Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review

Background: Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature. Objective: Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes. Methods: A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review. Results: Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions. Conclusion: The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.

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ECG SIGNAL GENERATION AND HEART RATE VARIABILITY SIGNAL EXTRACTION: SIGNAL PROCESSING, FEATURES DETECTION, AND THEIR CORRELATION WITH CARDIAC DISEASES

Journal of Mechanics in Medicine and Biology ◽

10.1142/s021951941240012x ◽

2012 ◽

Vol 12 (04) ◽

pp. 1240012 ◽

Cited By ~ 4

Author(s):

GOUTHAM SWAPNA ◽

DHANJOO N. GHISTA ◽

ROSHAN JOY MARTIS ◽

ALVIN P. C. ANG ◽

SUBBHURAAM VINITHA SREE

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Sinus Bradycardia ◽

Premature Ventricular Contraction ◽

P Wave ◽

Ecg Signal ◽

Qrs Complex ◽

T Wave ◽

St Segment ◽

Cardiac Disorders

The sum total of millions of cardiac cell depolarization potentials can be represented by an electrocardiogram (ECG). Inspection of the P–QRS–T wave allows for the identification of the cardiac bioelectrical health and disorders of a subject. In order to extract the important features of the ECG signal, the detection of the P wave, QRS complex, and ST segment is essential. Therefore, abnormalities of these ECG parameters are associated with cardiac disorders. In this work, an introduction to the genesis of the ECG is given, followed by a depiction of some abnormal ECG patterns and rhythms (associated with P–QRS–T wave parameters), which have come to be empirically correlated with cardiac disorders (such as sinus bradycardia, premature ventricular contraction, bundle-branch block, atrial flutter, and atrial fibrillation). We employed algorithms for ECG pattern analysis, for the accurate detection of the P wave, QRS complex, and ST segment of the ECG signal. We then catagorited and tabulated these cardiac disorders in terms of heart rate, PR interval, QRS width, and P wave amplitude. Finally, we discussed the characteristics and different methods (and their measures) of analyting the heart rate variability (HRV) signal, derived from the ECG waveform. The HRV signals are characterised in terms of these measures, then fed into classifiers for grouping into categories (for normal subjects and for disorders such as cardiac disorders and diabetes) for carrying out diagnosis.

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Electrocardiographic parameters of the American Miniature Horse: influence of age and sex

Pesquisa Veterinária Brasileira ◽

10.1590/s0100-736x2016000600015 ◽

2016 ◽

Vol 36 (6) ◽

pp. 551-558

Author(s):

Bianca P. Santarosa ◽

Maria L.G. Lourenço ◽

Gabriela N. Dantas ◽

Carla M.V. Ulian ◽

Marta C.T. Heckler ◽

...

Keyword(s):

Age Groups ◽

Frontal Plane ◽

The Elderly ◽

P Wave ◽

Sinus Arrhythmia ◽

T Wave ◽

St Segment ◽

Electrocardiographic Parameters ◽

Electrocardiogram Ecg ◽

Age And Sex

Abstract: The veterinary cardiology has growing importance in equine medicine. There are studies of standardization of electrocardiographic parameters of many races, according to their stature and ability. However, no studies are in the literature with the American Miniature Horse. To evaluate the electrocardiogram (ECG) tracing configuration of this breed at rest and to verify the influence of age and sex on ECG parameters, 203 horses including 143 females and 60 males were divided into four age groups (foals, yearlings, adults and elderly). Electrocardiographic parameters were performed by computerized electrocardiogram (TEB), and the parameters were evaluated in six leads of frontal plane (Lead I, II, III, aVR, aVL and aVF) and base-apex (BA). Heart rates (HR) decreased with increasing age were higher in males than in females. Sinus tachycardia followed by sinus arrhythmia was dominant in both sexes. The cardiac axis was higher in males and ranged between 120° and 150° for foals, 30° and 60° for yearlings and adults, and 60° and 90° for the elderly. The P wave was bifid in several animals. The P-wave amplitude and T-wave duration from lead II and BA were larger in males than in females. The majority of the animals exhibited ST segment depression and a negative T-wave. The most common QRS complex morphology was Qr. Differences were observed between the electrocardiographic tracings of males and females, and age influenced the ECG parameters. Therefore, this study established the ECG patterns for the American Miniature Horse breed and could be used to determine the influence of age and sex on several of the studied variables.

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Changes in the Electrocardiogram and Achilles Reflex Test during Treatment of Hypothyroidism

Scottish Medical Journal ◽

10.1177/003693306901400206 ◽

1969 ◽

Vol 14 (2) ◽

pp. 59-63 ◽

Cited By ~ 1

Author(s):

R. J. Weir ◽

J. A. Young ◽

J. B. McGuinness

Keyword(s):

P Wave ◽

Qrs Complex ◽

T Wave ◽

St Segment ◽

Pr Interval ◽

Myocardial Muscle ◽

Reflex Time

In 10 patients with hypothyroidism, the electrocardiogram and Achilles reflex test have been recorded before and during treatment with l-thyroxine sodium. Aspects of the electrocardiogram affected by hypothyroidism are the rate, duration of PR interval, height of P-wave, of QRS complex and of T-wave and the ST segment. Each of these improved with therapy, the earliest and most sensitive change being the height of the QRS complex. The Achilles reflex time as recorded by the photomotograph also showed a parallel decrease with therapy but this is considered to be less reliable as an isolated test. The prolongation of the PR interval is briefly discussed and a correlation between the changes in skeletal and myocardial muscle is suggested.

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Research on the Values of Amplitudes of Electrocardiographic Waves Depending on Age in Kids

Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Veterinary Medicine ◽

10.15835/buasvmcn-vm:2020.0019 ◽

2020 ◽

Vol 77 (2) ◽

pp. 80

Author(s):

Dragos Corneliu COTOR ◽

Gabriel GAJAILA ◽

Aurel DAMIAN ◽

Ana Maria ZAGRAI ◽

Carmen PETCU ◽

...

Keyword(s):

Statistical Analysis ◽

Electric Activity ◽

P Wave ◽

Mechanical Activity ◽

Qrs Complex ◽

T Wave ◽

Electrocardiogram Ecg

The electrocardiogram (ECG) is a graphical recording of the cardiac electric activity during cardiac revolutions. This bio-current triggers and maintains the mechanical activity of the heart. Within this research, the amplitudes values of the electrocardiographic waves were determined in 6 leads: I, II, III, aVL, aVR and aVF. Thus, some electrocardiograms were recorded using limb lead in clinically healthy kids, aged 1 month, 3 months and 5 months, in order to achieve the proposed objectives. Then, the statistical analysis of the obtained results was performed using t (student) test.As a consequence of the interpretation of the obtained results, it was noticed that the limb leads can be used successfully for recording the electrocardiogram in kids because it provides an easy aspect to interpret. The highest amplitude of the electrocardiographic waves is recorded in I lead, in the case of the 1 month old kids (having the following values: 0.115 mV ± 0.010 for P wave; 0.625 mV ± 0.078 for QRS complex; 0.460 mV ± 0.045 for T wave) and in II lead (having the following values for the 3 months old kids: 0.071 mV ± 0.015 for P wave; 0.540 mV ± 0.064 for QRS complex; 0.310 mV ± 0.052 for T wave and having the following values for the 5 months old kids: 0.071 mV ± 0.015 for P wave; 0.455 mV ± 0.028 for QRS complex; 0.430 mV ± 0.026 for T wave). It also found that the lowest amplitude of electrocardiographic waves is recorded in the aVF lead, but this lead cannot be used for ECG recording in kids.

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Pulse Oximetric and ECG changes during continuous infusion of propofol in medetomidine – pentazocine and midazolam – pentazocine premedicated buffalo calves

Indian Journal of Animal Research ◽

10.18805/ijar.5719 ◽

2015 ◽

Author(s):

M. Saibaba ◽

P. Veena ◽

N. Dhana Lakshmi ◽

K. Veera Bramhaiah

Keyword(s):

Intravenous Infusion ◽

P Wave ◽

Continuous Intravenous Infusion ◽

Qrs Complex ◽

Normal Range ◽

Ecg Changes ◽

Buffalo Calves ◽

T Wave ◽

Group I ◽

Surgical Conditions

Twelve buffalo calves of either sex presented to the clinic with surgical conditions like umbilical hernia, urolithiasis and fractures were utilized to study the effect of continuous intravenous infusion of propofol after premedication with medetomidine – pentazocine and midazolam – pentazocine. The animals were divided into two groups of six animals each. Medetomidine (@ 2.5 μg/kg b.wt.) – pentazocine (@ 0.5 mg/kg b.wt.) and midazolam (@ 0.25 mg/kg b.wt.) – pentazocine (@ 0.5 mg/kg b.wt.) was given intravenously in group I and II respectively. Propofol was given intravenously (@ 4 mg/kg b.wt.) after pre-medication and maintained by continuous intravenous infusion of propofol (@ 0.4 mg/kg b.wt.) in 5 % dextrose normal saline in both groups. Pulse oximetric and electrocardographic changes were recorded at 0, 5,10,15,30 and 60 min. Saturation of oxygen percentage of haemoglobin showed significant (P £ 0.05) difference in both groups but the changes were within the normal range. Electrocardiographic studies did not reveal any abnormalities except slight variations in the amplitude of P wave, T wave and QRS complex in both groups. It is concluded that both anaesthetic drug combinations can be used safely in buffaloes as they did not alter the pulse oximetry and ECG values.

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Characteristics of the reindeer electrocardiogram

Rangifer ◽

10.7557/2.2.2.412 ◽

1982 ◽

Vol 2 (2) ◽

pp. 36

Author(s):

Jouni Timisjärvi ◽

Mauri Nieminen ◽

Sven Nikander

Keyword(s):

Heart Rate ◽

Indirect Evidence ◽

Frontal Plane ◽

Heart Beat ◽

P Wave ◽

Qrs Complex ◽

Single Plane ◽

T Wave ◽

Wide Range ◽

Electrocardiogram Ecg

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 sydämen syketiheydestä, sähköisestä johtumisesta ja välillisesti jossain määrin myös sydänlihaksen toiminnallisesta tilasta. Suurin osa tämänkaltaista tietoa voidaan saada tavanomaisia skalaarisia kytkentöjäkäyttäen, ja usein yhdessä tasossa tapahtuva rekisteröinti on riittävä. Tässä työssä on tutkittu porojen normaalia sydänsähkökäyrää ja sen eri poikkeamien suuntautumista frontaalitasossa, kun rekisteröinnissä on käytetty Einthovenin postulaattien mukaisia raajakytkentöjä. P aalto suuntautui ylöspäin kythkennöissä II, III ja aVF, alaspäin kytkennässä aVL ja vaihteli kytkennöissä I ja aVR. P vektorin suunta oli 60 - 120°. QRS kompleksi vaihteli. Tavallisimmat muodot olivat R ja rS kytkennöissä I ja aVR; R, Rs ja rS kytkennässä aVL ja Qr tai qR muissa kytkennöissä. Tavallisin QRS vektorin suunta oli 240 - 300°. T aalto vaihteli. Poikkeaminen ja intervallien kesto riippui sydämen syketiheydestä.

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Electrocardiographic changes in awassi diarrheic suckling lambs in Iraq

The Iraqi Journal of Veterinary Medicine ◽

10.30539/iraqijvm.v43i1.467 ◽

2019 ◽

Vol 43 (1) ◽

pp. 26-33

Author(s):

Islam Jawad . Alkhafaji

Keyword(s):

P Wave ◽

Qrs Complex ◽

Sinus Arrhythmia ◽

T Wave ◽

St Depression ◽

St Segment ◽

Electrocardiographic Changes ◽

Qrs Duration ◽

Awassi Lambs ◽

T Waves

This study was done to investigate the electrocardiographic changes in 90 diarrheic nursed Awassi lambs, in comparison with 10 clinically healthy lambs of the same breed. Their ages were ranged from 5 days to 2 months, in Karbala City-Iraq, from November 2015 to April 2016. The diarrheic lambs showed significant (P≤0.05) decreased duration of P-wave (0.039±0.0000001 ms and shorter QRS wave amplitudes 0.6 0±0.042 mV with duration 0.041±0.0008 ms , higher T wave amplitude and duration ( 0.25±0.034 mV and 0.070±0.002 ms) , prolonged QT (0.21±0.004 ms) but ST-segment ( 0.17±0.004 ms) were its observed sinus arrhythmia with tachycardia in lead-II in diarrheic lambs were recorded compared with non-diarrheic lambs group which their QRS duration and amplitude were it was (0.04±0.000001ms and 0.65±0.026 mV ) , T waves duration and amplitude were ( 0.076±0.004 ms and 0.21±0.012 mV ) QT interval (0.20±0.011 ms) and ST-segment ( 0.16±0.011 ms) .The morphological abnormal of ECG changes in diarrheic suckling lambs characterized by a widening or flattening, bifid(mitral) and pulmonale (tall) shape of P wave, increased P-R interval, increased duration of QRS complex and QT-prolongation, ST-depression or elevation .Inverted or board (slurring) tall, symmetric, peaked shape of T waves. These abnormal shapes appeared alternately in lead I, II, III, aVR, aVL and aVF. Conclusively the diarrheic lambs showed serious abnormal changes of electrocardiography..

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Opening the black box: interpretability of machine learning algorithms in electrocardiography

Philosophical Transactions of The Royal Society A Mathematical Physical and Engineering Sciences ◽

10.1098/rsta.2020.0253 ◽

2021 ◽

Vol 379 (2212) ◽

Cited By ~ 1

Author(s):

Matteo Bodini ◽

Massimo W. Rivolta ◽

Roberto Sassi

Keyword(s):

Machine Learning ◽

Machine Learning Algorithms ◽

P Wave ◽

Qrs Complex ◽

Ecg Signals ◽

T Wave ◽

Cardiac Abnormalities ◽

Challenges And Opportunities ◽

Clinically Significant ◽

Electrocardiogram Ecg

Recent studies have suggested that cardiac abnormalities can be detected from the electrocardiogram (ECG) using deep machine learning (DL) models. However, most DL algorithms lack interpretability, since they do not provide any justification for their decisions. In this study, we designed two new frameworks to interpret the classification results of DL algorithms trained for 12-lead ECG classification. The frameworks allow us to highlight not only the ECG samples that contributed most to the classification, but also which between the P-wave, QRS complex and T-wave, hereafter simply called ‘waves’, were the most relevant for the diagnosis. The frameworks were designed to be compatible with any DL model, including the ones already trained. The frameworks were tested on a selected Deep Neural Network, trained on a publicly available dataset, to automatically classify 24 cardiac abnormalities from 12-lead ECG signals. Experimental results showed that the frameworks were able to detect the most relevant ECG waves contributing to the classification. Often the network relied on portions of the ECG which are also considered by cardiologists to detect the same cardiac abnormalities, but this was not always the case. In conclusion, the proposed frameworks may unveil whether the network relies on features which are clinically significant for the detection of cardiac abnormalities from 12-lead ECG signals, thus increasing the trust in the DL models. This article is part of the theme issue ‘Advanced computation in cardiovascular physiology: new challenges and opportunities’.

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Abstract 17195: Hydroxychloroquine Associated Electrocardiographic Changes in Patients With COVID-19 Extend Beyond QTc Prolongation and Are Accentuated in Those With Myocardial Injury

Circulation ◽

10.1161/circ.142.suppl_3.17195 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Maen D Abou Ziki ◽

Roy Taoutel ◽

Jakob Park ◽

Romy Chamoun ◽

elio ragheb ◽

...

Keyword(s):

Myocardial Injury ◽

Illness Severity ◽

P Wave ◽

Qtc Prolongation ◽

Ecg Changes ◽

T Wave ◽

Qrs Prolongation ◽

Electrocardiographic Changes ◽

Stage Renal Disease ◽

End Stage

Introduction: Hydroxychloroquine (HCQ) is known to cause QTc prolongation, however its association with other ECG changes and how those are related to markers of myocardial injury in COVID-19 patients (pts) are not well described. Hypothesis: To study ECG changes in COVID-19 pts with or without troponin (Tn) elevation >3X normal (Tn +/-), who were or were not treated with HCQ (+/-). Methods: This is an observational study of pts admitted with COVID-19. All had at least 3 ECGs during admission; on day 1, day 2-3 and day 4-6. Pre-admission and final ECGs were included when available. Pts were excluded if they had atrial fibrillation, paced QRS, QRS>120msec, STEMI, or end stage renal disease. QRS, QTc, PR, P wave duration, QRS amplitude and the sum of T wave deflections in both limb and precordial leads were measured. Data were collected on medical history, illness severity, electrolytes, and medications within the 12-hour window of each ECG. Results: A total of 116 pts were included: 85 HCQ+ (40% Tn+) and 31 HCQ- (48% Tn+). There were no differences between the two groups in baseline characteristics, illness severity or mortality. Significant QTc prolongation was noted only in the HCQ+ group (p<0.001) peaking at +13.6 ms on day 5 compared to admission (p<0.01) and was accentuated in the HCQ+/Tn+ group (peak of +23.7 ms, p<0.01). QRS prolongation was seen in the HCQ+ group (p<0.001) peaking at +3.5 ms on day 5, and was accentuated in Tn+ pts peaking at +5.2 ms compared to Tn- pts +2.5 ms (p<0.05, both comparisons). The sum of precordial T-wave amplitude decreased in HCQ+ pts (-2.2 mm on final ECG, p=0.015) but this change was only significant in the Tn+ subgroup (peak of -3.6 mm, p<0.01). Finally, the PR interval was prolonged in the HCQ+ group, peaking at +7.6 ms on day 5 (p<0.01), but was again was more marked in the Tn+ subgroup (peak of +9.6 ms, p<0.05). Conclusions: HCQ related ECG effects extend beyond QTc prolongation. These are most notable in pts with evidence of myocardial injury.

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Quantification of Interpatient 12-lead ECG Variabilities within a Healthy Cohort

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-3127 ◽

2020 ◽

Vol 6 (3) ◽

pp. 493-496

Author(s):

Claudia Nagel ◽

Nicolas Pilia ◽

Axel Loewe ◽

Olaf Dössel

Keyword(s):

Healthy Subjects ◽

Large Scale ◽

Machine Learning Algorithms ◽

P Wave ◽

Qrs Complex ◽

T Wave ◽

Healthy Cohort ◽

Electrocardiogram Ecg ◽

Morphology Changes

AbstractThe morphology of the electrocardiogram (ECG) varies among different healthy subjects due to anatomical and structural reasons, such as for example the shape of the heart geometry or the position and size of surrounding organs in the torso. Knowledge about these ECG morphology changes could be used to parameterize electrophysiological simulations of the human heart. In this work, we detected the boundaries of ECG waveforms, i.e. the P-wave, the QRS-complex and the T-wave, in 12- lead ECGs from 918 healthy subjects in the Physionet Computing in Cardiology Challenge 2020 Database with the IBT openECG toolbox. Subsequently, we obtained the onset, the peak and the offset of each P-wave, QRS-complex and T-wave in the signal. In this way, the duration of the P-wave, the QRScomplex and the T-wave, the PQ-, RR- and the QT-interval as well as the amplitudes of the P-wave, the Q-, R- and Speak and the T-wave in each lead were extracted from the 918 healthy ECGs. Their statistical distributions and correlation between each other were assessed. The highest variabilities among the 918 healthy subject were found for the RR interval and the amplitudes of the QRScomplex. The highest correlation was observed for feature pairs that represent the same feature in different leads. Especially the R-peak amplitudes showed a strong correlation across different leads. The calculated feature distributions can be used to optimize the parameters of populations of cardiac electrophysiological models. In this way, realistic in-silico generated surface ECGs can be simulated in large scale and could be used as input data for machine learning algorithms for a classification of cardiovascular diseases.

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