The Exercise Electrocardiogram in Diagnosis

Blackburn, Henry

doi:10.1159/000169853

Cited by 12 publications

(5 citation statements)

References 7 publications

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“…A threelead electrocardiogram (Blackburn, 1969) was recorded continuously (CASE, Marquette, U.S.A.), together with a phonocardiogram (Cambridge Instruments) from the aortic area. The phonocardiogram was used to precisely define end-ejection from the aortic second sound during Doppler signal analysis, and was particularly useful on exercise where low-frequency artifacts in the signal sometimes obscured the nadir of the blood velocity signal (see Fig.…”

Section: Exercise Protocolsmentioning

confidence: 99%

The Effects of Exercise and Subject Age on Pulsed Doppler Measurements of Left Ventricular Ejection in Normal Man

et al. 1988

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SUMMARYPulsed Doppler measurements of ascending aortic blood velocity and acceleration were made in a group of normal subjects on exercise. The aims of the study were: (1) to document the normal response to exercise and its variability at various ages as a baseline for future studies in abnormal subjects, and (2) to investigate the accuracy and reproducibility of these noninvasive measurements. Doppler measurements were related to oxygen consumption in normal subjects aged between 22 and 69 years, during a submaximal 4 min incremental cycle exercise protocol. Computer-aided ensemble averaging of digital spectral data was used to reduce the effects of noise and respiratory variations in the signals. The mean relationship between cardiac output (Q) and oxygen consumption (VO2) was Q = 575 V. +422 1 min-1, r = 0-84 in subjects aged under 45 years, compared to Q = 6-16 VO +3-87 1 min-1, r = 0-65 in older subjects; this difference was not significant. These values are slmilar to those previously described in invasive studies. There was a wide range of individual responses especially in the older subjects. These inter-subject differences probably reflect true physiological differences between subjects rather than methodological errors because they were consistent on repeated testing in the same individual, similar differences occurred in heart-rate responses between individuals where Doppler errors do not apply, and inter-subject variability of similar magnitude was found in comparable studies using invasive methods. Peak velocity (PV) rose from 73 + 10 cm s-' at a 0Oof 0-4 1 min-' to 101 + 11 cm s-1 at a Vo of 12 1 min-' in subjects aged under 45 years; corresponding values in the older subjects were significantly lower at 48 + 12 and 64+10 cm s-1 respectively. Maximum acceleration was also significantly higher at rest and on exercise in subjects under 45 years compared to older subjects. Despite these differences, stroke volume and cardiac output responses showed no significant age dependence, suggesting that differences in ejection velocity are due to increasing aortic cross-sectional area with age. The wide variety of individual responses found suggests an underlying variability in the arteriovenous oxygen difference on exercise between subjects.

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Section: Exercise Protocolsmentioning

confidence: 99%

The Effects of Exercise and Subject Age on Pulsed Doppler Measurements of Left Ventricular Ejection in Normal Man

et al. 1988

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“…Intra-observer variation from one reading to another is 8 to 37% (Detre et al, 1975), with an average reader to reader variability of 21% (Zir et al, 1975). One must thus suspect that some "false positive" results are a reflection upon the angiogram rather than the ECG (Blackburn, 1977). In a proportion of "false positive" diagnoses, the angiogram shows a minor degree of coronary obstruction (30-50%); this is not usually regarded as significant disease, but nevertheless it may be sufficient to cause ischaemia in some regions of the myocardium (Ellestad and Halliday, 1967).…”

Section: Reference Criteria For Exercise Testsmentioning

confidence: 99%

“…stress ECG are improved by (i) carrying out near maximum rather than low intensity exercise, (ii) the use of multiple rather than single ECG leads and (iii) recording the electrocardiogram during and following exercise. Additional prognostic information can be derived according to Ellestad and Halliday in 1967 from the intensity of exercise at which ST depression is provoked, the contour of the ST segment, persistence of ST depression into the recovery period, and concordance of exercise and recovery records (Blackburn, 1977). However, even if a 12-lead ECG is recorded during exercise and recovery, with the test carried to 85% of maximum effort, the sensitivity relative to angiography is under 80%, while the specificity is around 90%.…”

Section: Reference Criteria For Exercise Testsmentioning

confidence: 99%

Prognostic value of exercise testing for ischaemic heart disease.

Shephard¹

1982

Br J Sports Med

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“…In contrast in 40 patients with angiocardiographically proven coronary artery disease it was possible clearly to outline the distribution, severity, and time course of praecordial areas of ST segment depression (36 patients) and ST segment elevation (10 patients). In addition these praecordial areas of ST segment changes were accompanied by a regional and significant fall in the R/S.The praecordial electrocardiogram with exercise complements the anatomical information obtained from the coronary arteriogram by clearly outlining electrocardiographic projections of regional myo--cardial ischaemia or cell death.The exercise electrocardiogram has long been used in the diagnosis and evaluation of patients with coronary artery disease (Bruce and McDonough, 1969;Sheffield and Roitman, 1975;Blackburn, 1977). Interest has centred on ST segment changes on exercise (Roitman et al, 1970;Redwood et al, 1977) though in recent years changes in the QRS vector have been described (Kilpatrick, 1976).…”

mentioning

confidence: 99%

“…The exercise electrocardiogram has long been used in the diagnosis and evaluation of patients with coronary artery disease (Bruce and McDonough, 1969;Sheffield and Roitman, 1975;Blackburn, 1977). Interest has centred on ST segment changes on exercise (Roitman et al, 1970;Redwood et al, 1977) though in recent years changes in the QRS vector have been described (Kilpatrick, 1976).…”

mentioning

confidence: 99%

Projection of electrocardiographic signs in praecordial maps after exercise in patients with ischaemic heart disease.

Fox¹,

Selwyn²,

Shillingford³

1979

Heart

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suMMARY Praecordial surface maps of the electrocardiogram were recorded before and after exercise using 16 electrodes covering the left hemithorax. The ST segment and R and S wave changes were measured in the praecordial maps from 20 individuals with no detectable cardiovascular disease. These showed no significant alteration in ST segments or R/S. In contrast in 40 patients with angiocardiographically proven coronary artery disease it was possible clearly to outline the distribution, severity, and time course of praecordial areas of ST segment depression (36 patients) and ST segment elevation (10 patients). In addition these praecordial areas of ST segment changes were accompanied by a regional and significant fall in the R/S.The praecordial electrocardiogram with exercise complements the anatomical information obtained from the coronary arteriogram by clearly outlining electrocardiographic projections of regional myo--cardial ischaemia or cell death.The exercise electrocardiogram has long been used in the diagnosis and evaluation of patients with coronary artery disease (Bruce and McDonough, 1969;Sheffield and Roitman, 1975;Blackburn, 1977). Interest has centred on ST segment changes on exercise (Roitman et al., 1970;Redwood et al., 1977) though in recent years changes in the QRS vector have been described (Kilpatrick, 1976). Though the praecordial electrocardiogram using 36 to 72 leads is being used to study the natural history of acute myocardial infarction and the effect of interventions (Maroko et al., 1972;Selwyn et al., 1977a;Selwyn and Shillingford, 1977), this technique has not been widely applied to the exercise electrocardiogram. This is the result of difficulties in recording the surface electrocardiogram before transient changes have regressed and in designing an adequate electrode system which is stable during severe exertion. In a recent study, a technique for recording the praecordial electrocardiogram, using conventional equipment available in most hospitals, has been described (Fox et al., 1978). The purpose of the present study is to describe the variety of praecordial electrocardiographic abnormalities that occur on exercise.'This work was supported by a grant from the British Heart Foundation and Welcome Trust.Received for publication 13 February 1979 Methods Twenty normal male volunteers (aged 28 to 74, mean 52 years) and 40 consecutive male patients (aged 32 to 72, mean 54 years) with a typical history of angina pectoris, ST segment changes after exercise, and anatomical evidence of coronary artery disease shown by coronary arteriography were studied. Routine 12 lead electrocardiograms were recorded in all patients. All patients were in sinus rhythm at rest. Patients whose electrocardiograms showed abnormalities in the mean frontal axis (that is beyond -30°and + 120°) or QRS duration more than 110 ms before exercise were excluded from the study.Praecordial exercise electrocardiograms were recorded using a direct writing ink jet Mingograf (Elema-Schonander) recording on four channels si...

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The Exercise Electrocardiogram in Diagnosis

Cited by 12 publications

References 7 publications

The Effects of Exercise and Subject Age on Pulsed Doppler Measurements of Left Ventricular Ejection in Normal Man

The Effects of Exercise and Subject Age on Pulsed Doppler Measurements of Left Ventricular Ejection in Normal Man

Prognostic value of exercise testing for ischaemic heart disease.

Projection of electrocardiographic signs in praecordial maps after exercise in patients with ischaemic heart disease.

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