Chapter 2 the Electrocardiogram
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Left Ventricular Wall Findings in Non-Electrocardiography-Gated CE-CT After ECPR Might Be Useful for Diagnosis and Prognostic Prediction
Sugiyama et al. Critical Care (2019) 23:357 https://doi.org/10.1186/s13054-019-2624-1 RESEARCH Open Access Left ventricular wall findings in non- electrocardiography-gated contrast- enhanced computed tomography after extracorporeal cardiopulmonary resuscitation Kazuhiro Sugiyama1* , Masamichi Takahashi2, Kazuki Miyazaki1, Takuto Ishida1, Mioko Kobayashi1 and Yuichi Hamabe1 Abstract Background: Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis. Methods: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns. Results: A total of 74 patients (median age, 59 years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs. -
Pregnancy As a Rare Cause of Electrical Alternans on Electrocardiography
Journal of Cardiology & Current Research Pregnancy as a rare cause of electrical alternans on electrocardiography Abstract Case Report Electrical alternans is a phenomenon defined as an alternating amplitude or axis of the Volume 11 Issue 1 - 2018 QRS complexes, ST segment, P or T waves in electrocardiography. It is most commonly associated with a large pericardial effusions causing cardiac tamponade; however, a Çağlar Alp,1 İsmail Ekinözü,1 Osman variety of other clinical scenarios including cardiomyopathies, myocardial ischemia, Karaarslan,1 Tolga Doğan,1 Mucahit atriovantricular re-entrant tachycardia, large pleural effusion has been associated with Yetim,1 Lütfü Bekar,2 Macit Kalcik,2 Yusuf electrical alternans. Here, first in the literature, we present a young patient with term Karavelioğlu,2 pregnancy who was admitted with electrical alternans in electrocardiography due to 1Department of Cardiology, Hitit University Çorum Training and excessive respiratory movements mainly by the intercostal and accessory muscles. Research Hospital, Turkey 2Department of Cardiology, Hitit University Faculty of Medicine, Keywords: Electrical alternans, electrocardiography, pregnancy, respiration Turkey Correspondence: Macit Kalçık, Hitit University Çorum Training and Research Hospital, Yeniyol, Çamlık Cad. No:2, Çorum/Turkey, Fax +903642230300, Tel (90)536 4921789, Email [email protected] Received: July 22, 2017 | Published: February 28, 2018 Case presentation motion of her heart in the large pericardial effusion.1 The extreme pendulous change in the orientation of the heart within the large A 21-year-old woman with 39-weeks pregnancy was admitted pericardial effusion explains the alternating QRS vectors on the 12- to emergency department with dyspnea and atypical chest pain. Her lead electrocardiogram. -
Sparse-Input Detection Algorithm with Applications in Electrocardiography and Ballistocardiography
Sparse-input Detection Algorithm with Applications in Electrocardiography and Ballistocardiography ;1 ;1 2 1 1 F. Wadehn∗ , L. Bruderer∗ , D. Waltisberg , T. Keresztfalvi and H.-A. Loeliger 1 Signal and Information Processing Laboratory, ETH Zurich, Gloriastrasse 35, Zurich, Switzerland 2 Institut fuer Elektronik, ETH Zurich, Gloriastrasse 35, Zurich, Switzerland Keywords: Ballistocardiography, Heart Rate Estimation, Hypothesis Test, Factor Graphs, System identification, State- space Models, Maximum likelihood, Maximum a posteriori. Abstract: Sparse-input learning, especially of inputs with some form of periodicity, is of major importance in bio- signal processing, including electrocardiography and ballistocardiography. Ballistocardiography (BCG), the measurement of forces on the body, exerted by heart contraction and subsequent blood ejection, allows non- invasive and non-obstructive monitoring of several key biomarkers such as the respiration rate, the heart rate and the cardiac output. In the following we present an efficient online multi-channel algorithm for estimating single heart beat positions and their approximate strength using a statistical hypothesis test. The algorithm was validated with 10 minutes long ballistocardiographic recordings of 12 healthy subjects, comparing it to synchronized surface ECG measurements. The achieved mean error rate for the heart beat detection excluding movement artifacts was 4:7%. 1 INTRODUCTION Early signal-processing methods for BCG signals (Watanabe et al., 2005; Mack et al., 2009) concerned Cardiovascular diseases are among the leading causes estimation of heart rates averaged over a few sec- of death and severe health impairments both in high- onds using frequency-based methods. These meth- income countries with an aging population, as well ods do not provide beat-to-beat resolution or infor- as in developing countries, which are increasingly mation on irregular arrhythmias. -
2Nd Quarter 2001 Medicare Part a Bulletin
In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care -
Electrocardiography: a Technologist's Guide to Interpretation
CONTINUING EDUCATION Electrocardiography: A Technologist’s Guide to Interpretation Colin Tso, MBBS, PhD, FRACP, FCSANZ1,2, Geoffrey M. Currie, BPharm, MMedRadSc(NucMed), MAppMngt(Hlth), MBA, PhD, CNMT1,3, David Gilmore, ABD, CNMT, RT(R)(N)3,4, and Hosen Kiat, MBBS, FRACP, FACP, FACC, FCCP, FCSANZ, FASNC, DDU1,2,3,5 1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia; 2Cardiac Health Institute, Sydney, New South Wales, Australia; 3Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia; 4Faculty of Medical Imaging, Regis College, Boston, Massachusetts; and 5Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than December 2018. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test. foundation for understanding the science of electrocardiog- The nuclear medicine technologist works with electrocardio- raphy and its interpretation. graphy when performing cardiac stress testing and gated cardiac imaging and when monitoring critical patients. -
Pericarditis, Pericardial Effusion and Cardiac Tamponade
International Journal of Internal Medicine 2012, 1(4): 37-41 DOI: 10.5923/j.ijim.20120104.01 Electrocardiography – Pericarditis, Pericardial Effusion and Cardiac Tamponade Sharan Badiger1,*, Prema T. Akkasaligar2, Biradar MS1 1Department of Medicine, BLDE University's, Sri.B.M.Patil Medical College, Bijapur, 586103, Karnataka, India 2Department of Computer Science, B.L.D.E.A’s Dr.P.G.H.Engineering College, Bijapur, 586103, Karnataka, India Abstract Patients with pericardial effusions may quickly progress to cardiac tamponade. These conditions are often difficult to diagnose, although physical examination and chest radiography are known to be poorly diagnostic of pericardial effusion. Advanced imaging techniques can accurately detect and quantify the size of pericardial effusions. Unfortunately, these advanced techniques are expensive and are often not feasible as screening tests for pericardial effusion. In contrast, 12-lead electrocardiogram is inexpensive and is easily performed, but to our knowledge, its diagnostic value for pericardial effusion and cardiac tamponade has not been systematically examined. Pericarditis, pericardial effusion, and cardiac tamponade are associated with various electrocardiographic signs. Low voltage, PR segment depression, ST-T changes and electrical alternans have each been diagnostic of pericardial effusion and / or cardiac tamponade. However, many of the studies that previously investigated these electrocardiographic signs examined patient populations. The diagnostic value of 12-lead electrocardiogram for pericarditis, pericardial effusion and cardiac tamponade has been reviewed in this article. Ke ywo rds Cardiac Tamponade, Electrocardiogram, Pericarditis, Pericardial Effusion fluid. It is suggested that low QRS voltage in patients with a 1. Introduction pericardial effusion is actually a specific manifestation of tamponade, not of the effusion. -
Electrical Alternans in Cardiac Tamponade Andreas P
Henry Ford Hospital Medical Journal Volume 21 | Number 4 Article 3 12-1973 Electrical Alternans in Cardiac Tamponade Andreas P. Niarchos Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Niarchos, Andreas P. (1973) "Electrical Alternans in Cardiac Tamponade," Henry Ford Hospital Medical Journal : Vol. 21 : No. 4 , 169-180. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol21/iss4/3 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. FHenry Ford FHosp. Med. Journal Vol. 21, No. 4, 1973 Electrical Alternans in Cardiac Tamponade Andreas P. Niarchos, M.D.,* tLECTRICAL alternans has been de fined as an alternation of the configura tion of the electrocardiographic com plexes arising from the same pacemaker and independent of periodic extracardiac Of nine patients with pericardial effusion phenomena.' This electrocardiographic due to various causes, four developed cardiac abnormality was initially observed in the tamponade. Electrical alternans was present In laboratory by Herring in 1909,^ and first all four, being total in three, and ventricular in one. From the diagnostic point of view, the reported clinically the year after by alternans corresponded with the clinical diag Lewis.^ Other early reports were those of nosis of cardiac tamponade and the radiologi Hamburger, Katz and Saphir," and of cal signs of a large pericardial effusion. The Brody and Rossman.^ The literature on pericardial fluid was hemorrhagic in three pa the subject up to 1955 has been reviewed tients and transudate (hydropericardium) in the fourth. -
Early Or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
The new england journal of medicine Original Article Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation N.A.H.A. Pluymaekers, E.A.M.P. Dudink, J.G.L.M. Luermans, J.G. Meeder, T. Lenderink, J. Widdershoven, J.J.J. Bucx, M. Rienstra, O. Kamp, J.M. Van Opstal, M. Alings, A. Oomen, C.J. Kirchhof, V.F. Van Dijk, H. Ramanna, A. Liem, L.R. Dekker, B.A.B. Essers, J.G.P. Tijssen, I.C. Van Gelder, and H.J.G.M. Crijns, for the RACE 7 ACWAS Investigators* ABSTRACT BACKGROUND Patients with recent-onset atrial fibrillation commonly undergo immediate restora- The authors’ full names, academic degrees, tion of sinus rhythm by pharmacologic or electrical cardioversion. However, whether and affiliations are listed in the Appen- dix. Address reprint requests to Dr. Crijns immediate restoration of sinus rhythm is necessary is not known, since atrial fibril- at the Department of Cardiology, Maas- lation often terminates spontaneously. tricht University Medical Center, P. Debye- laan 25, 6229 HX Maastricht, the Nether- METHODS lands, or at hjgm . crijns@ mumc . nl. In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned *A complete list of investigators in the patients with hemodynamically stable, recent-onset (<36 hours), symptomatic atrial RACE 7 ACWAS trial is provided in the fibrillation in the emergency department to be treated with a wait-and-see approach Supplementary Appendix, available at (delayed-cardioversion group) or early cardioversion. The wait-and-see approach in- NEJM.org. volved initial treatment with rate-control medication only and delayed cardioversion Drs. -
Guide to Exercise Electrocardiogram
Guide to the Exercise Electrocardiogram (The Treadmill Stress Test) An exercise stress test is performed to evaluate heart rate, heart rhythm, blood pressure and electrocardiographic (ECG) responses to progressive exercise. You do not need to be an athlete or to be trained to have this test for evaluation of your cardiovascular system, but you do need to be able to walk without support. The exercise ECG is used to evaluate the adequacy of blood supply to the heart during exercise that may be symptomatic or asymptomatic and to assess the extent of limitation of blood supply to the heart in people with known coronary artery disease. The test is also used to quantify effort capacity, to evaluate the effect of medications on symptoms and effort tolerance, to assess general health and prognosis, and to evaluate the heart rate and blood pressure responses to exercise before surgical procedures and before entry into programs of cardiac rehabilitation. Imaging of the heart with echocardiography or with radionuclide agents is not performed during basic exercise ECG unless prearranged by the referring physician. Pre-Registration and Testing Location Please call 2 days before the date your test is scheduled to confirm your appointment. At this time we can also answer questions you may have. Please have your referring physician complete the order form. Plan to arrive 20 minutes before the scheduled time of your test. Bring your hospital and insurance cards with you. Go directly to the test location. NewYork-Presbyterian Hospital/Weill Cornell Medical Center 212-746-4670 Exercise ECG Laboratory Starr Pavilion 520 East 70th Street, east of York Avenue New York, NY 10021 Take the Starr elevators to the 4th floor, follow the signs to room K-425. -
Echocardiography to Supplement Stress Electrocardiography in Emergency Department Chest Pain Patients
Original research Echocardiography to Supplement Stress Electrocardiography in Emergency Department Chest Pain Patients Mark I. Langdorf, MD, MHPE* * University of California, Irvine, Department of Emergency Medicine, Irvine, CA Eric Wei, MD† † University of Michigan, Ann Arbor, MI Ali Ghobadi, MD* Scott E. Rudkin, MD, MBA* Shahram Lotfipour, MD, MPH* Supervising Section Editor: David E. Slattery, MD Submission history: Submitted July 18, 2009; Revision Received February 21, 2010; Accepted March 24, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Introduction: Chest pain (CP) patients in the Emergency Department (ED) present a diagnostic dilemma, with a low prevalence of coronary disease but grave consequences with misdiagnosis. A common diagnostic strategy involves ED cardiac monitoring while excluding myocardial necrosis, followed by stress testing. We sought to describe the use of stress echocardiography (echo) at our institution, to identify cardiac pathology compared with stress electrocardiography (ECG) alone. Methods: Retrospective cohort study of 57 urban ED Chest Pain Unit (CPU) patients from 2002- 2005 with stress testing suggesting ischemia. Our main descriptive outcome was proportion and type of discordant findings between stress ECG testing and stress echo.The secondary outcome was whether stress echo results appeared to change management. Results: Thirty-four of 57 patients [59.7%, 95% confidence interval (CI) 46.9-72.4%] had stress echo results discordant with stress ECG results. The most common discordance was an abnormal stress ECG with a normal stress echo (n=17/57, 29.8%, CI 17.9-41.7%), followed by normal stress ECG but with reversible regional wall-motion abnormality on stress echo (n = 10/57, 17.5%, CI 7.7- 27.4%). -
Computer Processing of the Orthogonal Electrocardiogram and Vectorcardiogram
Physiol. Res. 43: 95-98, 1993 Computer Processing of the Orthogonal Electrocardiogram and Vectorcardiogram L. BACHÂROVÀ Research Institute of Medical Informatics, Bratislava Summary The aim of this contribution was to review the possibilities of presentation of orthogonal ECG signals and to evaluate the progress in computerized electrocardiography achieved in Czechoslovakia. The information about the cardiac electric field in orthogonal electrocardiography is defined and consequently displayed as a fixed single dipole (vector). The spatial trajectory of vector end-point (spatial vectorcardiographic loop) can be presented in different ways — as orthogonal electrocardiogram, polarcardiogram, planar vectorcardiogram and decartogram, respectively. The advantages of particular methods of presentation, as well as their limitations are discussed. Computer-assisted electrocardiography was introduced in Czechoslovakia in 1974. The original AVA program has been further developed in the Research Institute of Medical Informatics (formerly Research Institute of Medical Bionics). The currently developed system CardioSys allows the utilization of all the possibilities of orthogonal ECG and vectorcardiographic presentation for clinical and epidemiological cardiology as well as for the research. Key words Orthogonal Electrocardiography - Vectorcardiography - Computer analysis The electrographic signal provides are the physiological source of electrocardiographic irreplaceable information about the status and activity potentials. The front of myocardial depolarization is in of the heart. In current clinical practice, it is mostly fact an electrical double-layer and, as such, may be registered by means of a standard 12-lead ECG system. represented by a set of regularly spaced unit vectors. However, the information obtained in this way is The vectorial sum of these unit vectors gives the characterized by a considerable redundancy. -
June-July 2000 Part a Bulletin
In This Issue... Disclosure of Itemized Statement Providers Must Furnish an Itemmized Statement when Requested in Writing by the Beneficiary .................................................................................................... 6 Prospective Payment System The Outpatient Code Editor Software Has Been Modified in Preparation for the Implementation of Outpatient Prospective Payment System ........................... 8 Reclassification of Certain Urban Hospitals Certain Urban Hospitals in the State of Florida May Be Permitted to Be Reclassified as Rural Hospitals................................................................................ 13 ulletin Final Medical Review Policies 33216, 53850, 70541, 82108, 83735, 87621, 93303, 94010, 95004, A0320, J0207, J2430, J2792, J3240, J7190, and J9999 .......................................... 15 B Payment of Skilled Nursing Facility Claims Involving a Terminating Medicare+Choice Plan Payment of Skilled Nursing Facility Care for Beneficiaries Involuntarily Disenrolling from M+C plans Who Have Not Met the 3-Day Stay Requirement ........................................................................................... 67 Features From the Medical Director 3 Administrative 4 lease share the Medicare A roviders PBulletin with appropriate General Information 5 members of your organization. Outpatient Prospective Payment System 7 Routing Suggestions: General Coverage 12 o Medicare Manager Hospital Services 13 o Reimbursement Director Local and Focused Medical Policies 15 o Chief Financial