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Diagnostic ECG

Fei Chen, Yong Peng, Mao Chen
Cardiac involvement in idiopathic inflammatory myopathies (IIMs) attracts more attention than it ever did because of its morbidity and impact on worse prognosis, although the accurate information needs further epidemiological studies. Early identification and intervention for the diseased heart may help improve the clinical outcomes of IIMs with cardiac involvement. Cardiac troponin assays, allowing for sensitive detection of minor myocardium injury, may provide a new way for early detection for heart involvement in IIMs...
March 20, 2018: International Heart Journal
Iain Parsons, E J Hutley, I Gibb, J Lentaigne, D Wilson, A T Cox
INTRODUCTION: The role of the military physician in Deployed Hospital Care involves the diagnosis and management of a wide variety of disease states. Broad clinical skills need to be complemented by judicious use of a limited array of investigations. No study has specifically quantified what investigations physicians use on operations. METHODS: A retrospective cross-sectional study was performed to ascertain what investigations were undertaken on all patients managed by the General Internal Medicine teams over a 14 month period during a recent enduring operation in Afghanistan...
March 21, 2018: Journal of the Royal Army Medical Corps
John W Kakareka, Anthony Z Faranesh, Randall H Pursley, Adrienne Campbell-Washburn, Daniel A Herzka, Toby Rogers, Josh Kanter, Kanishka Ratnayaka, Robert J Lederman, Thomas J Pohida
Hemodynamic recording during interventional cardiovascular procedures is essential for procedural guidance, monitoring patient status, and collection of diagnostic information. Recent advances have made interventions guided by magnetic resonance imaging (MRI) possible and attractive in certain clinical scenarios. However, in the MRI environment, electromagnetic interference (EMI) can cause severe distortions and artifacts in acquired hemodynamic waveforms. The primary aim of this paper was to develop and validate a system to minimize EMI on electrocardiogram (ECG) and invasive blood pressure (IBP) signals...
2018: IEEE Journal of Translational Engineering in Health and Medicine
Abdulla Shehab, Khalid F AlHabib, Akshaya Srikanth Bhagavathul, Ahmad Hersi, Hussam Alfaleh, Mostafa Q Alshamiri, Anhar Ullah, Khadim Sulaiman, Wael Almahmeed, Jassim Al Suwaidi, Alwai A Alsheikh-Ali, Haitham Amin, Mohammed Al Jarallah, Amar M Salam
BACKGROUND: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIM: To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries...
March 14, 2018: Current Vascular Pharmacology
Nils Arne Sörensen, Johannes Tobias Neumann, Francisco Ojeda, Sarina Schäfer, Christina Magnussen, Till Keller, Karl J Lackner, Tanja Zeller, Mahir Karakas, Thomas Münzel, Stefan Blankenberg, Dirk Westermann, Renate B Schnabel
BACKGROUND: The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men. METHODS AND RESULTS: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately...
March 10, 2018: Journal of the American Heart Association
Yalcin Velibey, Baris Yaylak, Tolga Sinan Guvenc, Goksel Cinier, Koray Kalenderoglu, Ozge Guzelburc, Ozlem Yildirimturk
BACKGROUND: Temporary transvenous pacemaker implantation is an important and critical procedure for emergency physicians. Traditionally, temporary pacemakers are inserted by electrocardiography (ECG) guidance in the emergency department because fluoroscopy at the bedside in an unstable patient can be limited by time and equipment availability. However, in the presence of atrial septal defect, ventricular septal defect, and patent foramen ovale, the pacemaker lead can be implanted inadvertently into the left ventricle or directly into the coronary sinus instead of right ventricle...
March 6, 2018: Journal of Emergency Medicine
Iacopo Olivotto, Gherardo Finocchiaro, Niccolò Maurizi, Lia Crotti
Ventricular or supraventricular ectopic beats or atrial fibrillation may be the first presentation of uncommon cardiac disease, both acquired and genetically determined. In some patients, these manifestations can be the first sign of the underlying cardiac disorder. In others, however, they are also important as prognostic indicators, reflecting electrical instability and risk. Most cardiology clinics are busy environments where the implementation of complex diagnostic algorithms is not feasible. However, it is equally impossible to reach a final diagnosis, among the thousands of rare diseases that involve the heart, moving from a first line clinical and instrumental examination...
April 15, 2018: International Journal of Cardiology
Dario Buccheri, Paola Rosa Chirco, Salvatore Geraci, Giuseppe Caramanno, Bernardo Cortese
Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries. Its clinical relevance focusses mainly on the mechanism of "coronary steal phenomenon", causing myocardial functional ischaemia even in the absence of stenosis, hence common symptoms are angina or effort dyspnoea. The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance and coronary angiography...
February 9, 2018: Heart, Lung & Circulation
Deepika Narasimha, Nader Hanna, Hiroko Beck, Michael Chaskes, Robert Glover, Robert Gatewood, Mohamad Bourji, Gregory D Gudleski, Susan Danzer, Anne B Curtis
INTRODUCTION: Ambulatory cardiac monitoring devices such as external loop recorders (ELRs) are often used in the outpatient clinic to evaluate palpitations. However, ELRs can be bulky and uncomfortable to use, especially in public, at work, or in social situations. An alternative approach is a smartphone-based electrocardiographic (ECG) recorder/event recorder (Kardia Mobile (KM)), but the comparative diagnostic yield of each approach has not been studied. METHODS: Thirty-three patients with palpitations wore an ELR and carried a KM for a period of 14-30 days...
March 1, 2018: Pacing and Clinical Electrophysiology: PACE
Sock Keow Tan, Chai Hong Yeong, Raja Rizal Azman Raja Aman, Kwan-Hoong Ng, Yang Faridah Abdul Aziz, Kok Han Chee, Zhonghua Sun
OBJECTIVE: This study aimed (1) to perform a systematic review on scanning parameters and contrast medium (CM) reduction methods used in prospectively ECG-triggered low tube voltage coronary CT angiography (CCTA), (2) to compare the achievable dose reduction and image quality, and (3) to propose appropriate scanning techniques and CM administration methods. METHODS: A systematic search were performed in PubMed, the Cochrane library, CINAHL, Web of Science, ScienceDirect and Scopus, where 20 studies were selected for analysis of scanning parameters and CM reduction methods...
March 1, 2018: British Journal of Radiology
K S Funder, L S Rasmussen, V Siersma, N Lohse, R Hesselfeldt, F Pedersen, O M Hendriksen, J Steinmetz
BACKGROUND: Implementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS on mortality and labour market affiliation in patients admitted for primary percutaneous coronary intervention (PCI). METHODS: In this prospective observational study, we included patients with suspected STEMI within the region covered by the HEMS from January 1, 2010, to April 30, 2013, transported by either HEMS or ground emergency medical services (GEMS) to the regional PCI centre...
February 27, 2018: Acta Anaesthesiologica Scandinavica
Yuzo Yamasaki, Satoshi Kawanami, Takeshi Kamitani, Koji Sagiyama, Seitaro Shin, Takuya Hino, Kenichiro Yamamura, Hidetake Yabuuchi, Michinobu Nagao, Hiroshi Honda
We explored the clinical value of low-tube voltage prospective second-generation ECG-triggered 320-row CT angiography in infants with complex CHD (37 male, 23 female, aged 0-2 years). The diagnostic accuracy of 320-row CT in complex CHD was 99.4% for intracardiac cardiovascular malformations, 99.8% for extracardiac cardiovascular malformations, and 100% for other malformations. The average subjective overall image quality score for cardiac structures was 3.7 ± 0.5 points. Second-generation 320-row CT angiography with low-tube voltage and prospective ECG-triggered volume target scanning allows accurate diagnosis of cardiovascular anomalies in infants with complex CHD...
February 15, 2018: Clinical Imaging
Hamidreza Reihani, Alireza Sepehri Shamloo, Assadollah Keshmiri
Background: The role of D-dimer as a diagnostic marker in myocardial infarction (MI) and acute coronary syndrome (ACS) is still a question. The aim of this study was to evaluate the diagnostic value of D-dimer in the diagnosis of AMI in patients suspected with ACS. Methods: This cross-sectional study was conducted on patients suspected with ACS. Serial standard 12-lead electrocardiogram (ECG), D-dimer, and troponin tests were done for all the patients. According to the examinations, ECG changes, and troponin, patients were allocated into two groups of MI and unstable angina (UA)...
February 2018: Cardiology Research
Ivo Strebel, Raphael Twerenbold, Jasper Boeddinghaus, Roger Abächerli, Maria Rubini Giménez, Karin Wildi, Karin Grimm, Christian Puelacher, Patrick Badertscher, Zaid Sabti, Dominik Breitenbücher, Janina Jann, Farah Selman, Jeanne du Fay de Lavallaz, Nicolas Schaerli, Thomas Nestelberger, Claudia Stelzig, Michael Freese, Lukas Schumacher, Stefan Osswald, Christian Mueller, Tobias Reichlin
BACKGROUND: The cardiac electrical biomarker (CEB) is a novel electrocardiographic (ECG) marker quantifying the dipolar activity of the heart with higher levels indicating myocardial injury. METHODS: We prospectively enrolled 1097 patients presenting with suspected non-ST-elevation myocardial infarction (NSTEMI) to the emergency department (ED). Digital 12-lead ECGs were recorded at presentation and the CEB values were calculated in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists...
February 24, 2018: Annals of Noninvasive Electrocardiology
Richard Lee, David Carr
Cardiac emergencies in pregnancy and the postpartum period are rare but often life-threatening. An emergency physician's differential diagnosis for chest pain in the peripartum patient often includes serious etiologies such as pulmonary embolism or myocardial infarction (MI). A lesser-known but important consideration on the differential for MI is that of a spontaneous coronary artery dissection (SCAD). SCAD is defined as an intramural hematoma within the coronary artery that compresses the true lumen. Expansion by increased pressures may lead to subsequent myocardial ischemia and infarction...
February 22, 2018: CJEM
Tamanna K Singh, Aaron L Baggish
Premature ventricular beats (PVBs) in competitive athletes are incidentally found during pre-participation ECG screening. Their clinical significance remains debatable with several studies suggesting they are a benign reflection of athlete's heart, and others proposing they may indicate underlying structural heart disease and heightened risk for sudden cardiac death (SCD). Areas covered: Effective management of athletes with PVBs may best be accomplished using an algorithmic approach for risk stratification with a goal of differentiating benign PVBs from those reflective of underlying cardiomyopathies...
February 23, 2018: Expert Review of Cardiovascular Therapy
Mia M Pries-Heje, Rasmus B Hasselbalch, Henriette Raaschou, Bijan Rezanavaz-Gheshlagh, Hanne Heebøll, Shazia Rehman, Mariana Kristensen, Erik Henning Andersen, Lisbet Ravn, Michel C Nèmery, Morten N Lind, Thomas Boel, Peter Sommer Ulriksen, Kasper K Iversen
BACKGROUND: Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment...
February 17, 2018: Emergency Radiology
L Jordaens
Understanding arrhythmias and their treatment is not always easy. The current straightforward approach with catheter ablation and device therapy is an amazing achievement, but does not make management of underlying or other cardiac disease and pharmacological therapy unnecessary. The goal of this paper is to describe how much of the knowledge of the 1980s and early 1990s can and should still be applied in the modern treatment of patients with arrhythmias. After an introduction, this review will focus on paroxysmal atrial fibrillation and a prototype of 'idiopathic' ventricular arrhythmias, two diseases with a striking similarity, and will discuss the arrhythmogenesis...
February 15, 2018: Netherlands Heart Journal
H-J Trappe
The 12-lead surface electrocardiogram (ECG) is of great importance for the diagnostics of cardiac arrhythmias. For the correct and systematic analysis it has a sensitivity and specificity for the correct diagnosis of supraventricular tachycardia or ventricular tachycardia of more than 95%. Nevertheless, the assessment of cardiac rhythm disorders is difficult for many physicians. In this way errors can occur, frequently due to a non-systematic analysis of the ECG; therefore, the aim of this article is to present the techniques and the necessary knowledge for assessment of the most frequent bradycardiac and tachycardiac heart rhythm disorders...
February 15, 2018: Herz
Jay S Shavadia, William French, Anne S Hellkamp, Laine Thomas, Eric R Bates, Steven V Manoukian, Michael C Kontos, Robert Suter, Timothy D Henry, Harold L Dauerman, Matthew T Roe
BACKGROUND: 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. METHODS: 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)...
March 2018: American Heart Journal
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