Is silent ischemia on the routine admission ECG an important finding?

Bridges, S. Louis; Hollowell, John S.; Stagg, Stephen W.; Kemle, Kathy A.; Nusynowitz, Martin L.; Allensworth, Daniel C.; Pryor, David B.; Moorman, J. Randall

doi:10.1016/0022-0736(93)90005-x

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…11 The second category includes factors that hide underlying disease or deteriorating cardiac function and thus precipitate false negative results, a situation known as “electrocardiographically silent ischemia”. 8,22 Silent ischemia is much more difficult to detect and is also of greater clinical concern as failure to detect a true injury has such a high impact on patient well being. The settings in which such errors are of the greatest concern include the emergency room and intensive care units, where patient monitoring is constant and the consequences of hesitation can be costly.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Position Sensitivity Study in the Electrocardiographic Forward Problem Using Stochastic Collocation and Boundary Element Methods

Swenson

Geneser²,

Stinstra³

et al. 2011

Ann Biomed Eng

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The electrocardiogram (ECG) is ubiquitously employed as a diagnostic and monitoring tool for patients experiencing cardiac distress and/or disease. It is widely known that changes in heart position resulting from, for example, posture of the patient (sitting, standing, lying) and respiration significantly affect the body-surface potentials; however, few studies have quantitatively and systematically evaluated the effects of heart displacement on the ECG. The goal of this study was to evaluate the impact of positional changes of the heart on the ECG in the specific clinical setting of myocardial ischemia. To carry out the necessary comprehensive sensitivity analysis, we applied a relatively novel and highly efficient statistical approach, the generalized polynomial chaos-stochastic collocation method, to a boundary element formulation of the electrocardiographic forward problem, and we drove these simulations with measured epicardial potentials from whole-heart experiments. Results of the analysis identified regions on the body-surface where the potentials were especially sensitive to realistic heart motion. The standard deviation (STD) of ST-segment voltage changes caused by the apex of a normal heart, swinging forward and backward or side-to-side was approximately 0.2 mV. Variations were even larger, 0.3 mV, for a heart exhibiting elevated ischemic potentials. These variations could be large enough to mask or to mimic signs of ischemia in the ECG. Our results suggest possible modifications to ECG protocols that could reduce the diagnostic error related to postural changes in patients possibly suffering from myocardial ischemia.

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Section: Introductionmentioning

confidence: 99%