Nontraumatic ascending aortic disruption.

This report documents a case of completely spontaneous ascending aortic disruption. A 54-year-old African American male day laborer presented with severe retro-sternal chest and back pain and shortness of breath. He had no history of hypertension, smoking, or trauma and was taking no medications. The computed tomographic angiography scan performed to exclude pulmonary embolism instead demonstrated a hemorrhagic pericardial effusion and an ascending aortic pseudoaneurysm. He was taken emergently to the operating room for repair of his ascending aorta. The histopathology report was normal.

Electrocardiograms with pacemakers: accuracy of computer reading.

OBJECTIVE: We analyzed the accuracy with which a computer algorithm reads electrocardiograms (ECGs) with electronic pacemakers (PMs). METHODS: Electrocardiograms were screened for the presence of electronic pacing spikes. Computer-derived interpretations were compared with cardiologists' readings. RESULTS: Computer-drawn interpretations required revision by cardiologists in 61.3% of cases. In 18.4% of cases, the ECG reading algorithm failed to recognize the presence of a PM. The misinterpretation of paced beats as intrinsic beats led to multiple secondary errors, including myocardial infarctions in varying localization. The most common error in computer reading was the failure to identify an underlying rhythm. This error caused frequent misidentification of the PM type, especially when the presence of normal sinus rhythm was not recognized in a tracing with a DDD PM tracking the atrial activity. CONCLUSION: The increasing number of pacing devices, and the resulting number of ECGs with pacing spikes, mandates the refining of ECG reading algorithms. Improvement is especially needed in the recognition of the underlying rhythm, pacing spikes, and mode of pacing.

Analysis of current nuclear cardiology literature in MEDLINE database: a study of gated SPECT imaging using PubMed.

BACKGROUND: Easy access to relevant clinical information is necessary for physicians to make the best decisions for patient management. The increasing amount of information available has made it difficult for physicians to retrieve up-to-date information efficiently. We sought to determine the accessibility and accuracy of indexing in the nuclear cardiology literature by conducting sample searches in the MEDLINE database on the topic of gated single photon emission computed tomography (SPECT) imaging. METHODS AND RESULTS: The MEDLINE database was initially searched by use of both a primary and a comprehensive search strategy on PubMed for publications in English from 1994 to 2000. A total of 260 papers were retrieved from the primary search and 306 additional papers from the comprehensive search. Only 204 of the 566 citations from the combined electronic searches were truly relevant to gated SPECT. The resulting specificity index (precision) was 36%. A hand search was conducted in 11 top journals from 1994 to 2000. It yielded 81 additional citations that were missed by the PubMed search. The sensitivity index (recall) was calculated for all 11 journals. The Journal of Nuclear Cardiology had the highest rate of publication but the lowest rate of recall (44%). The clinical nuclear cardiology terminology and classifications were compared with the available Medical Subject Headings (MeSH) and MeSH Trees used for indexing in MEDLINE. CONCLUSIONS: There are 6 nuclear cardiology techniques, including gated SPECT and myocardial perfusion imaging, that are not specifically indexed in the current MEDLINE database. The lack of specific MeSH headings and indexing structure results in low recall and precision for retrieval of nuclear cardiology literature. We recommend 2 additions to the MeSH Tree Structure and 6 new MeSH headings.