The normal variability of the electrocardiogram as a basis for differentiation between “normal” and “abnormal” in clinical electrocardiography

Simonson, Ernst

doi:10.1016/0002-8703(58)90258-8

Cited by 22 publications

(12 citation statements)

References 36 publications

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“…Hafkesbring et al (1937) observed differences in the axes of boys and girls throughout childhood but did not determine whether or not these were significant. On the other hand, Simonson et al (1960) in comparing the electrocardiograms of men and women found no significant sex differentiation in the QRS axis although they did see significant differences in voltage in the precordial leads. This study supports Simonson's findings in both respects.…”

Section: Resultsmentioning

confidence: 83%

“…The fact that the periods at which the correlation is most significant correspond to the ages of rapid longitudinal growth strongly suggests that the rightward trends are due to the more vertical position of the heart during such periods of growth. (Simonson, 1958), review of earlier publications reveals a lack of agreement concerning some of the changes that occur during childhood and adolescence.…”

Section: Resultsmentioning

confidence: 99%

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Influence of Age, Sex, and Body Habitus on the Mean QRS Electrical Axis in Childhood and Adolescence

Wershing¹,

Walker²

1963

Heart

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The "mean QRS electrical axis" has been defined by Ziegler (1951) as the average direction in which the excitatory process spreads throughout the ventricular myocardium. This mean axis or vector in the frontal plane may be calculated from the standard limb leads and used as an index of cardiac abnormality. In biometrics the term "deviation" is usually used to indicate the departure of a measurement from an established normal value. Thus in electrocardiography right or left axis deviation denotes departure of the electrical forces from the normal toward one or other side of the body. Accurate interpretation of such deviation is dependent upon well-established normal standards, and several authorities (Johnston, 1961;Ezra, 1961;Milnor, 1962) Ashman, 1937;Epstein, 1948;Gros, Gordon, and Miller, 1951;Yu, Joos, and Katsampes, 1951;Veasy and Adams, 1952; Sodi-Pallares et al., 1958a), and many have contained relatively few cases in later childhood and adolescence. Ziegler (1951) considered that his own data on the mean QRS axis merely acted as a "satisfactory nucleus for further study and revision."This investigation, which is part of a larger study of electrocardiograms in normal children and adolescents (Walker and Rose, 1961; Walker and Wershing, in preparation) was thus designed to test statistically the hypotheses of previous writers and to present normal standards related to age, sex, and body habitus from an adequate number of subjects between the ages of 6 months and 20 years. SUBJECTS AND METHODSThe records of 2082 patients who attended the Denver Rheumatic Fever Diagnostic Service during the years 1957 to 1961 were reviewed. Despite the special nature of this clinic, a complete history was taken and a thorough physical examination performed, each patient being examined by two or more experienced piediatric cardiologists on the medical centre faculty. Laboratory studies included urine examination, himatocrit, white blood cell count, differential count, sedimentation rate (Wintrobe), C-reactive protein, and serum mucoprotein tyrosine. A 14-lead electrocardiogram (standard 12 leads plus V3R and V7) was recorded on a standard direct writing Cambridge instrument at 25 mm./sec. paper speed, with a calibration of 1 mV= 10 mm. The majority of the earlier patients had either cardiac fluoroscopy or routine radiograms with barium swallow. More recently, if the history was negative and the murmur typically innocent, this examination was omitted in order to avoid unnecessary radiation. As a result of the evaluation of the 2082 case records, 1199 patients were excluded for one of the following reasons: the history or presence of recent illness (as evidenced by physical findings, raised sedimentation rate, white blood count, or abnormalities in the urine), diagnosis or suspicion of rheumatic fever (past or present), the diagnosis of congenital or acquired organic heart disease or the suspicion of such abnormality. The remaining 883 patients were thus regarded as being normal and were included in this study.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Influence of Age, Sex, and Body Habitus on the Mean QRS Electrical Axis in Childhood and Adolescence

Wershing¹,

Walker²

1963

Heart

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“…No exercise ECG is recorded, because of the risk entailed. The ECG is recorded using the cus tomary procedures and is evaluated in the normal way [Estes, 1970;Simonson, 1961], The ECG recording is then evaluated using a rating scale (see 'Cardiovascular Parameters and ECG').…”

Section: Ecgmentioning

confidence: 99%

A Long-Term Study with Co-Dergocrine Mesylate (Hydergine®) in Healthy Pensioners

Köberle

Spiegel²

1984

Gerontology

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“…Unfortunately abnormal electrical patterns shown by the ECG, even when they are highly suggestive, are not specific for coronary disease. Furthermore, there may be considerable difficulty in differentiating normal from abnormal tracings (Simonson, 1958). It is not surprising, therefore, that a number of studies have revealed variation between different observers in their classification ofECGs as normal or abnormal and especially of whether the abnormality is due to coronary disease or not (Davies, 1958; Thomas, Cochrane, and Higgins, 1958;Segall, 1960;Acheson, 1960;Epstein, Doyle, Pollack, Pollack, Robb, and Simonson, 1961;Higgins, Cochrane, and Thomas, 1963).…”

mentioning

confidence: 99%

The Electrocardiogram in Epidemiological Studies: Reproducibility, Validity, and International Comparison

Higgins¹,

Kannel²,

Dawber³

1965

Journal of Epidemiology & Community Health

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The normal variability of the electrocardiogram as a basis for differentiation between “normal” and “abnormal” in clinical electrocardiography

Cited by 22 publications

References 36 publications

Influence of Age, Sex, and Body Habitus on the Mean QRS Electrical Axis in Childhood and Adolescence

Influence of Age, Sex, and Body Habitus on the Mean QRS Electrical Axis in Childhood and Adolescence

A Long-Term Study with Co-Dergocrine Mesylate (Hydergine®) in Healthy Pensioners

The Electrocardiogram in Epidemiological Studies: Reproducibility, Validity, and International Comparison

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