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Swenson DJ, Geneser SE, Stinstra JG, Kirby RM, MacLeod RS. Cardiac position sensitivity study in the electrocardiographic forward problem using stochastic collocation and boundary element methods. Ann Biomed Eng 2011; 39:2900-10. [PMID: 21909818 DOI: 10.1007/s10439-011-0391-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/27/2011] [Indexed: 11/26/2022]
Abstract
The electrocardiogram (ECG) is ubiquitously employed as a diagnostic and monitoring tool for patients experiencing cardiac distress and/or disease. It is widely known that changes in heart position resulting from, for example, posture of the patient (sitting, standing, lying) and respiration significantly affect the body-surface potentials; however, few studies have quantitatively and systematically evaluated the effects of heart displacement on the ECG. The goal of this study was to evaluate the impact of positional changes of the heart on the ECG in the specific clinical setting of myocardial ischemia. To carry out the necessary comprehensive sensitivity analysis, we applied a relatively novel and highly efficient statistical approach, the generalized polynomial chaos-stochastic collocation method, to a boundary element formulation of the electrocardiographic forward problem, and we drove these simulations with measured epicardial potentials from whole-heart experiments. Results of the analysis identified regions on the body-surface where the potentials were especially sensitive to realistic heart motion. The standard deviation (STD) of ST-segment voltage changes caused by the apex of a normal heart, swinging forward and backward or side-to-side was approximately 0.2 mV. Variations were even larger, 0.3 mV, for a heart exhibiting elevated ischemic potentials. These variations could be large enough to mask or to mimic signs of ischemia in the ECG. Our results suggest possible modifications to ECG protocols that could reduce the diagnostic error related to postural changes in patients possibly suffering from myocardial ischemia.
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Affiliation(s)
- Darrell J Swenson
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
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2
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Zhong-qun Z, Wei W, Shu-yi D, Chong-quan W, Jun-feng W, Zheng C. Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads. J Electrocardiol 2009; 42:432-9. [DOI: 10.1016/j.jelectrocard.2009.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Indexed: 11/15/2022]
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3
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Birnbaum Y. Understanding the dynamic electrocardiographic changes that occur during ischemia. J Electrocardiol 2008; 41:431-2. [PMID: 18440550 DOI: 10.1016/j.jelectrocard.2008.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Indexed: 10/22/2022]
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Erdöl C, Baykan M, Celik S, Gökçe M, Karahan B, Orem C. Relationship between changes in R-wave amplitude during left ventriculography and the seriousness of coronary heart disease. Ann Noninvasive Electrocardiol 2006; 7:114-9. [PMID: 12049682 PMCID: PMC7027602 DOI: 10.1111/j.1542-474x.2002.tb00151.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Serious complications, such as myocardial infarction or death, may occur particularly in patients with severe coronary heart disease during coronary angiographies. Therefore, prediction of severe coronary heart disease before or during the initial steps of the procedure can provide a decrease in frequency of such complications. To predict the seriousness of coronary heart disease during left ventriculography, before, during, and after the application of contrast matter, electrocardiography (ECG) records were taken and R-wave amplitudes were measured. Lead DII was used for calculations. The patients were classified according to vessel lesions and were compared with the control group. Before and after left ventriculography, there was no significant difference between the groups with normal coronary arteries and one, two, or three vessel lesions. Although there was no significant difference obtained from the comparison of the control group and the groups with one-vessel and two-vessel lesions (9.7 mm, 9.2 mm, 10.1 mm, respectively, P > 0.05); there was statistical difference between the group with three-vessel lesions and the control group during left ventriculography (6.4 mm, 9.7 mm, respectively, P < 0.05). Nonionic contrast material was used in all procedures. The decrement of R-wave amplitude that is observed during left ventriculography can predict three-vessel disease, which is a more serious condition for the patients. These patients should be monitored more carefully during coronary angiographies.
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Affiliation(s)
- Cevdet Erdöl
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey.
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Atar S, Barbagelata A, Birnbaum Y. Electrocardiographic Markers of Reperfusion in ST-elevation Myocardial Infarction. Cardiol Clin 2006; 24:367-76, viii. [PMID: 16939829 DOI: 10.1016/j.ccl.2006.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The outcome of patients who fail to reperfuse with thrombolytic therapy or percutaneous coronary intervention (PCI) for ST-elevation acute myocardial infarction (STEMI) may be improved with additional pharmacologic and mechanical interventions such as rescue PCI or intravenous glycoprotein IIb/IIIa infusion. The standard 12-lead ECG is the most commonly available and suitable tool for routine bedside evaluation of the success of reperfusion therapy for STEMI. This article reviews and discusses the current data on the four ECG markers for prediction of the perfusion status of the ischemic myocardium: ST-segment deviation, T-wave configuration, QRS changes, and reperfusion arrhythmias.
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Affiliation(s)
- Shaul Atar
- Division of Cardiology, University of Texas Medical Branch, 5.106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555, USA
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Abstract
The ECG is an essential part of the initial evaluation of patients who have chest pain, especially in the immediate decision-making process in patients who have ST-elevation myocardial infarction. This article reviews and summarizes the current information that can be obtained from the admission ECG in patients who have ST-elevation acute myocardial infarction, with an emphasis on: (1) prediction of final infarct size, (2) estimation of prognosis, and (3) the correlations between various ECG patterns and the localization of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Shaul Atar
- Division of Cardiology, University of Texas Medical Branch, 5.106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555, USA
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Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J 2003; 79:490-504. [PMID: 13679544 PMCID: PMC1742828 DOI: 10.1136/pmj.79.935.490] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The electrocardiogram is considered an essential part of the diagnosis and initial evaluation of patients with chest pain. This review summarises the information that can be obtained from the admission electrocardiogram in patients with ST elevation acute myocardial infarction, with emphasis on: (1) prediction of infarct size, (2) estimation of prognosis, and (3) the correlations between various electrocardiographic patterns and the localisation of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Y Birnbaum
- University of Texas Medical Branch, Galveston, Texas 77555-0553, USA.
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Bak I, Szendrei L, Turoczi T, Papp G, Joo F, Das DK, de Leiris J, Der P, Juhasz B, Varga E, Bacskay I, Balla J, Kovacs P, Tosaki A. Heme oxygenase-1-related carbon monoxide production and ventricular fibrillation in isolated ischemic/reperfused mouse myocardium. FASEB J 2003; 17:2133-5. [PMID: 12958158 DOI: 10.1096/fj.03-0032fje] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heme oxygenase-1 (HO-1)-dependent carbon monoxide (CO) production related to reperfusion-induced ventricular fibrillation (VF) was studied in HO-1 wild-type (+/+), heterozygous (+/-), and homozygous (-/-) isolated ischemic/reperfused mouse heart. In HO-1 homozygous myocardium, under aerobic conditions, HO-1 enzyme activity, HO-1 mRNA, and protein expression were not detected in comparison with aerobically perfused wild-type and heterozygous myocardium. In wild-type, HO-1 hetero- and homozygous hearts subjected to 20 min ischemia followed by 2 h of reperfusion, the expression of HO-1 mRNA, protein, and HO-1 enzyme activity was detected in various degrees. A reduction in the expression of HO-1 mRNA, protein, and enzyme activity in fibrillated wild-type and heterozygous myocardium was observed. In reperfused/nonfibrillated wild-type and heterozygous hearts, a reduction in HO-1 mRNA, protein expression, and HO-1 enzyme activity was not observed, indicating that changes in HO-1 mRNA, protein, and enzyme activity could be related to the development of VF. These changes were reflected in the HO-1-related endogenous CO production measured by gas chromatography. In HO-1 knockout ischemic/reperfused myocardium, all hearts showed VF, and no detection in HO-1 mRNA, protein, and enzyme activity was observed. Thus, interventions that are able to increase endogenous CO may prevent the development of VF.
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Affiliation(s)
- Istvan Bak
- Department of Pharmacology, Health and Science Center, University of Debrecen, Nagyerdei krt. 98, 4032-Debrecen, Hungary
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Vaturi M, Birnbaum Y. The use of the electrocardiogram to identify epicardial coronary and tissue reperfusion in acute myocardial infarction. J Thromb Thrombolysis 2000; 10:137-47. [PMID: 11005936 DOI: 10.1023/a:1018762509887] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The standard 12-lead electrocardiogram (ECG) gives us crucial information concerning myocardial perfusion and the success of reperfusion therapy for ST elevation acute myocardial infarction. Continuous monitoring has advantages over repeated snapshot recordings. There are four electrocardiographic markers for prediction of the perfusion status of the ischemic myocardium: (1) ST-segment measurements, (2) T-wave configuration, (3) QRS changes, and (4) reperfusion arrhythmias. Complete and stable (> or = 70%) resolution of ST-segment elevation is associated with better outcome and preservation of left ventricular function than partial (30 to 70%) or no (<30%) ST-segment resolution. Early inversion of the T waves after initiation of reperfusion therapy is another marker of myocardial reperfusion and a good prognostic sign. Using standard 12-lead ECG, dynamic changes in Q-wave number, amplitude, and width; R-wave amplitude; and S-wave appearance are detected during reperfusion therapy. However, the significance of these changes has not been clarified. Reperfusion arrhythmias, especially bradycardia and accelerated idioventricular rhythm, are detected occasionally during reperfusion therapy, but the value of reperfusion arrhythmias as a marker of coronary artery patency is still debatable. Dynamic changes in the QRS complexes, ST segments and T waves occur during reperfusion therapy and the days after. Whereas changes in ST-segment amplitude have been extensively studied, the significance of QRS-complex and T-wave changes is less clear, and especially whether changes in the QRS complex and T wave may be complementary and additive to ST-segment monitoring. It has remained unclear whether electrocardiographic signs of reperfusion and reischemia should be used for therapeutic decision making in the clinical setting.
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Affiliation(s)
- M Vaturi
- The Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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Vaturi MD M, Birnbaum MD Y. The use of the electrocardiogram to identify epicardial coronary and tissue reperfusion in acute myocardial infarction. J Thromb Thrombolysis 2000; 10:5-14. [PMID: 10947909 DOI: 10.1023/a:1018794918584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The standard 12-lead ECG gives us crucial information concerning myocardial perfusion and the success of reperfusion therapy for ST-elevation acute myocardial infarction. Continuous monitoring has advantages over repeated snapshot recordings. There are four electrocardiographic markers for prediction of the perfusion status of the ischemic myocardium: 1) ST-segment measurements; 2) T-wave configuration; 3) QRS changes; and 4) reperfusion arrhythmias. Complete and stable (> or = 70%) resolution of ST-segment elevation is associated with better outcome and preservation of left ventricular function than partial (30% to 70%) or no (< 30%) ST-segment resolution. Early inversion of the T-waves after initiation of reperfusion therapy is another marker of myocardial reperfusion and a good prognostic sign. Using standard 12-lead ECG, dynamic changes in Q-wave number, amplitude and width, R-wave amplitude and S-wave appearance are detected during reperfusion therapy. However, the significance of these changes have not been clarified. Reperfusion arrhythmias, especially bradycardia and accelerated idioventricular rhythm are detected occasionally during reperfusion therapy, but the value of reperfusion arrhythmias as a marker of coronary artery patency is still debatable. Dynamic changes in the QRS complexes, ST-segments and T-waves occur during reperfusion therapy and the days after. While changes in ST-segment amplitude have been extensively studied, the significance of QRS-complex and T-wave changes are less clear, and especially whether changes in the QRS-complex and T-wave may be complementary and additive to ST-segment monitoring. It has remained unclear whether electrocardiographic signs of reperfusion and re-ischemia should be used for therapeutic decision-making in the clinical setting.
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Affiliation(s)
- M Vaturi MD
- The Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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Assali AR, Herz I, Vaturi M, Adler Y, Solodky A, Birnbaum Y, Sclarovsky S. Electrocardiographic criteria for predicting the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol 1999; 84:87-9, A8. [PMID: 10404857 DOI: 10.1016/s0002-9149(99)00197-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Two patterns of the QRS complex in the lateral lead aVL on the admission electrocardiograms of patients with inferior wall acute myocardial infarction (AMI) were correlated with the culprit artery. S/R wave ratio < or =1/3 with ST depression < or =1 mm was found to be a sensitive and specific marker for left circumflex artery AMI, whereas S/R-wave ratio >1/3 with ST-segment depression >1 mm was suggestive of right coronary artery AMI.
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Affiliation(s)
- A R Assali
- Department of Cardiology, Rabin Medical Center, Petah Tiqva, Israel
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