave in lead aVR. An additional indication can be right axis deviation.

Hyperthyroidism with dome-and-dart T wave: A case report

Science.gov (United States)

Lai, Ping; Yuan, Jing-ling; Xue, Jin-hua; Qiu, Yue-qun

2017-01-01

Abstract Rationale: Dome-and-dart T waves (or bifid T waves) are a rare phenomenon in the surface electrocardiogram. These wave forms are mainly observed in patients with congenital heart disease such as atrial septal defect and ventricular septal defect. And hyperthyroidism who presented with an electrocardiogram that had dome-and-dart T waves in a precordial lead is never been reported. Patient concerns: The patient presented with continuous tachycardia, palpitations, chest tightness, and headache for 4 days, and aggravated for 1 day. Diagnoses: Hyperthyroidism. Interventions: Methimazole. Outcomes: All symptoms were alleviated. Lessons: Dome-and-dart or bifid T waves have been reported in the conventional 12-lead electrocardiograms in some patients with congenital heart disease. The case illustrated here, to the best of our knowledge, dome-and-dart or bifid T waves may associate with hyperthyroidism patients. PMID:28178156

Electrocardiogram classification using delay differential equations.

Science.gov (United States)

Lainscsek, Claudia; Sejnowski, Terrence J

2013-06-01

Time series analysis with nonlinear delay differential equations (DDEs) reveals nonlinear as well as spectral properties of the underlying dynamical system. Here, global DDE models were used to analyze 5 min data segments of electrocardiographic (ECG) recordings in order to capture distinguishing features for different heart conditions such as normal heart beat, congestive heart failure, and atrial fibrillation. The number of terms and delays in the model as well as the order of nonlinearity of the model have to be selected that are the most discriminative. The DDE model form that best separates the three classes of data was chosen by exhaustive search up to third order polynomials. Such an approach can provide deep insight into the nature of the data since linear terms of a DDE correspond to the main time-scales in the signal and the nonlinear terms in the DDE are related to nonlinear couplings between the harmonic signal parts. The DDEs were able to detect atrial fibrillation with an accuracy of 72%, congestive heart failure with an accuracy of 88%, and normal heart beat with an accuracy of 97% from 5 min of ECG, a much shorter time interval than required to achieve comparable performance with other methods.

Multiscale permutation entropy analysis of electrocardiogram

Science.gov (United States)

Liu, Tiebing; Yao, Wenpo; Wu, Min; Shi, Zhaorong; Wang, Jun; Ning, Xinbao

2017-04-01

To make a comprehensive nonlinear analysis to ECG, multiscale permutation entropy (MPE) was applied to ECG characteristics extraction to make a comprehensive nonlinear analysis of ECG. Three kinds of ECG from PhysioNet database, congestive heart failure (CHF) patients, healthy young and elderly subjects, are applied in this paper. We set embedding dimension to 4 and adjust scale factor from 2 to 100 with a step size of 2, and compare MPE with multiscale entropy (MSE). As increase of scale factor, MPE complexity of the three ECG signals are showing first-decrease and last-increase trends. When scale factor is between 10 and 32, complexities of the three ECG had biggest difference, entropy of the elderly is 0.146 less than the CHF patients and 0.025 larger than the healthy young in average, in line with normal physiological characteristics. Test results showed that MPE can effectively apply in ECG nonlinear analysis, and can effectively distinguish different ECG signals.

Impact of electrocardiogram-gated multi-slice computed tomography-based aortic annular measurement in the evaluation of paravalvular leakage following transcatheter aortic valve replacement: the efficacy of the OverSized AortiC Annular ratio (OSACA ratio) in TAVR.

Science.gov (United States)

Maeda, Koichi; Kuratani, Toru; Torikai, Kei; Shimamura, Kazuo; Mizote, Isamu; Ichibori, Yasuhiro; Takeda, Yasuharu; Daimon, Takashi; Nakatani, Satoshi; Nanto, Shinsuke; Sawa, Yoshiki

2013-07-01

Even mild paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is associated with increased late mortality. Electrocardiogram-gated multi-slice computed tomography (MSCT) enables detailed aortic annulus assessment. We describe the impact of MSCT for PVL following TAVR. Congruence between the prosthesis and annulus diameters affects PVL; therefore, we calculated the OverSized AortiC Annular ratio (OSACA ratio) and OSACA (transesophageal echocardiography, TEE) ratio as prosthesis diameter/annulus diameter on MSCT or TEE, respectively, and compared their relationship with PVL ≤ trace following TAVR. Of 36 consecutive patients undergoing TAVR (Group A), the occurrence of PVL ≤ trace (33.3%) was significantly related to the OSACA ratio (p = 0.00020). In receiver-operating characteristics analysis, the cutoff value of 1.03 for the OSACA ratio had the highest sum of sensitivity (75.0%) and specificity (91.7%; AUC = 0.87) with significantly higher discriminatory performance for PVL as compared to the OSACA (TEE) ratio (AUC = 0.69, p = 0.028). In nine consecutive patients (Group B) undergoing TAVR based on guidelines formulated from our experience with Group A, PVL ≤ trace was significantly more frequent (88.9%) than that in Group A (p = 0.0060). The OSACA ratio has a significantly higher discriminatory performance for PVL ≤ trace than the OSACA (TEE) ratio, and aortic annular measurement from MSCT is more accurate than that from TEE. © 2013 Wiley Periodicals, Inc.

ФОРМИРОВАНИЕ И АНАЛИЗ СИГНАЛОВ ЭКГ С ПАТОЛОГИЯМИ

OpenAIRE

Аhadzhanian, A. R.; Loza, K. I.; Narimanova, O. V.

2017-01-01

Context. The work is devoted to the actual problem of the generation of electrocardiogram signals with distortions corresponding to thedifferent pathologies. These signals can be used as a standard for developing new and verification of existing methods for biomedical signals analyzing aimed at the diagnosis of heart diseases.Objective. The aim of this work is the formation of electrocardiogram signals with the known types of distortions corresponding to thecommon pathologies. The formation o...

Chronic valvular disease: correlation between clinical, electrocardiographic, radiographic and echocardiographic aspects in dogs

International Nuclear Information System (INIS)

Soares, E.C.; Larsson, M.H.M.A.; Yamato, R.J.

2005-01-01

Echocardiographic aspects of chronic mitral valvular disease were studied and compared to physical, radiographic and electrocardiographic aspects. Seventy dogs were used, and clinical examination, thoracic radiography, electrocardiogram and echocardiogram were performed. Correlations between regurgitation severity with cardiac failure functional class and murmur intensity were observed. The electrocardiogram showed a low sensibility in detecting cardiac chamber enlargement, caused by mitral regurgitation. All the dogs with severe mitral regurgitation showed cardiomegaly according to thoracic radiographies

Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

Science.gov (United States)

Brunetti, Natale Daniele; Di Pietro, Gaetano; Aquilino, Ambrogio; Bruno, Angela I; Dellegrottaglie, Giulia; Di Giuseppe, Giuseppe; Lopriore, Claudio; De Gennaro, Luisa; Lanzone, Saverio; Caldarola, Pasquale; Antonelli, Gianfranco; Di Biase, Matteo

2014-09-01

We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon primary-PCI). Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas. © The European Society of Cardiology 2014.

Natural history of disease in atomic bomb exposed twins in Hiroshima

International Nuclear Information System (INIS)

Satow, Yukio; Ohmae, Kiyokazu; Okamoto, Naomasa; Abe, Tsutomu; Watanabe, Shoji

1982-01-01

The subjects of this study are mainly pairs of monozygotic twins, one of whom was exposed to the atomic bomb and the other not exposed, and the natural history of the diseases of these twins was analyzed to find out genetic and environmental factors of the diseases and some biological effect of the atomic bomb exposure or other. In this study, 13 pairs of monozygotic and 5 pairs of dizygotic twins and other 34 cases of non-twins were examined by means of heart and lung X-ray films and electrocardiograms. The results suggest that most of the monozygotic twins show the similar findings of chest X-ray films, though their electrocardiograms have a tendency to deviate to the left in the QRS axis. These findings will not be enough to clear up the relation between the atomic bomb exposed and the abnormal electrocardiograms. (author)

Exercise thallium-201 scintigraphy and prognosis in typical angina pectoris and negative exercise electrocardiography

International Nuclear Information System (INIS)

Bairey, C.N.; Rozanski, A.; Maddahi, J.; Resser, K.J.; Berman, D.S.

1989-01-01

Patients with a history of typical angina but negative exercise electrocardiography represent a subgroup with an intermediate likelihood of having coronary artery disease and future cardiac events. A retrospective study of the prognostic utility of stress-redistribution thallium-201 scintigraphy was performed in 190 such patients. A second group of 203 patients with typical angina and a positive exercise electrocardiogram were analyzed for comparative scintigraphic purposes. The cardiac event rate for the 144 negative exercise electrocardiogram patients with normal thallium results was 5 vs 15% in the 46 patients with abnormal thallium results (p = 0.01). These patients were further stratified into high (14 to 18%), intermediate (9%) and low (less than 2%) risk groups for future cardiac events based on combining the thallium results with the percentage of maximal predicted heart rate achieved. A multivariate analysis revealed that an abnormal thallium result was the only significant correlate of future cardiac events. Mechanisms responsible for the discordant finding of a negative exercise electrocardiogram in patients with typical angina include (1) false-positive angina symptomatology in low prevalence coronary artery disease groups in whom the thallium test is negative, and (2) electrocardiographically silent ischemia in patients in whom the thallium test is positive. These findings reveal that thallium stress-redistribution scintigraphy can be used to stratify 1-year prognosis in this subgroup of patients with typical angina and negative exercise electrocardiograms

Gas exchange during exercise in different evolutional stages of chronic Chagas' heart disease

Directory of Open Access Journals (Sweden)

Fátima Palha de Oliveira

2000-12-01

Full Text Available OBJECTIVE: To compare gas exchange at rest and during exercise in patients with chronic Chagas' heart disease grouped according to the Los Andes clinical/hemodynamic classification. METHODS: We studied 15 healthy volunteers and 52 patients grouped according to the Los Andes clinical/hemodynamic classification as follows: 17 patients in group IA (normal electrocardiogram/echocardiogram, 9 patients in group IB (normal electrocardiogram and abnormal echocardiogram, 14 patients in group II (abnormal electrocardiogram/echocardiogram, without congestive heart failure, and 12 patients in group III (abnormal electrocardiogram/echocardiogram with congestive heart failure. The following variables were analyzed: oxygen consumption (V O2, carbon dioxide production (V CO2, gas exchange rate (R, inspiratory current volume (V IC, expiratory current volume (V EC, respiratory frequency, minute volume (V E, heart rate (HR, maximum load, O2 pulse, and ventilatory anaerobic threshold (AT. RESULTS: When compared with the healthy group, patients in groups II and III showed significant changes in the following variables: V O2peak, V CO2peak, V ICpeak, V ECpeak, E, HR, and maximum load. Group IA showed significantly better results for these same variables as compared with group III. CONCLUSION: The functional capacity of patients in the initial phase of chronic Chagas' heart disease is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance.

Gas exchange during exercise in different evolutional stages of chronic Chagas' heart disease.

Science.gov (United States)

Oliveira, F P; Pedrosa, R C; Giannella-Neto, A

2000-12-01

To compare gas exchange at rest and during exercise in patients with chronic Chagas' heart disease grouped according to the Los Andes clinical hemodynamic classification. We studied 15 healthy volunteers and 52 patients grouped according to the Los Andes clinical and hemodynamic classification as follows: 17 patients in group IA (normal electrocardiogram and echocardiogram), 9 patients in group IB (normal electrocardiogram and abnormal echocardiogram), 14 patients in group II (abnormal electrocardiogram and echocardiogram, without congestive heart failure), and 12 patients in group III (abnormal electrocardiogram and echocardiogram with congestive heart failure). The following variables were analyzed: oxygen consumption (V O2), carbon dioxide production (V CO2), gas exchange rate (R), inspiratory current volume (V IC), expiratory current volume (V EC), respiratory frequency, minute volume (V E), heart rate (HR), maximum load, O2 pulse, and ventilatory anaerobic threshold (AT). When compared with the healthy group, patients in groups II and III showed significant changes in the following variables: V O2 peak, V CO2 peak, V IC peak, V EC peak, E, HR, and maximum load. Group IA showed significantly better results for these same variables as compared with group III. The functional capacity of patients in the initial phase of chronic Chagas' heart disease is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance.

Incidencia de eventos vasculares mayores después de cirugía no cardiaca: impacto del monitoreo perioperatorio con troponina y electrocardiograma Incidence of major vascular events after cardiac surgery: impact of preoperative monitoring with troponin and electrocardiogram

Directory of Open Access Journals (Sweden)

Sandra M Quiroga

2009-06-01

led to an increased risk of major vascular events among patients undergoing non-cardiac surgery. Troponin and electrocardiogram monitoring would further identify these major vascular events. Methods: we prospectively collected data on elegible patients (non-selected individuals aged 45 or older undergoing non-cardiac surgery under general or regional anesthesia in two hospitals in Bucaramanga, with expected length of stay longer than 24 hours during a time-interrupted series, before and after postoperative diagnostic monitoring (blinded assessment of troponin T and electrocardiograms ignoring clinical data. For the period before the intervention (usual clinical care, two independent reviewers extracted clinical information from clinical histories (of all eligible patients from 3 randomly-selected months of 2005. For the period after diagnostic monitoring, we followed 100 consecutive eligible patients. Primary outcome was a composite of major vascular events within hospital, including myocardial infarction (defined as any troponin elevation associated with electrocardiographic changes suggesting ischemia, regardless of symptoms. Results: we included 534 clinical charts and 100 prospective surgical patients (mean age 62.2, SD 12.9 years; 56% women. The more frequent surgical procedures were orthopedics (26.8% followed by abdominal (20.2%. The incidence of major vascular events recorded in clinical charts was 2.8%, compared with 7% among monitored patients (p=0,071. All four myocardial infarctions identified among the later group were silent. Conclusion: postoperative monitoring with troponin and electrocardiography identified a higher proportion of major vascular events, mainly silent myocardial infarctions.

Clinical usefulness of multidetector-row CT to evaluate coronary artery calcium score in type 2 diabetes

International Nuclear Information System (INIS)

Nishioka, Makiko; Sakuma, Toru; Sano, Hironari; Utsunomiya, Kazunori; Agata, Toshihiko; Shimizu, Keisuke; Tajima, Naoko

2004-01-01

According to recent studies, multidetector-row CT (MDCT) with a retrospective electrocardiogram (ECG)-gating reconstruction algorithm shows a high correlation with coronary artery calcium score determined using electron-beam CT. Diabetes leads to many macrovascular complications, including coronary artery disease. The aim of this study was to evaluate risk factors for cardiac macroangiopathy in type 2 diabetes using MDCT. An observational cross-sectional study was performed in 90 patients with diabetes mellitus. Coronary calcium data was acquired by MDCT (SOMATOM Volume Zoom, Siemens AG, Medical Solutions, Germany). Physical examinations, laboratory data, glycemic control, and control of other risk factors were analyzed. The coronary artery calcium score increased with age. Multivariant analysis revealed that the coronary calcium score was closely correlated with electrocardiogram evaluation and control of hypertension. Coronary artery calcium score as determined by MDCT can be used as a screening radiological examination for cardiac macroangiopathy in diabetes patients with electrocardiogram abnormality and hypertension. (author)

Thallium-201 exercise myocardial imaging to evaluate myocardial perfusion after coronary artery bypass surgery

International Nuclear Information System (INIS)

Hirzel, H.O.; Nuesch, K.; Sialer, G.; Horst, W.; Krayenbuehl, H.P.

1980-01-01

To assess the usefulness of thallium-201 exercise scintigraphy in evaluating myocardial perfusion after coronary artery bypass surgery, imaging was performed after submaximal bicycle ergometry and at rest in 54 patients before and within 24 +- 10 (SD) weeks after operation. Scintigraphy identified 8 out of 20 patients who were symptom free after operation and showed normal exercise electrocardiograms as still having exercise-induced ischaemia and thus as having not truly benefited from the surgical intervention. In contrast, improvement in perfusion was documented in 17 out of 31 patients despite further complaints of chest pain and persistence of a pathological exercise electrocardiogram in 6 of them. Bypass graft patency rate paralleled the scintigraphic findings in the 35 patients who were restudied arteriographically. It was concluded that thallium-201 exercise scintigraphy is a useful technique to document changes in regional perfusion after surgery and is definitely superior to the clinical evaluation of patients including the exercise electrocardiogram. (author)

Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema

Directory of Open Access Journals (Sweden)

Budi Yuli Setianto

2017-04-01

Full Text Available Current guidelines for the management of patients with acute coronary syndromes (ACSs focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI or non-ST-elevation acute myocardial infarction (NSTEMI/unstable angina (UA. Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the ‘sine qua non’ for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.

Coronary spasm: 201Tl scintiscanning following pharmacological provocation

International Nuclear Information System (INIS)

Montz, R.; Mathey, D.; Bleifeld, W.; Hamburg Univ.

1981-01-01

According to the authors' experience so far, 201 Tl myocardial scintiscanning is a sufficiently sensitive non-invasive method for detection of coronary vasospasm provoked by ergotamine administration. Mild incomplete and asymptotic forms of coronary vasospasm were detected by scintiscanning. Indications for myocardial scintiscanning of ergotamine-provoked vasospasm are: Cases of angina pectoris at rest in which electrocardiograms during spasm are not available; elleviated symptoms after nitroglycerine administration; exercise electrocardiograms without any sign of ischaemia; negative results of exercise 201 Tl myocardial scintiscanning. (orig.) [de

The use of non-invasive fetal electrocardiography in diagnosing second-degree fetal atrioventricular block.

Science.gov (United States)

Lakhno, Igor; Behar, Joachim A; Oster, Julien; Shulgin, Vyacheslav; Ostras, Oleksii; Andreotti, Fernando

2017-01-01

Complete atrioventricular block in fetuses is known to be mostly associated with autoimmune disease and can be irreversible if no steroids treatment is provided. Conventional methods used in clinical practice for diagnosing fetal arrhythmia are limited since they do not reflect the primary electrophysiological conduction processes that take place in the myocardium. The non-invasive fetal electrocardiogram has the potential to better support fetal arrhythmias diagnosis through the continuous analysis of the beat to beat variation of the fetal heart rate and morphological analysis of the PQRST complex. We present two retrospective case reports on which atrioventricular block diagnosis could have been supported by the non-invasive fetal electrocardiogram. The two cases comprised a 22-year-old pregnant woman with the gestational age of 31 weeks and a 25-year-old pregnant woman with the gestational age of 41 weeks. Both women were admitted to the Department of Maternal and Fetal Medicine at the Kyiv and Kharkiv municipal perinatal clinics. Patients were observed using standard fetal monitoring methods as well as the non-invasive fetal electrocardiogram. The non-invasive fetal electrocardiographic recordings were analyzed retrospectively, where it is possible to identify the presence of the atrioventricular block. This study demonstrates, for the first time, the feasibility of the non-invasive fetal electrocardiogram as a supplementary method to diagnose of the fetal atrioventricular block. Combined with current fetal monitoring techniques, non-invasive fetal electrocardiography could support clinical decisions.

Overset Wolff-Parkinson-White-syndrom

DEFF Research Database (Denmark)

Nielsen, Trine Skov; Dalager, Søren; Larsen, Maiken Kudahl

2010-01-01

An autopsy in a 28-year-old man did not explain the cause of sudden unexpected death. However, a history of episodes with tachycardia and dizziness and a reassessed previous electrocardiogram exhibiting ventricular pre-excitation was consistent with Wolff-Parkinson-White (WPW) syndrome. In this p......An autopsy in a 28-year-old man did not explain the cause of sudden unexpected death. However, a history of episodes with tachycardia and dizziness and a reassessed previous electrocardiogram exhibiting ventricular pre-excitation was consistent with Wolff-Parkinson-White (WPW) syndrome...

ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.

Science.gov (United States)

Fernández Fernández, Juan; Deliz-Guzmán, Claudia; Andino-Colón, César; Claudio-Hernández, Héctor; Lugo-Amador, Nannette

2016-01-01

Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

Scanning protocol of dual-source computed tomography for aortic dissection

International Nuclear Information System (INIS)

Zhai Mingchun; Wang Yongmei

2013-01-01

Objective: To find a dual-source CT scanning protocol which can obtain high image quality with low radiation dose for diagnosis of aortic dissection. Methods: Total 120 patients with suspected aortic dissection were randomly and equally assigned into three groups. Patients in Croup A were performed CTA exam with prospectively electrocardiogram- gated high pitch spiral mode (FLASH). Patients in Croup B were performed CTA exam with retrospective electrocardiogram- gated spiral mode. Patients in Croup C were performed CTA exam with conventional mode which no electrocardiogram-gated. The image quality, radiation dose, advantages and disadvantages among the three scan protocol were analyzed. Results: For image quality, seventeen, twenty two and one patients in group A were granted to grade 1, 2, 3 respectively, and none was in grade 4; thirty three and seven patients in group B were granted to grade 1, 2, respectively, and none was in grade 3 and 4; fourteen and twenty six patients in group C were granted to grade 3, 4, respectively, and none was in grade 1 and 2. There was no significant difference between group A and B in image quality. Compared with the image quality, Group A and B were significantly higher than Group C. Mean effective radiation dose of Croup A, B and C were 7.7±0.4 mSv, 33.11±3.38 mSv, and 7.6±0.68 mSv, respectively. Group B was significantly higher than Groups A and C (P<0.05, P<0.05, respectively), and there was no significant difference between Group A and C (P=0.826). Conclusions: Prospectively electrocardiogram-gated high pitch spiral mode can be the first line protocol for evaluation of aortic dissection. It can achieve high image quality with low radiation dose. Conventional mode with no electrocardiogram-gated can be selectively used for Stanford B aortic dissection. (authors)

Knowledge and Utilization of Electrocardiogram among Resident ...

African Journals Online (AJOL)

2017-10-26

Oct 26, 2017 ... knowledge and utilization of ECG among family medicine residents in Nigeria. Materials and ... doctors regarding their ECG requests, preferred source of interpretation, most common ECG ..... There are no conflicts of interest.

Non-invasive fetal electrocardiogram : analysis and interpretation

NARCIS (Netherlands)

Vullings, R.

2010-01-01

High-risk pregnancies are becoming more and more prevalent because of the progressively higher age at which women get pregnant. Nowadays about twenty percent of all pregnancies are complicated to some degree, for instance because of preterm delivery, fetal oxygen deficiency, fetal growth

ECG (Electrocardiogram) Interpretation Training Program - Reference Manual

Science.gov (United States)

1984-05-08

begins to the start of the Q, or R if the Q is absent. Table #1 Rate Below 70 71-90 91-110 111-130 Above 130 Small adults 0.21 0.20 0.19 0.18...children. In adults they may indicate pericarditis. A sharply pointed T wave may be indicative of a myocardial infarct. T waves are normally 5mm. or...A longer than normal QT may indicate congestive heart failure, MI, hypocalcemia , or toxicity from quinidine,procaine amide, or phenothiazines

Knowledge and Utilization of Electrocardiogram among Resident ...

African Journals Online (AJOL)

2017-10-26

Oct 26, 2017 ... The impact of cardiovascular disease (CVD) on global disease burden ... from CVDs, with CVD projected to remain the single leading cause of death.[4] Over 80% of ..... burden of disease from 2002 to 2030. PLoS Med 2006 ...

THE ELECTROCARDIOGRAM IN CHRONIC BRONCmTIS AND ...

African Journals Online (AJOL)

1971-02-20

Feb 20, 1971 ... block, and the degree of clockwise rotation. The position of T wave inversion in the chest leads was noted. The. ECG findings for P wave axis and shape and QRS axis were .mbdivided, using the criteria of Spodick et al.' Single-peaked P waves were termed P pulmonale (ampli- tude >0'24 mY) or Gothic P ...

Fast Electrocardiogram Amplifier Recovery after Defibrillation Shock

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Ivan Dotsinsky

2005-04-01

Full Text Available A procedure for fast ECG amplifier recovery after defibrillation shocks was developed and simulated in the MATLAB environment. Exponentially decaying post-shock voltages have been recorded. Signals from the AHA database are taken and mixed with the recorded exponential disturbances. The algorithm applies moving averaging (comb filter on the compound input signal, thereby obtaining the samples of the disturbance. They are currently subtracted from the input signal. The results obtained show that its recovery is practically instantaneous.

THE ELECTROCARDIOGRAM IN CHRONIC BRONCmTIS AND ...

African Journals Online (AJOL)

1971-02-20

Feb 20, 1971 ... diseases, including bronchiectasis and pneumoconiosis, though the majority of cases have been diagnosed as chronic bronchitis and emphysema. Some articles included various lung function tests, but these usually provided evidence of airway obstruction and we could find no paper in which the degree ...

Implanted telemeter for electrocardiogram and body temperature

Science.gov (United States)

Barrows, W. F.

1972-01-01

Measuring system requiring one blocking oscillator to generate modulated pulse repetition rate is implantable in the bodies of small animals. Device has life of two years and transmission range of about three feet. EKG sensing unit also is used to sense electromyogram or electrooculogram of laboratory animals.

Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

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Singh Amarpal

2009-01-01

Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

Long QT in children with congenital deafness: a brief report

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Naseraldin Akbari Asbagh

2013-08-01

Full Text Available Background: Long QT syndromes (LQT are genetic abnormalities of ventricular repo-larization, with an estimated incidence of about one per 10000 births. It is characterized by prolongation of the QT interval in electrocardiogram (EKG and associated with a high risk for syncope and sudden death in patients. Type of this syndrome is association with congenital deafness. Our objective was to evaluate QT interval in children with congenital deafness.Methods: For 219 patients referred to Imam Khomeini Hospital audiometric clinic in 2011, questionnaire were completed. A total of 23 congenitally deaf children were incl-uded. All patients’ examinations were done by a pediatric cardiologist. Electrocardio-gram is conducted in all children (23 patients with sever and deep congenital deafness. Then the QT interval was measured based on Bazett’s formula. Echocardiography was also performed in these children to assess left ventricular function and the presence of mitral valve prolapse.Results: The overall patients were two hundred and nineteen children. A total of twenty three congenitally deaf children were included and electrocardiogram was obtained. Three children had obviously prolonged QTc (0.48±0.02 second. The median age of them was 6.1±5 year, the median weight was 18±11.3 kilogram and the median of QT interval was 0.48±0.02 second.Conclusion: The QT interval obtained 0.48±0.02 second. In the present study we found prolonged QT in congenital deafness, thus we recommend to evaluate the electrocardio-gram of children with congenital deafness.

Applying NISHIJIN historical textile technique for e-Textile.

Science.gov (United States)

Kuroda, Tomohiro; Hirano, Kikuo; Sugimura, Kazushige; Adachi, Satoshi; Igarashi, Hidetsugu; Ueshima, Kazuo; Nakamura, Hideo; Nambu, Masayuki; Doi, Takahiro

2013-01-01

The e-Textile is the key technology for continuous ambient health monitoring to increase quality of life of patients with chronic diseases. The authors introduce techniques of Japanese historical textile, NISHIJIN, which illustrate almost any pattern from one continuous yarn within the machine weaving process, which is suitable for mixed flow production. Thus, NISHIJIN is suitable for e-Textile production, which requires rapid prototyping and mass production of very complicated patterns. The authors prototyped and evaluated a few vests to take twelve-lead electrocardiogram. The result tells that the prototypes obtains electrocardiogram, which is good enough for diagnosis.

Complete atrioventricular block following radiation therapy for malignant thymoma

International Nuclear Information System (INIS)

Nakao, Takeshi; Kanaya, Honin; Namura, Masanobu; Ohsato, Kazuo; Araki, Tsutomu; Ohka, Takio; Sugihara, Norihiko; Takeda, Ryoyu.

1990-01-01

Complete atrioventricular block following radiation is very rare. We present a case which developed after radiation therapy for malignant thymoma. The etiology of conduction disturbances due to radiation is unknown. In our case, serial electrocardiograms showed stepwise progression of the conduction disturbance, and his bundle electrocardiograms revealed new prolongation of the H-V interval. Endomyocardial biopsy specimens demonstrated occlusion in small arteries and diffuse degenerative changes in the myocardium. We therefore attributed the complete atrioventricular block in our patient to secondary damage to the conduction system, caused by radiation-induced occlusive changes in the small arteries supplying the conduction system. (author)

Lyme carditis mimicking giant cell arteritis

Directory of Open Access Journals (Sweden)

Krati Chauhan

2015-10-01

Full Text Available Presenting an interesting case of a patient who complained of myalgias, fatigue, headache, jaw claudication and scalp tenderness. Patient’s physical examination was unremarkable. Laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein, bilateral temporal artery biopsy results were negative and first degree atrioventricular block was seen on electrocardiogram. Serology for Borrelia burgdorferi was positive; patient was diagnosed with Lyme carditis and treated with doxycycline. Lyme is a tick-borne, multi-system disease and occasionally its presentation may mimic giant cell arteritis. On follow-up there was complete resolution of symptoms and electrocardiogram findings.

Children: General Health

Science.gov (United States)

... Constipation Coughing Cystic Fibrosis (CF) Chloride Sweat Test ECG (Electrocardiogram) EEG (Electroencephalogram) EMG (Electromyogram) Febrile Seizures Giving Opioid Prescription Pain Medicine: ...

Relationship between Fibrosis and Ventricular Arrhythmias in Chagas Heart Disease Without Ventricular Dysfunction

Energy Technology Data Exchange (ETDEWEB)

Tassi, Eduardo Marinho, E-mail: etassi@ibest.com.br [Instituto de Cardiologia Edson Saad - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Continentino, Marcelo Abramoff [Hospital Frei Galvão, Guaratinguetá, SP (Brazil); Nascimento, Emília Matos do; Pereira, Basílio de Bragança [Instituto de Cardiologia Edson Saad - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Coppe - Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia - UFRJ, Rio de Janeiro, RJ (Brazil); Pedrosa, Roberto Coury [Instituto de Cardiologia Edson Saad - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil)

2014-05-15

Patients with Chagas disease and segmental wall motion abnormality (SWMA) have worse prognosis independent of left ventricular ejection fraction (LVEF). Cardiac magnetic resonance (CMR) is currently the best method to detect SWMA and to assess fibrosis. To quantify fibrosis by using late gadolinium enhancement CMR in patients with Chagas disease and preserved or minimally impaired ventricular function (> 45%), and to detect patterns of dependence between fibrosis, SWMA and LVEF in the presence of ventricular arrhythmia. Electrocardiogram, treadmill exercise test, Holter and CMR were carried out in 61 patients, who were divided into three groups as follows: (1) normal electrocardiogram and CMR without SWMA; (2) abnormal electrocardiogram and CMR without SWMA; (3) CMR with SWMA independently of electrocardiogram. The number of patients with ventricular arrhythmia in relation to the total of patients, the percentage of fibrosis, and the LVEF were, respectively: Group 1, 4/26, 0.74% and 74.34%; Group 2, 4/16, 3.96% and 68.5%; and Group 3, 11/19, 14.07% and 55.59%. Ventricular arrhythmia was found in 31.1% of the patients. Those with and without ventricular arrhythmia had mean LVEF of 59.87% and 70.18%, respectively, and fibrosis percentage of 11.03% and 3.01%, respectively. Of the variables SWMA, groups, age, LVEF and fibrosis, only the latter was significant for the presence of ventricular arrhythmia, with a cutoff point of 11.78% for fibrosis mass (p < 0.001). Even in patients with Chagas disease and preserved or minimally impaired ventricular function, electrical instability can be present. Regarding the presence of ventricular arrhythmia, fibrosis is the most important variable, its amount being proportional to the complexity of the groups.

Relationship between Fibrosis and Ventricular Arrhythmias in Chagas Heart Disease Without Ventricular Dysfunction

International Nuclear Information System (INIS)

Tassi, Eduardo Marinho; Continentino, Marcelo Abramoff; Nascimento, Emília Matos do; Pereira, Basílio de Bragança; Pedrosa, Roberto Coury

2014-01-01

Patients with Chagas disease and segmental wall motion abnormality (SWMA) have worse prognosis independent of left ventricular ejection fraction (LVEF). Cardiac magnetic resonance (CMR) is currently the best method to detect SWMA and to assess fibrosis. To quantify fibrosis by using late gadolinium enhancement CMR in patients with Chagas disease and preserved or minimally impaired ventricular function (> 45%), and to detect patterns of dependence between fibrosis, SWMA and LVEF in the presence of ventricular arrhythmia. Electrocardiogram, treadmill exercise test, Holter and CMR were carried out in 61 patients, who were divided into three groups as follows: (1) normal electrocardiogram and CMR without SWMA; (2) abnormal electrocardiogram and CMR without SWMA; (3) CMR with SWMA independently of electrocardiogram. The number of patients with ventricular arrhythmia in relation to the total of patients, the percentage of fibrosis, and the LVEF were, respectively: Group 1, 4/26, 0.74% and 74.34%; Group 2, 4/16, 3.96% and 68.5%; and Group 3, 11/19, 14.07% and 55.59%. Ventricular arrhythmia was found in 31.1% of the patients. Those with and without ventricular arrhythmia had mean LVEF of 59.87% and 70.18%, respectively, and fibrosis percentage of 11.03% and 3.01%, respectively. Of the variables SWMA, groups, age, LVEF and fibrosis, only the latter was significant for the presence of ventricular arrhythmia, with a cutoff point of 11.78% for fibrosis mass (p < 0.001). Even in patients with Chagas disease and preserved or minimally impaired ventricular function, electrical instability can be present. Regarding the presence of ventricular arrhythmia, fibrosis is the most important variable, its amount being proportional to the complexity of the groups

Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

Science.gov (United States)

Fabris, Enrico; van 't Hof, Arnoud; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens F; Goodman, Shaun G; Ten Berg, Jurriën M; Bolognese, Leonardo; Cequier, Angel; Chettibi, Mohamed; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Merkely, Béla; Storey, Robert F; Zeymer, Uwe; Cantor, Warren J; Tsatsaris, Anne; Kerneis, Mathieu; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles

2017-08-01

In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; pST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; pST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

201Tl myocard scintigraphy - a specialized non-invasive method in evaluating myocardial function

International Nuclear Information System (INIS)

Birke, S.; Deckart, H.; Mischke, W.; Schulz, J.; Koblitz, E.

1985-01-01

In 216 patients with ischemic heart disease (IHK) or with angina pectoris symptoms and suspected IHK the results of resting electrocardiograms were compared with those of 201 Tl scintigraphy under conditions of rest and exercise, resp. 201 Tl scintigraphy proved to be superior in sensitivity and specifity to the electrocardiograms of rest and under exercise as to the detection of coronary heart disease, the localization and assessment of the severity of coronary heart disease, and the evidence of load ischemia. Conclusions are drawn for a program of consecutive diagnostic steps in suspected IHK as well as for the evaluation of myocardial function in known IHK. (author)

Improved symptoms, physical limitation, and self-efficacy after resynchronization in a patient with heart failure and a prolonged QRS duration.

Science.gov (United States)

Conaway, Darcy G; Sullivan, Robbie; McCullough, Peter A

2004-01-01

This report examines the impact of resynchronization therapy in a patient with class IV heart failure and a prolonged QRS duration on electrocardiogram. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the patient's health status prior to, immediately after, and 2 months after placement of a biventricular pacemaker. B-type natriuretic peptide (BNP) values and electrocardiogram QRS duration were recorded to further document clinical status. Our patient experienced statistically significant improvements in 7 of 10 KCCQ domains after resynchronization. QRS duration narrowed following the procedure and BNP values decreased. Resynchronization therapy improved this patient's symptoms, physical limitations, and self-efficacy when maximal medical therapy failed.

A Novel Technique for Fetal ECG Extraction Using Single-Channel Abdominal Recording

Directory of Open Access Journals (Sweden)

Nannan Zhang

2017-02-01

Full Text Available Non-invasive fetal electrocardiograms (FECGs are an alternative method to standard means of fetal monitoring which permit long-term continual monitoring. However, in abdominal recording, the FECG amplitude is weak in the temporal domain and overlaps with the maternal electrocardiogram (MECG in the spectral domain. Research in the area of non-invasive separations of FECG from abdominal electrocardiograms (AECGs is in its infancy and several studies are currently focusing on this area. An adaptive noise canceller (ANC is commonly used for cancelling interference in cases where the reference signal only correlates with an interference signal, and not with a signal of interest. However, results from some existing studies suggest that propagation of electrocardiogram (ECG signals from the maternal heart to the abdomen is nonlinear, hence the adaptive filter approach may fail if the thoracic and abdominal MECG lack strict waveform similarity. In this study, singular value decomposition (SVD and smooth window (SW techniques are combined to build a reference signal in an ANC. This is to avoid the limitation that thoracic MECGs recorded separately must be similar to abdominal MECGs in waveform. Validation of the proposed method with r01 and r07 signals from a public dataset, and a self-recorded private dataset showed that the proposed method achieved F1 scores of 99.61%, 99.28% and 98.58%, respectively for the detection of fetal QRS. Compared with four other single-channel methods, the proposed method also achieved higher accuracy values of 99.22%, 98.57% and 97.21%, respectively. The findings from this study suggest that the proposed method could potentially aid accurate extraction of FECG from MECG recordings in both clinical and commercial applications.

Extraction of fetal electrocardiogram (ECG) by extended state ...

Indian Academy of Sciences (India)

of fetus and so, an early diagnosis of any cardiac defect before delivery ... By using low noise electronic amplifiers with high common mode rejection ratio, .... One possible ANFIS architecture to implement these two rules is shown in figure 4.

Electrocardiogram de-noising based on forward wavelet transform ...

Indian Academy of Sciences (India)

Ratio (SNR) and Mean Square Error (MSE) computations showed that our proposed ... This technique permits to cancel noises and retain the informa- tion of the ... Wavelet analysis is used for transforming the signal under investigation into joined temporal and ... introduced the BWT in our proposed ECG de-noising system.

The resting electrocardiogram of t. cruzi-infected rats

Directory of Open Access Journals (Sweden)

Reinaldo B. Bestetti

1987-08-01

Full Text Available A total of 125 rats were infected with the Colômbia strain of T. cruzi (2000 parasites/g shortly after weaning. Of these, 58 survived the acute phase and were used in the present experiment. Twenty eight similar but not infected rats served as controls. All rats were submitted to the resting ECG When they were 6 months old. Classic and 3 precordial leads were employed in order to record the ECG as completely as possible. Electrocardiographic changes similar to those found in human chronic Chagas' heart disease and not previously described in this model were found in 44% of the T. cruzi-infected rats: left axis deviation (22%, right axis deviation (7%, lengthened and bizarre QRS complex (14% and abnormal J point elevation (3%. On the basis of these results, we believe that the resting ECG constitutes a valuable tool for studying experimental chronic Chagas' heart disease in rats.

Electrocardiogram as prognostic and diagnostic parameter in follow ...

African Journals Online (AJOL)

Mohamed Sadaka

2012-10-27

Oct 27, 2012 ... nostic and diagnostic information in patients with HF. Figure 1 ... 10%, arrhythmias in 9%, anemia in 5%, intake of negative inotropic drugs in 3%, ..... tients with CHF, a recently described association of peripheral edema ...

Estimation of lung volume and pressure from electrocardiogram

KAUST Repository

Elsayed, Gamal Eldin Fathy Amin; Kosel, Jü rgen; Kaniušas, Eugenijus; Traxler, Stefan

2011-01-01

The Electrocardiography (ECG) is a tool measuring the electrical excitation of the heart that is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological

The electrocardiogram made (really) easy: Using small-group ...

African Journals Online (AJOL)

Medicine designed small-group tutorials using animations and analogies as methods to improve the ECG interpretation skills of students. Objectives. To improve students' ability to interpret ECGs and assess their perceptions of the tutorials. Methods. A questionnaire was administered to 67 final-year medical students after ...

Reliability of Computer Analysis of Electrocardiograms (ECG) of ...

African Journals Online (AJOL)

Background: Computer programmes have been introduced to electrocardiography (ECG) with most physicians in Africa depending on computer interpretation of ECG. This study was undertaken to evaluate the reliability of computer interpretation of the 12-Lead ECG in the Black race. Methodology: Using the SCHILLER ...

Estimation of lung volume and pressure from electrocardiogram

KAUST Repository

Elsayed, Gamal Eldin Fathy Amin

2011-05-01

The Electrocardiography (ECG) is a tool measuring the electrical excitation of the heart that is extensively used for diagnosis and monitoring of heart diseases. The ECG signal reflects not only the heart activity but also many other physiological processes. The respiratory activity is a prominent process that affects the ECG signal due to the close proximity of the heart and the lungs and, on the other hand, due to neural regulatory processes. In this paper, several means for the estimation of the respiratory process from the ECG signal are presented. The results show a strong correlation of the voltage difference between the R and S peak of the ECG and the lung\\'s volume and pressure. Correlation was also found for some features of the vector ECG, which is a two dimensional graph of two different ECG signals. The potential benefit of the multiparametric evaluation of the ECG signal is a reduction of the number of sensors connected to patients, which will increase the patients\\' comfort and reduce the costs associated with healthcare. In particular, it is relevant for sleep monitoring, where a reduction of the number of different sensors would facilitate a more natural sleeping environment and hence a higher sensitivity of the diagnosis. © 2011 IEEE.

Atriofascicular Mahaim with Ebstein anomaly: A case report

Directory of Open Access Journals (Sweden)

Kazushi Ueshima, MD

2017-10-01

Full Text Available We report a case of a 7-year-old girl with atriofascicular Mahaim (AFM pathway concomitant with Ebstein's anomaly. The QRS wave showed left bundle branch block pattern on electrocardiogram. Holter electrocardiogram showed prolongation of the PR interval and QRS morphological change during sinus tachycardia. An electrophysiological study demonstrated that the distal His potential appeared earlier than the proximal His potential, which suggested retrograde His conduction toward the atrioventricular node. Conduction from the Mahaim fiber to the His bundle was faster than that from the atrioventricular node towards the His bundle. The findings of this important case allowed a differential diagnosis between AFM and Wolff-Parkinson-White (WPW syndrome.

General anaesthesia for insertion of an automated implantable cardioverter defibrillator in a child with Brugada and autism

Directory of Open Access Journals (Sweden)

Shwetal Goraksha

2010-01-01

Full Text Available A 14-year-old autistic boy presented with acute gastroenteritis and hypotension. The electrocardiogram showed a ventricular fibrillation rhythm - he went into cardiorespiratory arrest and was immediately resuscitated. On investigation, the electrocardiogram showed a partial right bundle branch block with a "coved" pattern of ST elevation in leads v 1 -v 3 . A provisional diagnosis of Brugada syndrome was made, for which an automated implantable cardioverter defibrillator (AICD implantation was advised. Although the automated implantable cardioverter defibrillator implantation is usually performed under sedation, because this was an autistic child, he needed general anaesthesia. We performed the procedure uneventfully under general anaesthesia and he was discharged after a short hospital stay.

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

Abbreviations: ANOVA, Analysis of variance; ASE, American Society of Echocardiography; CV, Cardiovascular; ECG, Electrocardiogram; ... implicated as a marker of arrhythmogenesis and cardiac death. ..... dispersion in endurance athletes.

Dry Electrode Harness System For Wireless 12-LEAD ECG

Data.gov (United States)

National Aeronautics and Space Administration — Human spaceflight requires the ability to obtain diagnostic quality 12-lead electrocardiograms (ECGs). Current systems require significant upmass, volume, and crew...

[The characteristics of RR-Lorenz plot in persistent atrial fibrillation patients complicating with escape beats and rhythm].

Science.gov (United States)

Pan, Yunping; Zhang, Fangfang; Liu, Ru; Jing, Yan; Shen, Jihong; Li, Zhongjian; Zhu, Huaijie

2014-06-01

To explore the characteristics of RR-Lorenz plot in persistent atrial fibrillation (AF) patients complicating with escape beats and rhythm though ambulatory electrocardiogram. The 24-hour ambulatory electrocardiogram of 291 persistent AF patients in second affiliated hospital of Zhengzhou university from July 2005 to April 2013 were retrospectively analyzed and the RR interval and the QRS wave were measured. Patients were divided into two groups according to the distribution of the RR-Lorenz point [AF without escape beats and rhythm group (Group A, n = 259) and AF with escape beats and rhythm group (Group B, n = 32)]. The characteristics of RR-Lorenz plot between the two groups were compared. (1) Fan-shaped RR-Lorenz plots were evidenced in Group A. (2)In Group B, 30 cases showed fan-shaped with L-shaped and a short dense rods along 45° line. The proportion of escape beats and rhythm was 0.28% (275/98 369) -14.06% (11 263/80 112) . The other 2 cases in group B showed no typical RR-Lorenz plots features. RR-Lorenz plot could help to quickly diagnose persistent AF complicating with escape beats and rhythm according to the typical RR-Lorenz plot characteristics in 24-hour ambulatory electrocardiogram.

The impact on persistent ST-segment elevation to the effect of direct percutaneous coronary intervention

International Nuclear Information System (INIS)

Yang Wei; Jin Huigen; Liu Zongjun; Wang Weiqing; Shi Jia; Wang Dongyi; Wang Daying; Zhu Huafang; Chen Yixun; Fang Ping; Chen Wenchun

2005-01-01

Objective: To discuss the value of persistent ST-segment elevation on infarct related leads of electrocardiogram to judge the effect of direct percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Methods: 229 AMI patients already been undertaken direct PCI with the flow of TIMI III were divided into two groups. According to the results of ST-segment elevation resolution on infarct related leads in electrocardiogram: the group of ST-segment elevation resolution more than 50% (group A) and the group of ST-segment elevation resolution less than 50%(group B). The basic clinical features between the two groups, and the followed up frequency of cardiac events were compared. Results: The comparisons between group A with group B showed: no-reflow as 14/147 (9.52%)VS 21/82 (25.61%); the mortality during in-hospital period 5/147 (3.40%)VS 9/82 (10.98%); MACE 8/147 (5.44%)VS 11/82 (13.4%); the value of LVEF 56.99%±9.78% VS 49.82%±8.78%, P 0.05, showing statistically insignificant. Conclusions: That the results of ST-segment elevation resolution on infarct related leads in electrocardiogram can be used as an index for reperfusion of myocardial tissue level and judgment of prognosis after direct PCI. (authors)

Novel Left Ventricular Assist Systems® I and II for Cardiac Recovery: The Driver

OpenAIRE

Cervino, Claudio; Nasini, Victor; Sroka, Agnieszka; Diluch, Armando; Cáceres, Miguel; Sellanes, Miguel; Malusardi, Adriano; del Rio, Miguel; Pham, Si M.; Liotta, Domingo

2005-01-01

We have recently described the Novel Left Ventricular Assist Systems® (Novel LVAS®) I and II, which avoid cannulation of cardiac chambers and synchronize pumping with the patient's electrocardiogram.

Human ECG Changes During Prolonged Hyperbaric Exposures Breathing N2-O2 Mixtures

National Research Council Canada - National Science Library

Wilson, James M; Kligfield, Paul D; Adams, George M; Harvey, Claude; Schaefer, Karl E

1976-01-01

In an effort to determine whether hyperbaric exposures while breathing N2-O2 mixtures have an effect on cardiac depolarization and repolarization, electrocardiograms of 10 divers participating in four...

Toxicity of aerosol propellants in the respiratory and circulatory systems. VII. Influence of pulmonary emphysema and anesthesia in the rat.

Science.gov (United States)

Watanabe, T; Aviado, D M

1975-01-01

Experimental induction of pulmonary emphysema caused an increase in sensitivity of the rat to toxicity from inhalation of propellants. The emphysematous rat showed an exaggerated reduction in pulmonary compliance in response to inhalation of trichlorofluoromethane (FC 11). In emphysematous and non emphysematous rats without anesthesia the inhalation of FC 11 caused tachycardia, arrhythmias and other abnormalities in the electrocardiogram. The tachycardiac response was eliminated by induction of barbiturate anesthesia, which increased the sensitivity of the heart to occurrence of abnormalities in the electrocardiogram in response to inhalation of FC 11 as well as of dichlorodifluoromethane (FC 12) and difluoroethane (FC 152a). The acceleration in heart rate in response to inhalation of FC 11, hypoxia or hypercapnea was prevented by prior treatment with a beta-blocking drug.

Download this PDF file

African Journals Online (AJOL)

Marinda

evidence of pulmonary oedema, hepatomegaly or peripheral oedema. The electrocardiogram ... intravenous line was secured. Her oxygen saturation on ... epidural catheter was removed and the patient was transferred to the general ward.

Approach to chest pain and acute myocardial infarction | Pandie ...

African Journals Online (AJOL)

Approach to chest pain and acute myocardial infarction. ... Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers ... Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), ...

Effect of Mobile Phone Radiofrequency Electromagnetic Fields on ...

African Journals Online (AJOL)

olayemitoyin

Summary: Since cell phones emit radiofrequency electromagnetic fields (EMFs), this study tested the hypothesis that cell phones placed ... mobile phones on autonomic modulation of the heart. ..... Electrocardiogram and Its Technology. J. Am.

SPECT-CT Hybrid cardiac imaging synchronized to Ecg for the mouse after myocardium infarction; Imagerie cardiaque hybride TEMP-TDM synchronisee a l'ECG chez la souris apres infarctus du myocarde

Energy Technology Data Exchange (ETDEWEB)

Choquet, P.; Goetz, C.; Aubertin, G.; Hubele, F. [HUS Strasbourg, Service de biophysique et medecine nucleaire, 67 (France); El-Fertak, L.; Monassier, L. [Laboratoire de pharmacologie cardiovasculaire, 67 - Strasbourg (France)

2010-07-01

The preclinical SPECT-CT imaging synchronized to electrocardiogram among mice allows to acquire isotropic morphological and functional data, data of high spatial and temporal resolutions with relatively short acquisition times. (N.C.)

Computer-enhanced thallium scintigrams in asymptomatic men with abnormal exercise tests

International Nuclear Information System (INIS)

Uhl, G.S.; Kay, T.N.; Hickman, J.R. Jr.

1981-01-01

The use of treadmill testing in asymptomatic patients and those with an atypical chest pain syndrome is increasing, yet the proportion of false positive stress electrocardiograms increases as the prevalence of disease decreases. To determine the diagnostic accuracy of computer-enhanced thallium perfusion scintigraphy in this subgroup of patients, multigated thallium scans were obtained after peak exercise and 3 or 4 hours after exercise and the raw images enhanced by a computer before interpretations were made. The patient group consisted of 191 asymptomatic U.S. Air force aircrewmen who had an abnormal exercise electrocardiogram. Of these, 135 had normal coronary angiographic findings, 15 had subcritical coronary stenosis (less than 50 percent diameter narrowing) and 41 had significant coronary artery disease. Use of computer enhancement resulted in only four false positive and two false negative scintigrams. The small subgroup with subcritical coronary disease had equivocal results on thallium scintigraphy, 10 men having abnormal scans and 5 showing no defects. The clinical significance of such subcritical disease in unclear, but it can be detected with thallium scintigraphy. Thallium scintigrams that have been enhanced by readily available computer techniques are an accurate diagnostic tool even in asymptomatic patients with an easily interpretable abnormal maximal stress electrocardiogram. Thallium scans can be effectively used in counseling asymptomatic patients on the likelihood of their having coronary artery disease

Prevalence of stroke/cardiovascular risk factors in Hungary

Science.gov (United States)

Bodo, M.; Sipos, K.; Thuroczy, G.; Panczel, G.; Ilias, L.; Szonyi, P.; Bodo, M., Jr.; Nebella, T.; Banyasz, A.; Nagy, Z.

2010-04-01

A cross-sectional survey was conducted in Hungary using the Cerberus system which includes: 1) a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2) amplifiers to record the pulse waves of cerebral arteries (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; subjects were also screened for blood cholesterol, glucose, and triglyceride levels. Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries (by rheoencephalogram), 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality in electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. This method offers a standardizable, cost effective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease (primary prevention). In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and is a first step in applying an expert system to stroke prevention.

A Portable ECG Recorder for Shipboard Use

National Research Council Canada - National Science Library

Ryack, Bernard L

1989-01-01

...) that would serve as a medical consultant to the Independent Duty Corpsman. The system was designed for use on submarines where such common tools as x-rays and electrocardiograms (ECGs) are not available...

Atrial fibrillation cases seen at the University of Nigeria Teaching ...

African Journals Online (AJOL)

ECG) of patients attending the University of Nigeria Teaching Hospital (UNTH), Enugu. Subjects and Methods: Electrocardiograms done at the UNTH between April and September 2004 were analysed. The patients were mainly in-patients.

Acute Coronary Syndrome

Science.gov (United States)

... heart cells are dying. An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring ... Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Ventricular Septal Defect (For Teens)

Science.gov (United States)

... of the heart and surrounding organs an electrocardiogram (EKG) , which records the electrical activity of the heart ... couch doing quiet activities like watching TV or reading. Everyone heals differently. Your doctor will let you ...

Tilt Table Test

Science.gov (United States)

... connected by wires to an electrocardiogram (ECG or EKG) machine that monitors your heart rate. Place a ... pressure (the bottom number in a blood pressure reading), lowers peripheral vascular resistance, increases your heart rate ...

Understand Your Risk for Arrhythmia

Science.gov (United States)

... is likely monitoring your heart rhythm with regular EKGs ( electrocardiograms ). But arrhythmias that occur infrequently may not ... patient sheets Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Atrial Septal Defect (For Teens)

Science.gov (United States)

... of the heart and surrounding organs an electrocardiogram (EKG), which records the electrical activity of the heart ... on the couch doing quiet activities such as reading, sleeping, and watching TV. Within a week or ...

Heart Health Tests for Diabetes Patients

Science.gov (United States)

... or fluids in the body. They include: Electrocardiogram ("EKG" or "ECG") This test measures the electrical activity ... Tools & Resources Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

Menthol poisoning

Science.gov (United States)

... to treat aches and pains (such as Ben-Gay, Therapeutic Mineral Ice) Peppermint oil Other products may ... ECG (electrocardiogram, or heart tracing) Chest x-ray Tube down the windpipe and lungs (bronchoscopy) to look ...

Mercury poisoning

Science.gov (United States)

... now banned by the FDA) Fumes from burning coal Fish that have eaten a form of organic ... ECG (electrocardiogram) or heart tracing Treatment may include: Activated charcoal by mouth or tube through the nose ...

Antifreeze poisoning

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... and breathing machine Chest x-ray CT scan (advanced brain imaging) ECG (electrocardiogram or heart tracing) Intravenous ... Nelson ME. Toxic alcohols. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts ...

Morphine overdose

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... tests Chest x-ray EKG (electrocardiogram, or heart tracing) Fluids through a vein (IV) Laxative Naloxone, a ... Toxicology Data Network. Morphine. Toxnet.nlm.nih.gov Web site. toxnet.nlm.nih.gov/cgi-bin/sis/ ...

Computer-enhanced thallium scintigrams in asymptomatic men with abnormal exercise tests

International Nuclear Information System (INIS)

Uhl, G.S.; Kay, T.N.; Hickman, J.R. Jr.

1981-01-01

The usefulness of computer-enhanced thallium-201 myocardial perfusion scintigraphy in excluding the diagnosis of coronary artery disease in asymptomatic patients showing abnormal exercise electrocardiograms is evaluated. Multigated thallium scans were obtained immediately following and 3 or 4 hours after maximal exercise testing in 191 consecutive asymptomatic Air Force aircrew members who had shown abnormal exercise electrocardiograms and who were due to undergo coronary angiography. Computer enhancement of the raw images is found to lead to four false positive and two false negative scintigrams as revealed by angiographic results, while the group of 15 with subcritical coronary disease exhibited equivocal results. Results reveal that enhanced thallium scintigrams are an accurate diagnostics tool in detecting myocardial ischemia in asymptomatic patients and may be used in counseling asymptomatic patients on their likelihood of having coronary artery disease

Spectral of electrocardiographic RR intervals to indicate atrial fibrillation

Science.gov (United States)

Nuryani, Nuryani; Satrio Nugroho, Anto

2017-11-01

Atrial fibrillation is a serious heart diseases, which is associated on the risk of death, and thus an early detection of atrial fibrillation is necessary. We have investigated spectral pattern of electrocardiogram in relation to atrial fibrillation. The utilized feature of electrocardiogram is RR interval. RR interval is the time interval between a two-consecutive R peaks. A series of RR intervals in a time segment is converted to a signal with a frequency domain. The frequency components are investigated to find the components which significantly associate to atrial fibrillation. A segment is defined as atrial fibrillation or normal segments by considering a defined number of atrial fibrillation RR in the segment. Using clinical data of 23 patients with atrial fibrillation, we find that the frequency components could be used to indicate atrial fibrillation.

Cardiotoxicity in Asymptomatic Patients Receiving Adjuvant 5-fluorouracil

DEFF Research Database (Denmark)

Nielsen, Karin; Polk, Anne; Nielsen, Dorte Lisbet

2014-01-01

Evolving evidence of cardiotoxicity in cancer patients treated with 5-fluorouracil (5-FU) has been reported. We report two different clinical manifestations of asymptomatic 5-FU-associated cardiotoxicity in patients operated for colorectal cancer and treated with adjuvant chemotherapy of 5-FU...... (bolus-injection and continuous infusion for 46 hours), folinic acid and oxaliplatin (FOLFOX). For a research study evaluating cardiac events during 5-FU treatment, Holter monitoring, electrocardiogram (ECG) and echocardiography were done and cardiac markers monitored before and during the first...... and hyperlipidemia as well as an incidental finding of negative T-waves in electrocardiogram years before 5-FU treatment. No subjective cardiac symptoms were described during infusion, but approximately 12 hours after infusion she suffered from cardiac arrest but was revived. Subsequent analysis of the Holter...

In Search of Hidden Arrhythmia

Directory of Open Access Journals (Sweden)

Johnson Francis

2015-10-01

Full Text Available Cardiac rhythm disorders could be very common and minimal significance like isolated ventricular ectopics are very serious and life threatening like ventricular tachycardia or fibrillation. Often it is an irregular pulse or heart beats which calls our attention to the presence of cardiac rhythm disorders. But many times, cardiac arrhythmia is intermittent and not manifest at the time of physical examination. A simple 12 lead electrocardiogram with a long rhythm strip can document cardiac arrhythmia which is frequent, but often fails to record intermittent arrhythmia which can still be quite symptomatic and sometimes life threatenting. This brief review is on the various modalities of electrocardiographic recordings used for documenting arrhythmia which is not easily documented by a 12 lead electrocardiogram with a long rhythm strip.

[Study for portable dynamic ECG monitor and recorder].

Science.gov (United States)

Yang, Pengcheng; Li, Yongqin; Chen, Bihua

2012-09-01

This Paper presents a portable dynamic ECG monitor system based on MSP430F149 microcontroller. The electrocardiogram detecting system consists of ECG detecting circuit, man-machine interaction module, MSP430F149 and upper computer software. The ECG detecting circuit including a preamplifier, second-order Butterworth low-pass filter, high-pass filter, and 50Hz trap circuit to detects electrocardiogram and depresses various kinds of interference effectively. A microcontroller is used to collect three channel analog signals which can be displayed on TFT LCD. A SD card is used to record real-time data continuously and implement the FTA16 file system. In the end, a host computer system interface is also designed to analyze the ECG signal and the analysis results can provide diagnosis references to clinical doctors.

Iodine poisoning

Science.gov (United States)

... Iodine is also used during the production of methamphetamine. Note: This list may not be all inclusive. ... breathing machine (ventilator) Blood and urine tests Chest x-ray EKG (electrocardiogram, or heart tracing) Fluids through a ...

Atrial Fibrillation in Children

Science.gov (United States)

... of the following tests: Electrocardiogram (also called an EKG or ECG) — this is a noninvasive test used ... About Arrhythmia Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

user1

Com. Phone No. +2348023574042 & +2348038231667. Abbreviations: DS, Down symdrome; ECG, Electrocardiogram; PE, Pericardial effusion; TFT, Thyroid function test; TSH, Thyroid stimulating hormone; UCTH, University of Calabar Teaching Hospital;. Recurrent Pericardial Effusion Associated with Hypothyroidism in.

Methanol poisoning

Science.gov (United States)

... tests Chest x-ray CT (computerized tomography, or advanced imaging) scan EKG (electrocardiogram, or heart tracing) Fluids ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Windshield washer fluid

Science.gov (United States)

... tests Chest x-ray CT (computerized tomography, or advanced imaging) scan EKG (electrocardiogram, or heart tracing) Fluids ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Sodium bisulfate poisoning

Science.gov (United States)

... found in: Household cleaners Metal finishing Swimming pool pH additives Note: This list may not be all ... burns in the esophagus (food pipe) and the stomach (endoscopy) Chest x-ray EKG (electrocardiogram, or heart ...

Cardiac Rehabilitation: MedlinePlus Health Topic

Science.gov (United States)

... in Spanish Electrocardiogram (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Cardiac Rehabilitation updates ... How to take your pulse Pulse Related Health Topics Heart Attack Heart Diseases How to Prevent Heart ...

Kawasaki Disease: MedlinePlus Health Topic

Science.gov (United States)

... Spanish Kawasaki disease (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Kawasaki Disease updates ... GO MEDICAL ENCYCLOPEDIA Electrocardiogram Kawasaki disease Related Health Topics Vasculitis National Institutes of Health The primary NIH ...

Multiobjective Design of Wearable Sensor Systems for Electrocardiogram Monitoring

Directory of Open Access Journals (Sweden)

F. J. Martinez-Tabares

2016-01-01

Full Text Available Wearable sensor systems will soon become part of the available medical tools for remote and long term physiological monitoring. However, the set of variables involved in the performance of these systems are usually antagonistic, and therefore the design of usable wearable systems in real clinical applications entails a number of challenges that have to be addressed first. This paper describes a method to optimise the design of these systems for the specific application of cardiac monitoring. The method proposed is based on the selection of a subset of 5 design variables, sensor contact, location, and rotation, signal correlation, and patient comfort, and 2 objective functions, functionality and wearability. These variables are optimised using linear and nonlinear models to maximise those objective functions simultaneously. The methodology described and the results achieved demonstrate that it is possible to find an optimal solution and therefore overcome most of the design barriers that prevent wearable sensor systems from being used in normal clinical practice.

Hardware Prototyping of Neural Network based Fetal Electrocardiogram Extraction

Science.gov (United States)

Hasan, M. A.; Reaz, M. B. I.

2012-01-01

The aim of this paper is to model the algorithm for Fetal ECG (FECG) extraction from composite abdominal ECG (AECG) using VHDL (Very High Speed Integrated Circuit Hardware Description Language) for FPGA (Field Programmable Gate Array) implementation. Artificial Neural Network that provides efficient and effective ways of separating FECG signal from composite AECG signal has been designed. The proposed method gives an accuracy of 93.7% for R-peak detection in FHR monitoring. The designed VHDL model is synthesized and fitted into Altera's Stratix II EP2S15F484C3 using the Quartus II version 8.0 Web Edition for FPGA implementation.

The Utility of the Small Rodent Electrocardiogram in Toxicology

Science.gov (United States)

Extensive research has lead to a growing appreciation that the heart is acutely sensitive to a broad array of toxicants via multiple routes of exposure. These agents are as diverse as the anti-neoplastic drug doxorubicin and various components of ambient air pollution. Adverse ef...

RR-Interval variance of electrocardiogram for atrial fibrillation detection

Science.gov (United States)

Nuryani, N.; Solikhah, M.; Nugoho, A. S.; Afdala, A.; Anzihory, E.

2016-11-01

Atrial fibrillation is a serious heart problem originated from the upper chamber of the heart. The common indication of atrial fibrillation is irregularity of R peak-to-R-peak time interval, which is shortly called RR interval. The irregularity could be represented using variance or spread of RR interval. This article presents a system to detect atrial fibrillation using variances. Using clinical data of patients with atrial fibrillation attack, it is shown that the variance of electrocardiographic RR interval are higher during atrial fibrillation, compared to the normal one. Utilizing a simple detection technique and variances of RR intervals, we find a good performance of atrial fibrillation detection.

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African Journals Online (AJOL)

raoul

2011-02-22

Feb 22, 2011 ... A 12 lead electrocardiogram revealed ST-segment elevation in leads ... Congestive heart failure was controlled by diuretics, nitrate, and low doses of .... and immunization of mice with them results in enhanced atherosclerosis ...

Peripartum Cardiomyopathy

Science.gov (United States)

... short- ness of breath, and palpitations. •  Electrocardiogram (heart tracing) to assess heart rate and rhythm, to look ... Accessed January 22, 2013. The Peripartum Cardiomyopathy Network Web site. http: / / www. peripartumcmnetwork. pitt. edu. Accessed January ...

Spontaneous baroreflex sensitivity

DEFF Research Database (Denmark)

Barthel, Petra; Bauer, Axel; Müller, Alexander

2012-01-01

Low baroreflex sensitivity (BRS) indicates poor prognosis after acute myocardial infarction. Noninvasive BRS assessment is complicated by nonstationarities and noise in electrocardiogram and pressure signals. Phase-rectified signal averaging is a novel signal processing technology overcoming thes...

Diabetic hyperglycemic hyperosmolar syndrome

Science.gov (United States)

... glucose Evaluation for possible causes may include: Blood cultures Chest x-ray Electrocardiogram (ECG) Urinalysis Treatment At the start of treatment, the goal is to correct the water loss. This will improve the blood pressure, urine output, ...

A single exposure to acrolein causes arrhythmogenesis, cardiac electrical dysfunction and decreased heart rate variability in hypertensive rats

Science.gov (United States)

Epidemiological studies demonstrate an association between cardiovascular morbidity, arrhythmias, and exposure to air toxicants such as acrolein. We hypothesized that a single exposure to acrolein would increase arrhythmias and cause changes in the electrocardiogram (ECG) of hype...

Chronic Diseases: Asthma and You | NIH MedlinePlus the Magazine

Science.gov (United States)

... of cold air or breathing in a special chemical. Comparing your symptoms with those of conditions similar to asthma’s, such as reflux disease, vocal cord dysfunction, or sleep apnea. A chest X-ray or EKG (electrocardiogram) ...

Female alcoholics: electrocardiographic changes and associated metabolic and electrolytic disorders

Directory of Open Access Journals (Sweden)

Borini Paulo

2003-01-01

Full Text Available OBJECTIVE: To identify the electrocardiographic changes and their associations with metabolic and electrolytic changes in female alcoholics. METHODS: The study comprised 44 female alcoholics with no apparent physical disorder. They underwent the following examinations: conventional electrocardiography; serologic tests for syphilis, Chagas' disease, and hepatitis B and C viruses; urinary pregnancy testing; hematimetric analysis; biochemical measurements of albumin, fibrinogen, fasting and postprandial glycemias, lipids, hepatic enzymes, and markers for tissue necrosis and inflammation. RESULTS: Some type of electrocardiographic change was identified in 33 (75% patients. In 17 (38.6% patients, more than one of the following changes were present: prolonged QTc interval in 24 (54.5%, change in ventricular repolarization in 11(25%, left ventricular hypertrophy in 6 (13.6%, sinus bradycardia in 4 (9.1%, sinus tachycardia in 3 (6.8%, and conduction disorder in 3 (6.8%. The patients had elevated mean serum levels of creatine phosphokinase, aspartate aminotransferases, and gamma glutamyl transferase, as well as hypocalcemia and low levels of total cholesterol and LDL-cholesterol. The patients with altered electrocardiograms had a more elevated age, a lower alcohol consumption, hypopotassemia, and significantly elevated levels of triglycerides, postprandial glucose, sodium and gamma glutamyl transferase than those with normal electrocardiograms. The opposite occurred with fasting glycemia, magnesium, and alanine aminotransferase. CONCLUSION: The electrocardiographic changes found were prolonged QTc interval, change in ventricular repolarization, and left ventricular hypertrophy. Patients with normal and abnormal electrocardiograms had different metabolic and electrolytic changes.

Noninvasive detection of regional myocardial ischemia using rubidium-81 and scintillation camera. Comparison with stress electrocardiography in patients with arteriographically documented coronary stenosis

International Nuclear Information System (INIS)

Berman, D.S.; Salel, A.F.; DeNardo, G.L.; Mason, D.T.

1975-01-01

The sensitivity of rest and stress myocardial perfusion studies using scintillation camera imaging of intravenously administered rubidium-81 ( 81 Rb) in the detection of myocardial ischemia was compared to that of stress electrocardiography by relating results in 40 patients to the degree of stenosis delineated by coronary arteriography. Of 33 patients with greater than 75 percent stenosis of at least one of the three major coronary vessels (significant stenosis), rest and stress 81 Rb imaging detected ventricular ischemia in 29 (88 percent), whereas simultaneous stress electrocardiography was positive (1 mm or greater horizontal ST-segment depression) in only 19 (58 percent) of the same patients. Five of the 29 patients who developed stress-induced scintigraphic evidence of ischemia did not develop angina or a positive electrocardiogram with stress. In 31 of the 33 patients with significant coronary stenosis, either the stress scintigram or the stress electrocardiogram was positive. In seven patients with less than 50 percent narrowing of a major coronary vessel on coronary arteriography, the stress scintigrams were negative, whereas the stress electrocardiograms were positive in the two of these patients with the syndrome of angina with normal coronary arteriograms. It is concluded that high resolution images of the myocardium can be obtained with 81 Rb using the scintillation camera with special shielding, and that rest and stress 81 Rb scintigraphy appears to provide greater sensitivity and specificity when compared to stress electrocardiography in the noninvasive identification of significant coronary stenosis

Follow-up Thallium-201 scintigraphy after mantle field radiotherapy for Hodgkin's disease

International Nuclear Information System (INIS)

Pierga, J.Y.; Girinski, T.; Henry-Amar, M.; Maunoury, C.; Valette, H.; Tchernia, G.; Desgrez, A.; Socie, G.; Cosset, J.M.

1993-01-01

Assessment of the long-term cardiac effects of mediastinal radiotherapy for Hodgkin's disease, by Thallium scintigraphy. 32 patients (14 males and 18 females) who underwent mantle field radiotherapy for Hodgkin's disease were included in this study. Twenty patients received 4 fractions of 2.5 Gy per week and 12, five fraction of 2 Gy per week, delivered on alternate days. All the patients, except three, performed exercise testing electrocardiogram and Thallium-201 tomoscintigraphy. The average time interval from completion of treatment to the study was 7 years (range 3--13 years). No patients had clinical symptoms of cardiac disease. Mean age at the time of the study was 35 years (range 23--48 years). Two electrocardiograms revealed left bundle branch block and the patients were excluded from the study. Only one out of 27 exercise electrocardiograms was abnormal in a patient with mitral valve prolapse, who was also excluded from the study. Twenty-six scintigraphies were evaluable. Twenty-two (85%) were clearly abnormal with partial or complete redistribution on delayed images. The anterior region was affected in 19 of these cases (86%). Four explorations were undoubtedly normal. Coronary angiography was not performed for ethical reasons in these asymptomatic patients. Despite possible false positive tests, the high rate of abnormality (85%) in this small series is striking. These preliminary data justify larger studies and a close long-term follow-up of these patients. 24 refs., 1 fig., 2 tabs

Comparing the Effects of Simulation-Based and Traditional Teaching Methods on the Critical Thinking Abilities and Self-Confidence of Nursing Students.

Science.gov (United States)

AlAmrani, Mashael-Hasan; AlAmmar, Kamila-Ahmad; AlQahtani, Sarah-Saad; Salem, Olfat A

2017-10-10

Critical thinking and self-confidence are imperative to success in clinical practice. Educators should use teaching strategies that will help students enhance their critical thinking and self-confidence in complex content such as electrocardiogram interpretation. Therefore, teaching electrocardiogram interpretation to students is important for nurse educators. This study compares the effect of simulation-based and traditional teaching methods on the critical thinking and self-confidence of students during electrocardiogram interpretation sessions. Thirty undergraduate nursing students volunteered to participate in this study. The participants were divided into intervention and control groups, which were taught respectively using the simulation-based and traditional teaching programs. All of the participants were asked to complete the study instrumentpretest and posttest to measure their critical thinking and self-confidence. Improvement was observed in the control and experimental groups with respect to critical thinking and self-confidence, as evidenced by the results of the paired samples t test and the Wilcoxon signed-rank test (p .05). This study evaluated an innovative simulation-based teaching method for nurses. No significant differences in outcomes were identified between the simulator-based and traditional teaching methods, indicating that well-implemented educational programs that use either teaching method effectively promote critical thinking and self-confidence in nursing students. Nurse educators are encouraged to design educational plans with clear objectives to improve the critical thinking and self-confidence of their students. Future research should compare the effects of several teaching sessions using each method in a larger sample.

Ultra low-power biomedical signal processing : An analog wavelet filter approach for pacemakers

NARCIS (Netherlands)

Pavlík Haddad, S.A.

2006-01-01

The purpose of this thesis is to describe novel signal processing methodologies and analog integrated circuit techniques for low-power biomedical systems. Physiological signals, such as the electrocardiogram (ECG), the electroencephalogram (EEG) and the electromyogram (EMG) are mostly

Familial Brugada syndrome uncovered by hyperkalaemic diabetic ketoacidosis

NARCIS (Netherlands)

Postema, Pieter G.; Vlaar, Alexander P. J.; DeVries, J. Hans; Tan, Hanno L.

2011-01-01

We describe a case of diabetic ketoacidosis with concomitant hyperkalaemia that uncovered a typical Brugada syndrome electrocardiogram (ECG). Further provocation testing in the patient and his son confirmed familial Brugada syndrome. Diabetic ketoacidosis with hyperkalaemia may uncover an

Subtle involvement of the sympathetic nervous system in amyotrophic lateral sclerosis.

NARCIS (Netherlands)

Oey, P.L.; Vos, P.E.; Wieneke, G.H.; Wokke, J.H.J.; Blankestijn, P.J.; Karemaker, J.M.

2002-01-01

The literature on the involvement of the autonomic nervous system (ANS) in amyotrophic lateral sclerosis (ALS) is conflicting. We therefore investigated several aspects of autonomic function, namely muscle sympathetic nerve activity (MSNA), blood pressure, cardiac function (electrocardiogram; ECG),

Subtle involvement of the sympathetic nervous system in amyotrophic lateral sclerosis

NARCIS (Netherlands)

Oey, P. Liam; Vos, Pieter E.; Wieneke, George H.; Wokke, John H. J.; Blankestijn, Peter J.; Karemaker, John M.

2002-01-01

The literature on the involvement of the autonomic nervous system (ANS) in amyotrophic lateral sclerosis (ALS) is conflicting. We therefore investigated several aspects of autonomic function, namely muscle sympathetic nerve activity (MSNA), blood pressure, cardiac function (electrocardiogram; ECG),

Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

NARCIS (Netherlands)

W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

1985-01-01

textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

Influence of ST-segment recovery on infarct size and ejection fraction in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per

2010-01-01

In patients with ST-segment elevation myocardial infarction treated with fibrinolytics, electrocardiogram-derived measures of ST-segment recovery guide therapy decisions and predict infarct size. The comprehension of these relationships in patients undergoing mechanical reperfusion is limited. We...

Low-complexity R-peak detection for ambulatory fetal monitoring

NARCIS (Netherlands)

Rooijakkers, M.J.; Rabotti, C.; Oei, S.G.; Mischi, M.

2012-01-01

Non-invasive fetal health monitoring during pregnancy is becoming increasingly important because of the increasing number of high-risk pregnancies. Despite recent advances in signal-processing technology, which have enabled fetal monitoring during pregnancy using abdominal electrocardiogram (ECG)

A case of possible Kounis syndrome as a complication of scombroid syndrome

Directory of Open Access Journals (Sweden)

Stefano Rusconi

2017-11-01

Full Text Available Kounis syndrome is defined as the concurrence of acute coronary syndromes such as coronary spasm or acute myocardial infarction with conditions associated with activation of inflammatory mediators such histamine, arachidonic acid and various cytokines and chemokines. Recently, a variety of unusual etiologies have been reported, including scombroid syndrome. We present a case of a woman without previous history of cardiac diseases or cardiovascular risk factors, who presented to emergency department after the onset of flushing, asthenia, palpitations, burning sensation in the mouth having just eaten tuna. The electrocardiogram revealed a sinus tachycardia with diffuse ST segment depression. After therapy, in a short time symptoms recovered and a second electrocardiogram no longer showed any ST changes. These electrocardiographic changes observed in our case were probably due to transitory coronary vasospasm as described in type I variant of Kounis syndrome.

Left bundle-branch block

DEFF Research Database (Denmark)

Risum, Niels; Strauss, David; Sogaard, Peter

2013-01-01

The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently...

[Catecholaminergic polymorphic ventricular tachycardia is a rare inherited heart disease.

DEFF Research Database (Denmark)

Holst, Anders Gaarsdal; Tfelt-Hansen, 1jacob; Olesen, Morten S

2010-01-01

or cardiac arrest. The arrhythmias are usually triggered by exercise or emotional affection. The diagnosis is often made using exercise electrocardiogram, which typically triggers arrhythmias. The treatment consists of beta blockers, frequently in combination with implantation of a cardioverter...

Disease: H00730 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available t has been found a novel SCN5A missense mutation in one symptomatic IVF patient that did not exhibit the typical Brugada electrocardi...ogram (ECG). Recently, IVF linked to the DPP6 gene has b

Risk Factors for Atrial Fibrillation

NARCIS (Netherlands)

B.P. Krijthe (Bouwe)

2013-01-01

textabstractAtrial fibrillation is a common cardiac arrhythmia that is characterized by rapid disorganized atrial electrical activity resulting in absence of atrial contractions. It is diagnosed on the basis of typical findings on an electrocardiogram (ECG). The characteristic ECG findings are

Giant coronary aneurysm in Churg-Strauss syndrome

NARCIS (Netherlands)

Hartmann, M.; Hartmann, M.; Wajon, E.M.; van Houwelingen, G.K.; Stoel, M.G.; von Birgelen, Clemens

2012-01-01

A 64-year-old male with Churg-Strauss syndrome (CSS) presented with worsening dyspnoea without chest pain besides having long-standing asthma. There were no cardiovascular risk factors. The electrocardiogram showed signs of prior anterior infarction. Echocardiography demonstrated severely depressed

Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial

DEFF Research Database (Denmark)

Linde, Jesper James; Kofoed, Klaus Fuglsang; Sørgaard, Mathias

2013-01-01

In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive...

Katekolaminerg polymorf ventrikulaer takykardi er en sjaelden arvelig hjertesygdom

DEFF Research Database (Denmark)

Holst, Anders Gaarsdal; Tfelt-Hansen, Jacob; Olesen, Morten S

2010-01-01

or cardiac arrest. The arrhythmias are usually triggered by exercise or emotional affection. The diagnosis is often made using exercise electrocardiogram, which typically triggers arrhythmias. The treatment consists of beta blockers, frequently in combination with implantation of a cardioverter-defibrillator....

Anthracycline-induced cardiomyopathy: favourable effects of cardiac resynchronization therapy

DEFF Research Database (Denmark)

Ahlehoff, Ole; Galløe, Anders M; Hansen, Peter R

2010-01-01

We report a case of severe refractory congestive heart failure after anthracycline chemotherapy in a patient with a narrow QRS interval on the electrocardiogram and echocardiographic evidence of left ventricular dyssynchrony, where cardiac resynchronization therapy resulted in normalization of left...

Stent implantation and vascular healing of a spontaneous coronary artery dissection assessed by optical coherence tomography in a patient with acute coronary syndrome

DEFF Research Database (Denmark)

Hansen, Kirstine Nørregaard; Antonsen, Lisbeth; Jensen, Lisette Okkels

2018-01-01

A 60-year old woman with non-ST-segment elevation myocardial infarction, underwent coronary angiogram combined with optical coherence tomography (OCT) revealing a long dissection in the right coronary artery. The patient experienced peri-procedural chest pain, the electrocardiogram showed ST...