Galen Wagner, M.D., Ph.D. (1939-2016) as international mentor of young investigators in electrocardiology.

This paper describes a substantial part of the international mentoring network of students and young investigators in electrocardiology that developed around Dr. Galen Wagner (1939-2016), including many experiences of his mentees and co-mentors. The paper is meant to stimulate thinking about international mentoring as a means to achieve important learning experiences and personal development of young investigators, to intensify international scientific cooperation, and to stimulate scientific production.

Novel approach to documenting expert ECG interpretation using eye tracking technology: a historical and biographical representation of the late Dr Rory Childers in action.

The 12-lead electrocardiogram (ECG) is a complex set of cardiac signals that require a high degree of skill and clinical knowledge to interpret. Therefore, it is imperative to record and understand how expert readers interpret the 12-lead ECG. This short paper showcases how eye tracking technology and audio data can be fused together and visualised to gain insight into the interpretation techniques employed by an eminent ECG champion, namely Dr Rory Childers.

In memoriam: A tribute to the work and lives of Ron Selvester and Rory Childers.

At the April, 2015 International Society for Computerized Electrocardiology (ISCE) Annual Conference in San Jose, CA, a special session entitled Remembering Ron & Rory was held to pay tribute to the extraordinary work and lives of two experts in electrocardiology. The session was well attended by conference attendees, Childers' family members and friends, and additional colleagues who traveled to San Jose solely to participate in this session. The purpose of the present paper is to document the spirit of this special session as faithfully as possible using the words of the session speakers.

Of MIs and men--a historical perspective on the diagnostics of acute myocardial infarction.

The history of myocardial infarction (MI) diagnostics has gone through a continuous evolution over the past century, when several new discoveries have contributed to remarkably increase the number of patients appropriately diagnosed with this condition. The tale "of MIs and Men" displays rather a long history, since atherosclerosis was found to be present in humans several centuries before modern civilization and the identification of the most prevalent risk factors. It was only at the end of the 19th century and at the beginning of the 20th century that the physicians acknowledged that MI is principally sustained by coronary thrombosis, and that the clinical picture of MI could be subsequently confirmed at autopsy. With the first description of the electrocardiogram (ECG) in the 1910s and 1920s, the history of modern MI diagnostics really began. Additional important discoveries followed, which are mainly represented by radiography, echocardiography, computed tomography, and magnetic resonance imaging of the heart. Another major breakthrough occurred at the down of the third millennium, with the development of commercial immunoassays for the measurement of cardiac troponin I and T, which represent now the cornerstones for identifying any kind of myocardial injury, thus including MI. The major advancements in the understanding of MI pathophysiology and the progressive introduction of efficient diagnostic tools will be described and discussed in this narrative historical review.

"Who" can be found in and beyond of an electrocardiographic strip.

Over the years, an electrocardiogram had become the basic tool to study the heart physiology and pathophysiology. Many authors gave a substantial contribution in understanding the electrophysiological basis for numerous electrocardiographic changes. Some of them were named after authors themselves, or others used the names of scientists who first discovered or explained the nature of a particular electrocardiographic finding. In this article, electrocardiographic phenomena and eponyms used in today's electrocardiography are described.

Professor Herman Burger (1893-1965), eminent teacher and scientist, who laid the theoretical foundations of vectorcardiography--and electrocardiography.

Einthoven not only designed a high quality instrument, the string galvanometer, for recording the ECG, he also shaped the conceptual framework to understand it. He reduced the body to an equilateral triangle and the cardiac electric activity to a dipole, represented by an arrow (i.e. a vector) in the triangle's center. Up to the present day the interpretation of the ECG is based on the model of a dipole vector being projected on the various leads. The model is practical but intuitive, not physically founded. Burger analysed the relation between heart vector and leads according to the principles of physics. It then follows that an ECG lead must be treated as a vector (lead vector) and that the lead voltage is not simply proportional to the projection of the vector on the lead, but must be multiplied by the value (length) of the lead vector, the lead strength. Anatomical lead axis and electrical lead axis are different entities and the anatomical body space must be distinguished from electrical space. Appreciation of these underlying physical principles should contribute to a better understanding of the ECG. The development of these principles by Burger is described, together with some personal notes and a sketch of the personality of this pioneer of medical physics.

Antonio Bayés de Luna - the man behind the BaMa ECG Symposia.

Since 2005 Professor Antonio Bayés de Luna and Dr Miquel Fiol have invited experts in electrocardiography to consensus meeting in Barcelona and Mallorca. The meetings have resulted in consensus papers related to different electrocardiography topics. An interview with Professor Bayés de Luna was conducted.

An archaeologic dig: a rice-fruit diet reverses ECG changes in hypertension.

In 1940, a young German refugee physician scientist at Duke University in Durham, North Carolina began to treat patients with accelerated or "malignant" hypertension with a radical diet consisting of only white rice and fruit, with strikingly favorable results. He reported rapid reduction in blood pressure, rapid improvement in renal failure, papilledema, congestive heart failure and other manifestations of this previously fatal illness. This treatment was based on his theory that the kidney had both an excretory and a metabolic function, and that removing most of the sodium and protein burden from this organ enabled it to regain its normal ability to perform its more important metabolic functions. It was also effective in "ordinary" hypertension, in the absence of the dramatic vasculopathy of the accelerated form. The results were so dramatic that many experienced physicians suspected him of falsifying data. Among these results was the normalization of the ECG changes seen with hypertension. This paper reviews his published experience with this radical therapy, its controversial rise to fame, and its decline in popularity with the advent of effective antihypertensive drugs. It features the ECG changes seen in this then fatal disease, and the reversal of these changes by the rice diet. This treatment, though very difficult for the patient, produced effects which make it equal or superior to current multi-drug treatment of hypertension. A poorly known but important observation was that patients who were able to follow the regime, and who were slowly guided through a gradual modification of the diet over many months, were able to transition into a very tolerable low fat, largely vegetarian diet, while leading a normal, active life, without medications, indicating that the disease state had been permanently modified.

The rise of cardiovascular medicine.

Modern cardiology was born at the turn of the nineteenth to twentieth centuries with three great discoveries: the X ray, the sphygmomanometer, and the electrocardiograph. This was followed by cardiac catheterization, which led to coronary angiography and to percutaneous coronary intervention. The coronary care units and early reperfusion reduced the early mortality owing to acute myocardial infarction, and the discovery of coronary risk factors led to the development of Preventive Cardiology. Other major advances include several cardiac imaging techniques, the birth and development of cardiac surgery, and the control of cardiac arrhythmias. The treatment of heart failure, although greatly improved, remains a challenge. Current cardiology practice is evidence-based and global in scope. Research and practice are increasingly conducted in cardiovascular centres and institutes. It is likely that in the future, a greater emphasis will be placed on prevention, which will be enhanced by genetic information.