Tag Archives: ECG

Introduction An acute myocardial infarction causes a number of electrocardiogram (ECG) changes corresponding to coronary anatomy.1,2 The posterior myocardial infarction (PMI) refers to an infarction of the posterior wall of the left ventricle (LV).3 On the 12-lead ECG, the key to detecting a PMI is through indirect evidence via ST-depression in the antero-septal (V1–V4) leads and evolving R-waves in V1 or V2 with R/S ratios >1.1 A common theory is that these evolving R-waves represent inverted Q-waves. While ST-depression typically occurs in V1–V4, it may also extend into V5 and perhaps other leads.4 In these cases, posterior occlusion

Introduction Jonathan Bennett (FY2 Doctor, London) In less than a decade since the first iPhone, smartphone technology has become more powerful and portable. The opportunity to become more connected to friends, family and information has been nearly universally embraced. The ability of the smartphone has not been underestimated, and the development of the mobile health (mHealth) industry has been rapid.1 The approval of iECG2 for mobile patient-lead telemetry, the Dexcom cutaneous blood glucose monitoring3 and most recently the Proteus Digital ingestible sensor to promote medication adherence4 prove, not only how powerful the technology is, b

In the last few articles in this series, we have considered the methodological approach of working through an electrocardiogram (ECG), shared a few ‘hot tips’ and discovered the importance of actually looking at the ECG rather than relying on the digital interpretation! We have seen examples of how the digital interpretation can be very misleading at best, and totally inaccurate at worst. Hopefully by now, you know how to simply describe what you see, and from there build up the pieces of information to create a reasonable interpretation. So this issue, we are going to study an abnormal ECG and work through it. Here we are faced with a ty

Introduction Electrocardiogram (ECG) is a common investigation carried out in the Emergency Department (ED) and provides important information for both diagnosis and prognosis. In the pre-primary coronary intervention era, ECG had been the key investigation for the prompt diagnosis and management of patients with acute myocardial infarction, particularly those with ST elevation.1-5 Since primary coronary angioplasty became widely available in the UK, patients with typical ST-elevation myocardial infarction are filtered directly to specialist centres by the ambulance service. Acute coronary syndrome (ACS) patients without typical ST elevation

Introduction Screening has been proposed as a method to detect patients with undiagnosed atrial fibrillation (AF) as it is a dangerous, prevalent condition that may be easily diagnosed with a simple low-cost test, an electrocardiogram (ECG), and the risk of serious sequelae such as ischaemic stroke can be effectively reduced with anticoagulation.1 Hence, it fulfils the Wilson Jungner criteria for a screening programme.2 The potential benefits of AF screening are far reaching, as reducing stroke prevalence has massive implications for both patients and health services in the UK, where stroke consumes approximately 5% of total National Health S

Moreover, the quality of ECG interpretation remains completely obscure to the patient. When any healthcare professional speaks to a patient about that patient’s ECG, the patient automatically assigns to the healthcare professional a degree of competence in the said professional’s ability to read the ECG, which the patient (very reasonably) presumes the professional to have. Sadly, this confidence is usually misplaced. Furthermore, the healthcare workers themselves are often completely unaware of their lack of competence. Possible solutions There are three possible approaches to the alleviation of this problem: (i) the use of computers in

Normal values Firstly, the most important things to know, are normal values. Providing the paper speed is standard at 25 mm/second, then each small square = 0.04 seconds. So the only other thing you need to know, in order to correctly identify ECG abnormalities, is your 4 times table! Simple. Looking at figure 1, you can see the following: 1 small square on an ECG trace (at 25 mm/s speed) = 0.04 s The P wave 0.08–0.11 seconds (2–3 small squares) PR interval 0.11–0.20 seconds (3–5 small squares) QRS complex 0.06–0.11 seconds (1.5–2.5 small squares) QT interval 0.36–0.44 (9–11 small squares). Figure 1. What’s what in an ECG

Dr Heather Wetherell And what (if anything) can you do about it? If you find ECGs intimidating, you are not alone. Help is at hand! We are pleased to announce this new BJC series which is aimed at, “keeping the art of ECG interpretation alive in primary care”, in the words of series author, Dr Heather Wetherell (above). Heather, a general practitioner and a GP with a Special interest in Cardiology at James Cook University Hospital, Middlesbrough, recently launched an educational blog Keeping ECGs simple. This runs alongside the Twitter forum, #ECGclass, which is intended to offer some easy to follow ECG ‘refresher’ notes for clinician

Optimised beta blocker therapy in heart failure: is there space for additional heart rate control? Dear Sirs, We undertook a similar audit to Russell et al.1 within the heart failure service of a district general hospital auditing the case notes of 96 patients attending over three months. Applying the SHIFT inclusion and exclusion criteria, we identified only seven patients (6.7%) eligible for ivabradine. Using the SHIFT dataset the number needed to treat to prevent a single hospitalisation due to heart failure was 22.2 Extrapolating our data, over 12 months, we would expect to identify approximately 28 suitable patients. Treating 28 patients

A recent German study has shown the high diagnostic accuracy for a patient-activated, single-lead Omron Heart Scan (HCG-801-E). In the study carried out in four university hospitals in Germany, 508 consecutively enrolled patients with a clinical indication for an ECG, were asked to record a short-term ECG directly after their standard 12-lead procedure. The ECGs were analysed by a single, double-blinded observer for rhythm, intervals, amplitudes and conduction disturbances. The patient-activated system was able to detect over 90% of abnormalities in the 12-lead ECG, including ST-T wave changes and bundle branch block. Patients found the syste