MEANS ECG Physicians’ Manual for Welch Allyn CP Series Electrocardiographs Revision date: 2016-07 Welch Allyn 4341 State Street Road Skaneateles Falls, NY 13153 USA © 2016, DIR: 80011564, Ver: F www.welchallyn.com MEANS Physicians Manual Caution Federal US law restricts sale of the device identified in this manual to, or on the order of, a licensed physician. © 2016 Welch Allyn. All rights are reserved. To support the intended use of the product described in this publication, the purchaser of the product is permitted to copy this publication, for internal distribution only, from the media provided by Welch Allyn. No other use, reproduction, or distribution of this publication, or any part of it, is permitted without written permission from Welch Allyn. Welch Allyn assumes no responsibility for any injury to anyone, or for any illegal or improper use of the product, that may result from failure to use this product in accordance with the instructions, cautions, warnings, or statement of intended use published in this manual. About this manual This manual documents the logic behind the diagnostic criteria provided by the Welch Allyn CP series interpretive resting ECG system. It is provided as a supplement to the electrocardiographs user's manual for those interested in or requiring knowledge of specific details of the system's algorithms. Please refer to the electrocardiographs general user's manual for information about use, installation and configuration, as well as applicable precautions and warnings. The algorithms employed in our system are collectively known as the Modular ECG Analysis System, MEANS. MEANS was developed by the Department of Medical Informatics at the Erasmus University of Rotterdam in the Netherlands. Portions of this manual are copyright 1999 by the Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands. The initial sections of this manual provide an overview of the general signal processing methodology involved, followed by detailed descriptions of the contour and rhythm analysis statement logic, and an index to all statements. The final section provides an analysis of the performance of MEANS. Welch Allyn 2 MEANS Physicians Manual Contents 1 INTRODUCTION ................................................................................................................................... 4 1.1 Signal conditioning ............................................................................................................................... 4 1.2 Pattern recognition ............................................................................................................................... 5 1.3 Parameter extraction ............................................................................................................................ 6 1.4 Diagnostic classification ....................................................................................................................... 6 1.5 Outline of the manual ........................................................................................................................... 6 1.6 References ........................................................................................................................................... 8 2 CONTOUR ANALYSIS .......................................................................................................................... 9 2.1 Contour parameters ............................................................................................................................. 9 2.2 Dextrocardia and arm electrodes reversal.......................................................................................... 11 2.3 Wolf-Parkinson-White syndrome (WPW) ........................................................................................... 11 2.4 Left Bundle Branch Block (LBBB) ...................................................................................................... 12 2.5 Right Bundle Branch Block (RBBB).................................................................................................... 13 2.6 Incomplete Right Bundle Branch Block (IRBBB) ................................................................................ 14 2.7 Intraventricular conduction delay (IVCD) ............................................................................................ 14 2.8 Atrial overload .................................................................................................................................... 15 2.9 Atrial abnormalities ............................................................................................................................. 15 2.10 Axis deviations and fascicular blocks ................................................................................................. 16 2.11 Low QRS voltage ................................................................................................................................ 17 2.12 QT abnormalities ................................................................................................................................ 17 2.13 Left ventricular hypertrophy (LVH) ...................................................................................................... 18 2.14 Right ventricular hypertrophy.............................................................................................................. 19 2.15 Infarction ............................................................................................................................................. 20 2.16 Pulmonary disease ............................................................................................................................. 26 2.17 ST elevation ....................................................................................................................................... 26 2.18 ST and T abnormalities ...................................................................................................................... 27 2.19 Repolarization .................................................................................................................................... 28 2.20 Miscellaneous ..................................................................................................................................... 29 2.21 Interaction of statements .................................................................................................................... 30 2.22 Combination of statements ................................................................................................................. 32 3 RHYTHM ANALYSIS ........................................................................................................................... 33 3.1 Introduction ......................................................................................................................................... 33 3.2 Rhythm parameters ............................................................................................................................ 34 3.3 Decision tree ...................................................................................................................................... 35 3.4 Group 1: Rhythms with artificial pacemaker spikes ............................................................................ 38 3.5 Group 2: Non-dominant QRS complexes ........................................................................................... 38 3.6 Group 3: Rhythms with atrial flutter or tachycardia ............................................................................. 44 3.7 Group 4: Regular rhythms with P/QRS 0.15 .................................................................................... 45 3.8 Group 5: Regular rhythms with 0.15<P/QRS1.0 and PR range > 60 ms .......................................... 46 3.9 Group 6: Regular rhythms with P/QRS > 1.0 and PR range 30 ms ................................................. 47 3.10 Group 7: Regular rhythms with P/QRS > 1.0 and PR range > 30 ms................................................. 48 3.11 Group 8: Irregular rhythms with P/QRS 0.15 ................................................................................... 49 3.12 Group 9: Rhythms with paroxysmal acceleration or deceleration of ventricular rate ......................... 49 3.13 Group 10: Irregular rhythms with 0.15 < P/QRS 0.9 and PR range 30 ms ................................... 50 3.14 Group 11: Irregular rhythms with 0.15 < P/QRS 0.9 and PR range > 30 ms ................................... 51 3.15 Group 12: Irregular rhythms with 0.9 < P/QRS 1.2 and PR range > 30 ms ..................................... 52 3.16 Group 13: Irregular rhythms with P/QRS > 1.2 and PR range > 30 ms .............................................. 52 3.17 Group 14: Irregular rhythms with P/QRS > 1.0 and PR range 30 ms .............................................. 53 3.18 Group 15: Rhythms with constant PR interval .................................................................................... 54 4 STATEMENT INDEX ........................................................................................................................... 56 5 THE PERFORMANCE OF MEANS ..................................................................................................... 61 Welch Allyn 3 MEANS Physicians Manual 1 Introduction Computers