Diminution of QRS complexes caused by anasarca after an acute myocardial infarction: a case report and a discussion of the plausible underlying pathophysiological mechanisms

A proposal for monitoring patients with heart failure via "smart phone technology"-based electrocardiograms

The ubiquitous smart phone/device technology (SPT) has enabled the safe acquisition/transmission (A/T) of clinical and laboratory patient data, including the electrocardiogram (ECG). SPT-based A/T of the ECG has been found useful in the detection of atrial fibrillation, in monitoring of the QTc interval, in patients undergoing antiarrhythmic drug loading, and in management of patients with acute ST-elevation myocardial infarction. Previous work has shown a relationship between changes in the voltage of the ECG QRS complexes, with perturbations in the edematous state of various etiologies, including heart failure (HF). It is proposed herein to employ serially SPT-based 3-lead ECG A/T for the monitoring and management of patients with HF in their ambient environment. The proposed method will enable patients with HF to acquire/transmit their 3-lead ECG to the caring HF team, using only their smart phone and it takes into consideration the advanced degrees of physical incapacitation and age-related infirmities inherent to the HF population.

aVR, an index of all ECG limb leads, with clinical utility for monitoring of patients with edematous states, including heart failure

BACKGROUND

Nonreproducibility of precordial electrocardiogram (ECG) leads in serial ECGs has led to emphasis on the limb leads for some applications. Since modern electrocardiographs measure leads I and II and calculate on line the other four limb leads, the former can substitute for the set of six limb leads. Furthermore, based on the mathematical relationship of lead aVR and leads I and II, it was hypothesized that aVR could be used as a representative index of the set of the six limb leads. The aim of this study was to evaluate whether ECG lead aVR could function as an index of all limb leads, in clinical electrocardiography.

METHODS

Automation-derived and manually derived QRS voltage amplitude measurements of all limb leads in ECGs of a series of 100 randomly selected consecutive patients, and ECGs of 36 patients with various edematous states (EDST), congestive heart failure (CHF), or undergoing hemodialysis (HD), and aVR were inter-correlated with the sums of leads I and II (SigmaI&II), and the entire set of the six limb leads (Sigma6LbLds).

RESULTS

Correlation of aVR with SigmaI&II and Sigma6LbLds was excellent (P < 0.00005); also, aVR was found to be a reliable index of the six limb leads in repeat ECGs in the patients with various EDST, CHF, or undergoing HD, in whom changes in aVR correlated with changes in patients' body weight.

CONCLUSION

aVR could be taken as an index of all ECG limb leads in analysis in general, and in monitoring patients with EDST, CHF, and HD in particular.