Deriving the 12-lead electrocardiogram from four (EASI) electrodes

Dower, Gordon E.; Yakush, A.; Nazzal, Sami; Jutzy, Roy V.; Ruiz, Cynthia E.

doi:10.1016/0022-0736(88)90090-8

Cited by 207 publications

(82 citation statements)

References 7 publications

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“…These mechanisms include (1) prenatal exposure to cocaine causing coronary vasospasm in infants, 97 (2) cardiotoxicity during the treatment of severe childhood asthma, 98 (3) intraoperative hypoxia during repair of congenital defects, 99 (4) blunt chest trauma, 96 (5) coronary artery disease from Kawasaki disease, 100 (6) acute myocarditis, 101 and a diverse range of other cardiac conditions. 102 It may not be feasible to perform ST-segment monitoring in hospitalized children because neonatal and pediatric intensive care units may not be equipped with cardiac monitors that have ST-segment measurement software.…”

Section: Pediatric Patients At Risk Of Ischemia or Infarction Resultimentioning

confidence: 99%

“…During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity.…”

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confidence: 99%

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Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Drew

Funk

2006

Critical Care Nursing Clinics of North America

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential co...

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Section: Pediatric Patients At Risk Of Ischemia or Infarction Resultimentioning

confidence: 99%

mentioning

confidence: 99%

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Drew

Funk

2006

Critical Care Nursing Clinics of North America

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“…The EASI lead system is a reduced 5-lead set that uses the E, A, and I electrodes from the Frank lead system and adds an electrode, S, at the top of the mid sternum, along with a ground reference electrode to provide orthogonally oriented signals. 113 In addition to orthogonal data, transfer coefficients have been developed for the EASI lead system that produce synthesized 12-lead ECGs. 114 Advantages of the EASI lead system for patient monitoring applications are the absence of limb electrodes, which allows the patient to move around without intolerable noise in the ECG signal, elimination of the need to determine intercostal spaces, and avoidance of the breast.…”

Section: Reduced Lead Setsmentioning

confidence: 99%

Recommendations for the Standardization and Interpretation of the Electrocardiogram

Kligfield¹,

Gettes²,

Bailey³

et al. 2007

Circulation

530

152

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Abstract-This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Key Words: AHA Scientific Statements Ⅲ electrocardiography Ⅲ computers Ⅲ diagnosis Ⅲ electrophysiology Ⅲ intervals Ⅲ potentials Ⅲ tests I n the century since the introduction of the string galvanometer by Willem Einthoven, 1 the electrocardiogram (ECG) has become the most commonly conducted cardiovascular diagnostic procedure and a fundamental tool of clinical practice. 2,3 It is indispensable for the diagnosis and prompt initiation of therapy in patients with acute coronary syndromes and is the most accurate means of diagnosing intraventricular conduction disturbances and arrhythmias. Its interpretation may lead to the recognition of electrolyte abnormalities, particularly of serum potassium and calcium, and permit the detection of some forms of genetically mediated electrical or structural cardiac abnormalities. The ECG is routinely used to monitor patients treated with antiarrhythmic and other drugs, in the preoperative assessment of patients undergoing noncardiac surgery, and in screening individuals in high-risk occupations and, in some The American Heart Association, the American College of Cardiology, and the Heart Rhythm Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Copies: This document is available on the World Wide Web sites of the American Heart Association (www.americanheart.org) and the American College of Cardiology (www.acc.org). A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0389. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml? Identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2007 American...

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“…[22][23][24] Tanabe et al produced a 9-lead Holter monitor using switching methods, 25 and Dower et al reported on the efficacy of deriving a 12-lead ECG from 4 electrodes. 26 In 1987, Krucoff et al introduced a computer-assisted 12-lead electrocardiographic monitor (Mortara ELI-100/STM), 27 which provided multiple ECG acquisition and real-time analyses of the ST segment. This system was used for the noninvasive detection of reperfusion or silent coronary reocculusion after thrombolysis therapy in patients with acute myocardial infarction, 28 and for the detection of silent myocardial ischemia.…”

Section: Other New Devicesmentioning

confidence: 99%

Detection of Myocardial Ischemia With a Computer-Assisted 12-lead 24-hour ECG Monitoring System (EAGLE) in Patients With Suspected Unstable Angina

et al. 1998

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This study was undertaken to evaluate the diagnostic value of a new device, the 'EAGLE' computer-assisted multiple-lead long-term electrocardiography (ECG) monitoring and analyzing system, in patients with suspected unstable angina, and to compare the results with the Holter monitor. A total of 101 patients with a history of suspected unstable angina underwent a simultaneous 24-h examination with the EAGLE and 2-channel Holter monitors. The diagnosis of unstable angina was established in 70 patients: 41 had significant organic stenosis, and 29 had coronary spasm. Ischemic ST deviations were detected 229 times in 44 patients (62.9%) with the EAGLE system and 101 times in 20 patients (28.6%) with the Holter monitor. The sensitivity of myocardial ischemia in unstable angina with the EAGLE system was significantly higher than that with Holter monitor (62.9 vs 28.6%, p<0.05). The difference of sensitivity was due mainly to the low detection rate of the Holter monitor for asymptomatic myocardial ischemia (EAGLE vs Holter ; 187 times vs 72 times) and myocardial ischemia in the infero-posterior area in patients with organic stenosis (30 times vs none). It is concluded that the EAGLE system is a sensitive tool for the diagnosis of unstable angina in patients without significant ECG changes, and an excellent tool for evaluating silent myocardial ischemia or myocardial ischemia of the infero-posterior area. (Jpn Circ J 1998; 62: 586 -591)

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Deriving the 12-lead electrocardiogram from four (EASI) electrodes

Cited by 207 publications

References 7 publications

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Recommendations for the Standardization and Interpretation of the Electrocardiogram

Detection of Myocardial Ischemia With a Computer-Assisted 12-lead 24-hour ECG Monitoring System (EAGLE) in Patients With Suspected Unstable Angina

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