Methodology of ECG Interpretation in the AVA Program

AbstractThe AVA program combines a thirty-year history with an approach that remains innovative; namely: multivariate statistical analysis on orthogonal ECG leads. Its diagnostic reference base includes only diagnoses independently verified by non-ECG criteria. The diagnostic module assesses probabilities of nine alternative disease categories, based on QRS-T parameters; or four other categories in case of conduction defects. Probabilities of left or right atrial overload are also computed. The program also recognizes wall injury, T-wave abnormalities, electrolyte disturbances, myocardial ischemia, and makes differential diagnoses between strain and digitalis effects. An arrhythmia classification module can generate any of 40 rhythm statements. Signal recognition is based on the spatial velocity function. The program has been translated to a microcomputer version.

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Abstract 3265: A Comparison of Echocardiographic and Electrocardiographic Characteristics of Patients with Apical Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.116.suppl_16.ii_734-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Josepha Binder ◽

Brandon R Grossardt ◽

Christine Attenhofer Jost ◽

Kyle W Klarich ◽

Michael J Ackerman ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Ejection Fraction ◽

Left Ventricular ◽

Right Atrial ◽

Apical Hypertrophic Cardiomyopathy ◽

T Wave ◽

Atrial Enlargement ◽

Lv Ejection Fraction ◽

The Relationship ◽

T Waves

Background: Apical hypertrophic cardiomyopathy (apical HCM) is a less common subtype of HCM characterized by a focal thickening in the left ventricular apex. “Classic” ECG features have been described, however, apical HCM can persist for many years without detection. We investigated the relationship between ECG findings and echocardiographic morphometry in a large referral series of patients with apical HCM. Methods: We enumerated all patients diagnosed with apical HCM prior to Sept. 30, 2006 using the Mayo Clinic HCM database. We compared echocardiographic measures separately for patients with positive status for two ECG indices of left ventricular hypertrophy (LVH); the Sokolow-Lyon index and the Romhilt-Estes (RE) point-score. We also compared echocardiographic measurements in patients with and without negative T-waves in the precordial leads. Results: Apical HCM was detected in 177 patients (111 men and 68 women). Only 51% had positive Sokolow criteria and 51% had positive RE criteria. The agreement between Sokolow and RE status was high (agreement = 75.0%; kappa = 0.50; 95% CI = 0.38 – 0.62). In particular, Sokolow positive patients had increased LV ejection fraction (P = 0.02), and decreased LV end-systolic diameter (P = 0.03) compared with Sokolow negative patients. The prevalence of right atrial enlargement (47 vs. 28%; P = 0.02) and intracavity obstruction (22 vs. 8%; P = 0.01) were more common in Sokolow positive patients. Positive RE criteria was associated with a greater thickness of the basal septal and basal posterior walls (P = 0.001 and 0.02, respectively), and with a higher frequency of intracavity obstruction (21 vs. 9%; P = 0.04). Most patients (89%) exhibited at least one negative T-wave in the precordial leads; however, only 10% of patients had a negative T-wave of greater than 1.0 mV. We found that patients with an inverted T-wave larger than 0.4 mV (median) had a significantly increased LV ejection fraction (P = 0.03) compared with patients who had smaller or no negative T-waves. Conclusions: Among patients with apical HCM, nearly half do not have ECG evidence of LVH based on classic criteria and most do not have marked T-wave inversions. However, the majority did have at least a mild expression of negative T-waves.

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ECG criteria for right atrial enlargement

Archives of Internal Medicine ◽

10.1001/archinte.143.11.2155 ◽

1983 ◽

Vol 143 (11) ◽

pp. 2155-2156 ◽

Cited By ~ 1

Author(s):

W. C. Reeves

Keyword(s):

Right Atrial ◽

Atrial Enlargement ◽

Ecg Criteria

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P-305 Symmetrical T wave Inversion in Precordial ECG Leads; Should We Consult Dr. HJ Wellens?

CVD Prevention and Control ◽

10.1016/s1875-4570(09)60497-6 ◽

2009 ◽

Vol 4 ◽

pp. S138

Author(s):

Ali Mehmood Raufi ◽

Muaz Urabi ◽

Muhammad Asad Ali ◽

Muhammad Adnan Raufi

Keyword(s):

T Wave ◽

Wave Inversion ◽

Ecg Leads

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Inconstancy Of PGI2 Administration In Preventing Attacks Of Prinzmetal Angina

10.1055/s-0038-1652795 ◽

1981 ◽

Author(s):

S Chierchia ◽

R De Caterina ◽

F Crea ◽

W Bernini ◽

A Distante ◽

...

Keyword(s):

Healthy Volunteers ◽

Pulmonary Arterial Pressure ◽

Left Ventricular Pressure ◽

Left Ventricular ◽

Right Atrial ◽

Arterial Blood ◽

Pulmonary Arterial ◽

Local Defects ◽

Ecg Leads

It has been proposed that vasospastic angina, eventually due to local defects of PGI2 production, might benefit from PGI2 administration. We therefore investigated the effects of PGI2 in healthy volunteers and, then, in patients with frequent ischemic episodes (IE) of Prinzmetal angina, to detennine 1. hemodynamic, antiplatelet and possible side effects of the drug and 2. its possible therapeutic usefulness in the management of IE. In 6 healthy volunteers PGI2 was infused i.v. at doses of 2.5,5,10 and 20 ng/kg/min during consecutive periods of 30 min each. Heart rate (HR) and right atrial pressure were monitored continuously; cardiac output (thermodilution in 2 subjects, indirectly by a Doppler technique in all), arterial blood pressure (BP) and in-vitro platelet aggre- gability (PA) by ADP (Born), intermittently. In 2 subjects we also measured pulmonary arterial pressure and, in one, left ventricular pressure, during the infusion and in control conditions. PGI2 was then infused in 6 pts with frequent IE at maximal well tolerable rate (6-26 ng/kg/min) for periods of 3 hours alternated with equal periods of placebo (P), continuosly recording 2 ECG leads to detect ST-T changes, and sampling blood for PA as before. In all healthy volunteers PGI2, at the highest rates of infusion, decreased significantly (p < .001) both systolic BP (-10 ± 3%, mean ± SD) and diastolic BP (-19 ± 5%) increasing HR (+ 21 ± 5%); no significant changes were observed in the other hemodynamic parameters. The maximal decrease in PA was 58 ± 30%(p <. 001). Skin flushing, restlessness and headache, sometimes observed at the highest doses, rapidly disappeared decreasing the infusion rate. In the 6 pts the same trend in BP, HR and PA was evident. 106 IE were observed. PGI2 did not affect severity, duration and number of IE (44 during P, 62 during PGI2 infusion). One of the pts, however,not clinically different from the others, showed a reduction at 10 ng/ kg/min (6 IE during P, 2 during PGI2) and a complete abolition in the 3 following periods at 20 ng/kg/min (4,3,5 IE during P vs. none duringPGI2). We conclude that 1. PGI2 can be safely administered to humans and 2. it may prevent IE is some vasospastic pts, but not in others. Different pathogenetic mechanisms are perhaps involved in apparently similar Prinzmetal anginas.

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The Accuracy of Combined Electrocardiogram Criteria to Diagnose Right Atrial Enlargement in Adults With Uncorrected Secundum Atrial Septal Defect

Clinical Medicine Insights Cardiology ◽

10.1177/1179546819869948 ◽

2019 ◽

Vol 13 ◽

pp. 117954681986994

Author(s):

Purwati Pole Rio ◽

Hariadi Hariawan ◽

Dyah Wulan Anggrahini ◽

Anggoro Budi Hartopo ◽

Lucia Kris Dinarti

Keyword(s):

Atrial Septal Defect ◽

Wave Height ◽

Transthoracic Echocardiography ◽

Predictive Value ◽

Septal Defect ◽

P Wave ◽

Right Atrial ◽

Volume Index ◽

Heart Catheterization ◽

Ecg Criteria

Background: Right atrium (RA) enlargement in uncorrected atrial septal defect (ASD) is due to chronic volume overload. Several electrocardiogram (ECG) criteria had been proposed for screening RA enlargement. This study aimed to compare the accuracy of ECG criteria in detecting RA enlargement in adults with uncorrected ASD. Methods: This was a cross-sectional study involving 120 adults with uncorrected secundum ASD. The subjects underwent ECG examination, transthoracic echocardiography, and right heart catheterization. An RA enlargement was determined with RA volume index by transthoracic echocardiography. Various ECG and combined ECG criteria were evaluated. Statistical analysis was performed to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: An RA enlargement was detected in 64.2% subjects. The P wave height > 2.5 mm in lead II criterion had the best specificity (100%) and PPV (100%), but low sensitivity (19%) and accuracy (48%). The combined 2 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1) had 82% sensitivity, 56% specificity, 73% accuracy, 77% PPV, and 63% NPV. The combined 3 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1, and P wave height > 1.5 mm in V2) had 35% sensitivity, 86% specificity, 53% accuracy, 82% PPV, and 43% NPV. Conclusions: The combined 2 ECG criteria (QRS axis > 90° and R/S ratio > 1 in V1) had increased sensitivity, better accuracy, and more balance of PPV and NPV as compared with P wave > 2.5 mm in II criterion and combined 3 ECG criteria to diagnose RA enlargement in adults with uncorrected ASD.

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ELECTROCARDIOGRAM IMAGES OF PIGS (Sus scrofa) ANESTHETIZED WITH A COMBINATION OF KETAMINE-MEDETOMIDIN AND KETAMINE-ACEPROMAZIN

Jurnal Kedokteran Hewan - Indonesian Journal of Veterinary Sciences ◽

10.21157/j.ked.hewan.v14i4.16984 ◽

2021 ◽

Vol 14 (4) ◽

Author(s):

Jessica Anggun Safitri ◽

Gunanti Gunanti ◽

Deni Noviana ◽

Sus Derthi Widhyari

Keyword(s):

Heart Rate ◽

Qt Interval ◽

Heart Rhythm ◽

Front Wall ◽

Average Heart Rate ◽

T Wave ◽

Group I ◽

St Segment ◽

Pr Interval ◽

Ecg Leads

This study aims to evaluate and compare the effects of the combination of ketamine-medetomidine and ketamine-acepromazine anesthesia on pig electrocardiogram (ECG) images. The study was conducted to see the ECG Leads II in six pigs which were divided into two groups. Group I (K1) was given a combination of ketamine (10 mg/kg BW) and medetomidine (0.08 mg/kg BW), while Group II (K2) was given a combination of ketamine (22 mg/kg BW) and acepromazine (1.1 mg/kg BW) intramuscularly. ECG recording was performed after the pigs were anesthetized at the surgical stage by attaching the recording electrodes to the front wall of the chest, front left and right ankles, and back right and left back ankles. The ECG recording used 1 voltage (1 cm = 1mV) with a speed of 25 mm/sec. The parameters observed were heart rate frequency, heart rhythm, P duration, P amplitude, PR interval, R amplitude, QRS interval, QT interval, ST segment, T wave, and Mean Electrical Axis (MEA). Data obtained from this study were analyzed by T-test. The results showed that K1 had an average heart rate of 100 x/minute, regular heart rhythm, P duration of 0.07 sec, P amplitude of 0.27 mV, PR interval of 0.17 sec, R amplitude of 0.75 mV, QRS interval of 0.05 sec, QT interval of 0.20 sec, ST segment of 0.17sec, T wave of 0.17 mV, and MEA of 83.60°; meanwhile, K2 had an average heart rate of 122 x/minute, regular heart rhythm, P duration of 0.06 mm/sec, P amplitude of 0.23 mV, PR interval of 0.14 sec, R amplitude of 0.80 mV, QRS interval of 0.04 sec, QT interval of 0.16 sec, ST segment of 0.14 sec, T wave of 0.12 mV, and MEA of 68.60. The ketamine-medetomidine combination produced good quality of anesthetics for the cardiovascular system.

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Electrocardiographic manifestations in severe hypokalemia

Journal of International Medical Research ◽

10.1177/0300060518811058 ◽

2018 ◽

Vol 48 (1) ◽

pp. 030006051881105 ◽

Cited By ~ 1

Author(s):

Xiqiang Wang ◽

Dan Han ◽

Guoliang Li

Keyword(s):

P Wave ◽

Dynamic Changes ◽

T Wave ◽

Electrolyte Disturbances ◽

St Segment ◽

Pr Interval ◽

Wave Morphology ◽

Life Threatening

Hypokalemia is one of the most common electrolyte disturbances in the clinic and it can increase the risk of life-threatening arrhythmias. Electrocardiographic characteristics associated with hypokalemia include dynamic changes in T-wave morphology, ST-segment depression, and U waves, which are often best seen in the mid-precordial leads (V2–V4). The PR interval can also be prolonged along with an increase in the amplitude of the P wave. We report a case of a patient with hypokalemia (1.31 mmol/L) who showed typical electrocardiographic characteristics of hypokalemia.

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