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In JoVE (1)

Other Publications (65)

Articles by Mary G. Carey in JoVE

 JoVE Medicine

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

1Orvis School of Nursing, University of Nevada, Reno, 2The State University of New York at Buffalo, St. Joseph's Medical Center, 3Strong Memorial Hospital, University of Rochester Medical Center

JoVE 50124

Continuous 12-lead electrocardiographic (ECG) monitoring can identify transient myocardial ischemia, even when asymptomatic, among patients with suspected acute coronary syndrome (ACS). In this article we describe our method for initiating patient monitoring using a Holter device, downloading the ECG data for off-line analysis, and how to utilize the ECG software to identify transient ischemia.

Other articles by Mary G. Carey on PubMed

Rhythmic Premature Ventricular Contractions

Enhanced Automaticity of the His Bundle

Resynchronization Therapy

ST-segment Changes in Right Ventricular Paced Rhythms

Differentiating ST-Segment Strain Pattern From Acute Ischemia

Long QT Syndrome

Nonsustained Ventricular Tachycardia in the Elderly

ECG Changes During Induced Hypothermia After Cardiac Arrest

Evaluating Pacemaker Function with Full Disclosure

P Wave Alterations

Cardiac Arrhythmias After Traumatic Amputation

Interpreting 12-lead Electrocardiograms for Acute ST-elevation Myocardial Infarction: What Nurses Know

In patients with acute myocardial infarction, early reperfusion and sustained patency of the culprit artery are important determinants of survival. The 12-lead electrocardiogram (ECG) is considered the noninvasive gold standard for identification of acute ST-elevation myocardial infarction. Nurses play a critical role in the process of obtaining, interpreting, and communicating ECG findings. This study evaluates nurses' ability to differentiate ischemic from nonischemic ECG patterns, to detect affected ECG leads and location of ischemia, and assesses skill level by hospital unit type. Seventy-five nurses were given a set of 6 patient scenarios, each with a corresponding 12-lead ECG, and asked to identify the presence or absence of ischemia. Fourteen (19%) of the 75 nurses correctly identified the presence or absence of ischemia in all 6 scenarios. Of the 3 ECGs with a myocardial infarction pattern, 59 (79%) of the nurses identified all 3 as ischemic; however, no one was able to determine the correct leads, location, or amplitude of ST-segment elevation. For the 3 nonischemic ECGs, 37 (49%) of the nurses identified a normal ECG as ischemic, 47 (63%) determined that an early repolarization pattern was ischemic, and 34 (45%) indicated that a left bundle branch block pattern was ischemic. These results not only identify educational opportunities but also provide important information for researchers implementing clinical trials evaluating the use of bedside ECG monitoring systems for detection of acute myocardial ischemia.

Slow Escape Rhythms

Smoked Out: Emergency Evacuation of an ICU

ECG Marker of Nontransmural Myocardial Infarction

American Heart Association: Council on Cardiovascular Nursing Department

ECG Characteristics of a Genetic Disorder

Rapid Ventricular Response

Abnormal Conduction

American Heart Association: Council on Cardiovascular Nursing Department

Electrocardiographic Predictors of Sudden Cardiac Death

Sudden cardiac death (SCD) is widespread and the most serious of the cardiac diseases, accounting for over half of cardiovascular mortality in adults in the United States, and nearly 1 in 3 of these patients does not report symptoms of cardiac disease before the sudden death. Quantifying the left ventricular ejection fraction is currently the best way to risk-stratify patients for SCD and identify those who are most likely to benefit from the insertion of an implantable cardiac defibrillator (ICD). The strategy of systemically placing ICDs in patients at risk of SCD is expensive and leads to substantial psychological hardship. However, noninvasive electrocardiographic indices of depolarization and repolarization may better identify patients who are at an increased risk of SCD. Therefore, developing an approach to identify electrocardiographic changes associated with the highest risk of arrhythmic death could markedly improve patient selection for ICD therapy. This report describes electrocardiographic parameters that may be useful in identifying patients at risk of SCD. The state of the science currently suggests that it is unlikely that a single electrocardiographic parameter will predict SCD, but rather a risk stratification algorithm based on a combination of electrocardiographic parameters may yield the best result.

Cornell Voltage Criteria

Multilead Monitoring

Traumatic Injuries

Reduced and Alternative Lead Sets: Clinical Implications and Technical Challenges

ECG Computer Algorithms

Predictors of Pre-hospital Delay Among Patients with Acute Myocardial Infarction

To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI).

Resting Parasympathetic Tone

Symptomatic Bradycardia

American Heart Association: Scientific Council of Cardiovascular Nursing

Long Pause

Predictors of Decision Delay to Seeking Health Care Among Jordanians with Acute Myocardial Infarction

To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI).

Complaints of Skipped Beats

Sinus Node Dysfunction

High-resolution 12-lead Electrocardiograms of On-duty Professional Firefighters: a Pilot Feasibility Study

Cardiovascular deaths among on-duty firefighters are high--double that of police officers and quadruple that of first responders. The aim of this pilot study was to establish the feasibility of obtaining high-resolution electrocardiograms (ECGs) of on-duty firefighters useful for detecting ECG predictors for cardiac events.


Improving Nurses' Ability to Identify Anatomic Location and Leads on 12-lead Electrocardiograms with ST Elevation Myocardial Infarction

ST segment elevation on the electrocardiogram (ECG) signifies complete occlusion of a coronary artery. Nurses play a significant role in obtaining, interpreting, and communicating 12-lead ECG findings.

Adenosine During Arrhythmia

The Selvester QRS Score is More Accurate Than Q Waves and Fragmented QRS Complexes Using the Mason-Likar Configuration in Estimating Infarct Volume in Patients with Ischemic Cardiomyopathy

Infarct volume independently predicts cardiovascular events. Fragmented QRS complexes (fQRS) may complement Q waves for identifying infarction; however, their utility in advanced coronary disease is unknown. We tested whether fQRS could improve the electrocardiographic prediction of infarct volume by positron emission tomography in 138 patients with ischemic cardiomyopathy (ejection fraction, 0.27 +/- 0.09). Indices of infarction (pathologic Q waves, fQRS, and Selvester QRS Score) were analyzed by blinded observers. In patients with QRS duration less than 120 milliseconds, number of leads with pathologic Q waves (mean, 1.6 +/- 1.7) correlated weakly with infarct volume (r = 0.30, P < .05). Adding fQRS increased the number of affected leads (3.6 +/- 2.5), but the significant correlation with infarct volume was lost (r = 0.02, P = .10). Selvester Score was the most accurate (mean, 5.9 +/- 4.9 points; r = 0.49; P < .001). Fragmented QRS was not predictive of infarct size in patients with QRS duration of at least 120 milliseconds (r = 0.02, P = .19). Thus, in ischemic cardiomyopathy, consideration of fQRS complexes does not improve Q wave prediction of infarct volume; but Selvester Score was more accurate.

Patient-surrogate Agreement of Predictors of Decision Delay Among Patients with Acute Myocardial Infarction: a Questionnaire Survey

Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events.

Dynamic Conduction Defects

Conduction System Disease

Pharmacological Cardiosuppression

Evolving Myocardial Infarction

Discordant T Waves

A Low-glycemic Nutritional Fitness Program to Reverse Metabolic Syndrome in Professional Firefighters: Results of a Pilot Study

The risk for cardiovascular events is higher for those with metabolic syndrome (MetS), and it is known that firefighters have a 4-fold risk for cardiovascular events. The purpose of this study was to quantify MetS prevalence and evaluate the effect of a low-glycemic nutritional fitness program on the reduction of MetS risk factors among firefighters.

Council on Cardiovascular Nursing

Bedside Monitoring for Transient Myocardial Ischemia

Exercise Stress Treadmill Testing

American Heart Association: Council on Cardiovascular Nursing

Computerized Algorithms

Sleep Problems, Depression, Substance Use, Social Bonding, and Quality of Life in Professional Firefighters

Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters.

Coronary Artery Dominance

Increased T Wave Complexity Can Indicate Subclinical Myocardial Ischemia in Asymptomatic Adults

Altered ventricular repolarization and cardiovascular mortality are closely correlated, and recent novel findings show that a distorted T wave loop morphology is also strongly correlated with subsequent onset of myocardial infarction among patients with stable angina. Therefore, we hypothesized that an abnormal T wave complexity ratio (CR) can indicate vulnerability to myocardial ischemia in asymptomatic, apparently healthy adults.

AHA Council on Cardiovascular Nursing

New QRS Criteria

A New Puzzler Guide

Council on Cardiovascular Nursing

Congenital Anomaly

ECG Screening of Special Populations

Impaired Impulse Formation

High-risk Electrocardiographic Parameters Are Ubiquitous in Patients with Ischemic Cardiomyopathy

The electrocardiogram (ECG) can be used to predict cardiovascular risk; however, like all risk factors with imperfect specificity, studies in low risk populations have been plagued by poor predictive accuracy. Although predictive accuracy might be improved among cohorts with a higher likelihood of cardiovascular events, this would also affect the prevalence of abnormal parameters and their exclusions.

Indices of Sudden Cardiac Death

Sudden Shortness of Breath and Anxiety

The Influence of Indirect Collective Trauma on First Responders' Alcohol Use

Previous research has suggested increased risk for negative outcomes such as increased alcohol use among first responders who are involved with the response to a community disaster; however it is not clear how indirect exposure to a critical incident impacts first responders. This work examined the impact of secondary or indirect trauma on changes in alcohol use among urban firefighters who were not directly involved in the response to a large scale community-level disaster. Firefighters enrolled in larger trial of health outcomes whose interview period coincided with the crash of a commercial airplane were the basis for the current report. Aggregate level data on changes in alcohol consumption for these firefighters were examined pre- and post-incident. There was a significant increase in alcohol use following the critical incident. This increase did not occur immediately; it was observed within several days and peaked about 8 days post-incident. Post-hoc analyses revealed that the increased alcohol consumption persisted for several months, finally returning to pre-incident levels by 8 months post-incident. Indirect trauma effects, likely operationalized in part through the "brotherhood" of the firefighters, clearly placed firefighters at risk for negative outcomes following a disaster. Intervention/prevention efforts aimed at distress reduction among first responders should not solely focus on responders with direct involvement in a disaster.

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