Identification of the optimal electrocardiographic leads for detecting acute epicardial injury in acute myocardial infarction

Aldrich, Harry R.; Hindman, Nancy B.; Hinohara, Tomoaki; Jones, Michael; Boswick, Jane M.; Lee, Kerry L.; Bride, Wanda; Califf, Robert M.; Wagner, Galen S.

doi:10.1016/s0002-9149(87)80062-0

Cited by 54 publications

(22 citation statements)

References 17 publications

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“…For identification of ST changes in established AMI, leads III and V 2 have been suggested to be optimal. 24 However, these results are not immediately applicable to ED patients with suspected ACS. First, many ED patients with ACS do not have ST-segment changes at all but, rather, T-wave inversions, new Q waves, or no ECG changes at all, and the ECG changes may, in turn, be due to subtotal and varying occlusion of branches of the large coronary arteries.…”

Section: Discussionmentioning

confidence: 93%

Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome

Green

Ohlsson

Forberg

et al. 2007

Journal of Electrocardiology

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Section: Discussionmentioning

confidence: 93%

Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome

Green

Ohlsson

Forberg

et al. 2007

Journal of Electrocardiology

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“…The frequency response was set at the range of 0.05-150Hz and the sampling rate was 500 Hz. The admission ECG was used to designate the location of the acute ischemia based on ST deviation patterns according to the method described by Aldrich et al (22). To estimate MI size from the ECG, the 50-criteria/31-point Selvester QRS scoring system was employed.…”

Section: Electrocardiographic Recordings and Analysismentioning

confidence: 99%

Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram

Engblom

Hedström

Heiberg

et al. 2005

American Heart Journal

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“…For example, although V 1 is an excellent lead for diagnosing arrhythmias with a wide QRS complex (bundle-branch blocks, ventricular pacemaker rhythms, and wide QRS tachycardias), it is insensitive for detecting acute myocardial ischemia. 83,116,117 …”

Section: Common 5-electrode Limb Leads Plus 1 Precordial Lead Combinamentioning

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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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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Identification of the optimal electrocardiographic leads for detecting acute epicardial injury in acute myocardial infarction

Cited by 54 publications

References 17 publications

Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome

Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome

Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram

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

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