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In JoVE (1)

Other Publications (84)

Articles by Michele M. Pelter 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 Michele M. Pelter on PubMed

ST-elevation Myocardial Infarction

Inverted P Waves

Reperfusion Arrhythmias

Association of Transient Myocardial Ischemia with Adverse In-hospital Outcomes for Angina Patients Treated in a Telemetry Unit or a Coronary Care Unit

Little is known about the frequency or consequences of transient myocardial ischemia in patients admitted to a telemetry unit for treatment of angina.

A Class III Antiarrhythmic Agent

Reperfusion Arrhythmias

Intermittent Conduction Disturbances

Bradycardic ECG Monitoring Alarms

Comparison of a New Reduced Lead Set ECG with the Standard ECG for Diagnosing Cardiac Arrhythmias and Myocardial Ischemia

In a few patients, 12-lead electrocardiograms (ECGs) derived from reduced-lead-set configurations do not match the standard ECG. Constructing an ECG from a reduced number of standard leads should minimize this problem because some of the resultant 12 leads would always include "true" standard leads. The purpose of this study was to compare the ability of a new reduced-lead-set 12-lead ECG ("interpolated" ECG) with the standard ECG to diagnose cardiac arrhythmias and acute myocardial ischemia. The interpolated ECG uses six standard electrode sites (limb leads plus V(1) and V(5)), from which the remaining four precordial leads (V(2), V(3), V(4), and V(6)) are constructed. Standard and interpolated ECGs were compared using data from 2 prospective clinical trials involving 649 patients evaluated for 1) chest pain in the emergency department (ischemia group, n = 509) or 2) tachycardias in the cardiac electrophysiology laboratory (arrhythmia group, n = 140). Diagnoses were identical between standard and interpolated ECGs for bundle branch and fascicular blocks, left atrial enlargement, right ventricular hypertrophy, prior inferior myocardial infarction (MI), and the distinction of ventricular tachycardia from supraventricular tachycardia with aberrant conduction. There was 99% agreement for prior anterior MI (kappa, .935, P =.000). The percent agreement for acute myocardial ischemia on the initial ECG recorded in chest-pain patients in the emergency department was 99.2% (kappa, .978, P =.000). Of the 120 patients who had ST events with continuous standard 12-lead ECG monitoring, 116 (97%) also had criteria for transient ischemia with the interpolated ECG (ie, DeltaST >or= 100 microV in >or=1 lead(s) lasting >or=1 minute(s). The interpolated 12-lead ECG is comparable to the standard ECG for diagnosing multiple cardiac abnormalities, including wide-QRS-complex tachycardias and acute myocardial ischemia. The advantages of this ECG method are that the standard electrode sites are familiar to clinicians and that eight of the 12 leads are "true" standard leads. Hence, QRS-axis and morphology criteria for diagnosing wide-QRS-complex tachycardia and bundle branch and fascicular blocks are preserved.

Heart Blocks

Low Amplitude QRS

Transient Myocardial Ischemia is an Independent Predictor of Adverse In-hospital Outcomes in Patients with Acute Coronary Syndromes Treated in the Telemetry Unit

The purpose of this study was to determine whether transient myocardial ischemia (TMI) is predictive of adverse in-hospital outcomes among patients admitted to a telemetry unit with acute coronary syndrome (ACS). Design and Setting: The study was designed as a prospective clinical trial in a telemetry unit of a large, urban, university medical center.

Interpreting a Postoperative 12-lead ECG Waveform

Increased Automaticity of the AV Node

Ventricular Escape Rhythms

Non-conducted P Waves

Electrolyte Imbalances

Nonischemic ST-segment Elevation

Retrograde Atrial Conduction

Wide QRS Duration

An Evolving Myocardial Infarction

Premature Beats

Bedside Monitoring of Spinal Cord Injuries

Nonrespiratory Sinus Arrhythmia

Relative Refractory Period

ST Segment Changes in Right Bundle Branch Block

Rhythmic Premature Ventricular Contractions

Designing Prehospital ECG Systems for Acute Coronary Syndromes. Lessons Learned from Clinical Trials Involving 12-lead ST-segment Monitoring

Clinical trials in prehospital electrocardiography have focused primarily on ST elevation myocardial infarction (STEMI). The aims of this study were to determine, in patients presenting to the emergency department with acute coronary syndrome (ACS), the (1) relative frequency of various ACS types and (2) sensitivity of conventional ST-T criteria for diagnosing ischemia in non-STEMI or unstable angina.

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

New Female Catheterization Device

Data from one patient enrolled in the early phase of the ongoing clinical trial evaluating an experimental device called the Cath-Assist are presented. The device is designed to facilitate female urethral catheterization by exposing the vulvar vestibule, isolating the urethral opening, and blocking the entrance to the vagina.

Cardiac Arrhythmias After Traumatic Amputation

An Evaluation of a Numbered Surgical Sponge Product

Surgical sponge counting is an essential patient safety measure in the OR in which all members of the surgical team must participate. The RN acting as circulator is responsible for accurately documenting sponge counts during the surgical procedure. A sequentially numbered sponge product was evaluated in a survey of OR personnel to determine ease of use and whether the product affected the flow of the surgical procedure. Survey respondents reported that the numbered sponge product was easy to use and did not lengthen or affect the flow of the surgical procedure. Respondents also indicated that the product may contribute to patient safety.

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

ECG Marker of Nontransmural Myocardial Infarction

ECG Characteristics of a Genetic Disorder

Rapid Ventricular Response

How Our ICU Decreased the Rate of Hospital-acquired Pressure Ulcers

We describe 7 strategies our intensive care unit implemented to decrease the rate of hospital-acquired pressure ulcers. These strategies include the following: (1) restructured risk assessment and documentation, (2) translated numeric data into graphs for ease of understanding by staff, (3) increased staff awareness, (4) implemented "turn rounds," (5) increased prevalence assessments and redesigned structure of the skin team, (6) used evidence-based practice as a basis for care, and (7) created an Access database to track weekly prevalence.

Abnormal Conduction

Evaluation of a Device to Facilitate Female Urethral Catheterization

Urethral catheterization is a skilled procedure that nurses in hospital settings perform routinely. The opening of the female urethra is located within the vulvar vestibule, making insertion of urinary catheters into females a greater technical challenge than in males. Researchers evaluated whether a new device might decrease the time required for catheter insertion, increase the likelihood of inserting the catheter on the first attempt (improved accuracy), and reduce patient discomfort. Comments about the device from both patients and nurses also are reported.

Cornell Voltage Criteria

Effective Strategies for Implementing a Multicenter International Clinical Trial

International collaboration in research is essential in order to improve worldwide health. The purpose of this paper is to describe strategies used to administer an international multicenter trial to assess the effectiveness of a nursing educational intervention.

Multilead Monitoring

Traumatic Injuries

ECG Computer Algorithms

Electrocardiographic Monitoring in the Medical-surgical Setting: Clinical Implications, Basis, Lead Configurations, and Nursing Implications

Resting Parasympathetic Tone

Symptomatic Bradycardia

Transient Arrhythmia Revealed

Long Pause

Complaints of Skipped Beats

Sinus Node Dysfunction


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.

Commentary: Time to Treatment for Acute Coronary Syndromes: the Cost of Indecision

Adenosine During Arrhythmia

Differences in Mortality in Acute Coronary Syndrome Symptom Clusters

The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups.

Dynamic Conduction Defects

Conduction System Disease

Pharmacological Cardiosuppression

Evolving Myocardial Infarction

Gender-specific Characteristics of Individuals with Depressive Symptoms and Coronary Heart Disease

In individuals with depressive symptoms and coronary heart disease (CHD), little is known about gender-specific characteristics that may inform treatments and outcomes. This study sought to identify characteristics that distinguish men from women with both conditions.

Discordant T Waves

Bedside Monitoring for Transient Myocardial Ischemia

Exercise Stress Treadmill Testing

Computerized Algorithms

Coronary Artery Dominance

Assessing Health Literacy in Heart Failure Patients

Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL).

New QRS Criteria

A New Puzzler Guide

Congenital Anomaly

ECG Screening of Special Populations

Are There Symptom Differences in Patients with Coronary Artery Disease Presenting to the ED Ultimately Diagnosed with or Without ACS?

Symptoms are compared among patients with coronary artery disease (CAD) admitted to the emergency department with or without acute coronary syndrome (ACS). Sex and age are also assessed.

Impaired Impulse Formation

Indices of Sudden Cardiac Death

Sudden Shortness of Breath and Anxiety

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