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

Journal of Electrocardiology. 2002  |  Pubmed ID: 12539095

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.

ST-elevation Myocardial Infarction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2002  |  Pubmed ID: 11785562

Inverted P Waves

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2002  |  Pubmed ID: 11888131

Reperfusion Arrhythmias

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2002  |  Pubmed ID: 12022492

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2002  |  Pubmed ID: 12102432

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2002  |  Pubmed ID: 12102441

Reperfusion Arrhythmias

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2002  |  Pubmed ID: 12102442

Intermittent Conduction Disturbances

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2002  |  Pubmed ID: 12233976

Bradycardic ECG Monitoring Alarms

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2002  |  Pubmed ID: 12425410

Heart Blocks

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2003  |  Pubmed ID: 12526242

Low Amplitude QRS

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2003  |  Pubmed ID: 12625177

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

Heart & Lung : the Journal of Critical Care. Mar-Apr, 2003  |  Pubmed ID: 12734529

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2003  |  Pubmed ID: 12751403

Increased Automaticity of the AV Node

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2003  |  Pubmed ID: 12882072

Ventricular Escape Rhythms

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2003  |  Pubmed ID: 14503433

Non-conducted P Waves

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2003  |  Pubmed ID: 14619365

Electrolyte Imbalances

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2004  |  Pubmed ID: 14735652

Nonischemic ST-segment Elevation

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2004  |  Pubmed ID: 15043245

Retrograde Atrial Conduction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2004  |  Pubmed ID: 15149061

Wide QRS Duration

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2004  |  Pubmed ID: 15293590

An Evolving Myocardial Infarction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2004  |  Pubmed ID: 15470862

Premature Beats

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2004  |  Pubmed ID: 15568658

Bedside Monitoring of Spinal Cord Injuries

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2005  |  Pubmed ID: 15608115

Nonrespiratory Sinus Arrhythmia

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2005  |  Pubmed ID: 15728960

Relative Refractory Period

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2005  |  Pubmed ID: 15840900

ST Segment Changes in Right Bundle Branch Block

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2005  |  Pubmed ID: 15980427

Rhythmic Premature Ventricular Contractions

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2005  |  Pubmed ID: 16120897

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

Journal of Electrocardiology. Oct, 2005  |  Pubmed ID: 16226097

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2005  |  Pubmed ID: 16249594

Resynchronization Therapy

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2006  |  Pubmed ID: 16391321

ST-segment Changes in Right Ventricular Paced Rhythms

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2006  |  Pubmed ID: 16501144

Differentiating ST-Segment Strain Pattern From Acute Ischemia

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2006  |  Pubmed ID: 16632776

Long QT Syndrome

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2006  |  Pubmed ID: 16823024

Nonsustained Ventricular Tachycardia in the Elderly

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2006  |  Pubmed ID: 16926375

ECG Changes During Induced Hypothermia After Cardiac Arrest

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2006  |  Pubmed ID: 17053272

Evaluating Pacemaker Function with Full Disclosure

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2007  |  Pubmed ID: 17192532

P Wave Alterations

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2007  |  Pubmed ID: 17322021

New Female Catheterization Device

Urologic Nursing. Feb, 2007  |  Pubmed ID: 17390928

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2007  |  Pubmed ID: 17460325

An Evaluation of a Numbered Surgical Sponge Product

AORN Journal. May, 2007  |  Pubmed ID: 17499056

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

The Journal of Cardiovascular Nursing. May-Jun, 2007  |  Pubmed ID: 17545821

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2007  |  Pubmed ID: 17595375

ECG Marker of Nontransmural Myocardial Infarction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2007  |  Pubmed ID: 17724250

ECG Characteristics of a Genetic Disorder

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2007  |  Pubmed ID: 17962508

Rapid Ventricular Response

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2008  |  Pubmed ID: 18158395

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

Journal of Nursing Care Quality. Jan-Mar, 2008  |  Pubmed ID: 18281882

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2008  |  Pubmed ID: 18310658

Evaluation of a Device to Facilitate Female Urethral Catheterization

Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. Feb, 2008  |  Pubmed ID: 18429536

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2008  |  Pubmed ID: 18450685

Effective Strategies for Implementing a Multicenter International Clinical Trial

Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2008  |  Pubmed ID: 18507563

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2008  |  Pubmed ID: 18593839

Traumatic Injuries

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2008  |  Pubmed ID: 18776005

ECG Computer Algorithms

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2008  |  Pubmed ID: 18978244

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

Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. Dec, 2008  |  Pubmed ID: 19248409

Symptomatic Bradycardia

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2009  |  Pubmed ID: 19255108

Transient Arrhythmia Revealed

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2009  |  Pubmed ID: 19411588

Long Pause

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2009  |  Pubmed ID: 19556417

Complaints of Skipped Beats

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2009  |  Pubmed ID: 19723870

Sinus Node Dysfunction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2009  |  Pubmed ID: 19880961

Resting Parasympathetic Tone

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2009  |  Pubmed ID: 19116410

Asystole

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2010  |  Pubmed ID: 20045851

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

European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. Dec, 2010  |  Pubmed ID: 20153979

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

The Journal of Cardiovascular Nursing. Mar-Apr, 2010  |  Pubmed ID: 20168190

Adenosine During Arrhythmia

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2010  |  Pubmed ID: 20194616

Differences in Mortality in Acute Coronary Syndrome Symptom Clusters

American Heart Journal. Mar, 2010  |  Pubmed ID: 20211300

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2010  |  Pubmed ID: 20436067

Conduction System Disease

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2010  |  Pubmed ID: 20595219

Pharmacological Cardiosuppression

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2010  |  Pubmed ID: 20810421

Evolving Myocardial Infarction

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2010  |  Pubmed ID: 21041198

Discordant T Waves

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2011  |  Pubmed ID: 21196572

Bedside Monitoring for Transient Myocardial Ischemia

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2011  |  Pubmed ID: 21362722

Exercise Stress Treadmill Testing

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2011  |  Pubmed ID: 21532047

Computerized Algorithms

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2011  |  Pubmed ID: 21724638

Coronary Artery Dominance

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2011  |  Pubmed ID: 21885462

Assessing Health Literacy in Heart Failure Patients

Journal of Cardiac Failure. Nov, 2011  |  Pubmed ID: 22041324

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2011  |  Pubmed ID: 22045146

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

Heart & Lung : the Journal of Critical Care. May-Jun, 2011  |  Pubmed ID: 20561880

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.

A New Puzzler Guide

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jan, 2012  |  Pubmed ID: 22210702

Congenital Anomaly

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Mar, 2012  |  Pubmed ID: 22381990

ECG Screening of Special Populations

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. May, 2012  |  Pubmed ID: 22549579

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

The American Journal of Emergency Medicine. Nov, 2012  |  Pubmed ID: 22633702

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

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Jul, 2012  |  Pubmed ID: 22751373

Indices of Sudden Cardiac Death

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Sep, 2012  |  Pubmed ID: 22941711

Sudden Shortness of Breath and Anxiety

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. Nov, 2012  |  Pubmed ID: 23117909