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1.
Circ Arrhythm Electrophysiol ; 13(8): e008253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32634327

RESUMO

BACKGROUND: Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing Z-scores. METHODS: One hundred two ECG variables were collected from a retrospective cohort of 27 085 study subjects with no known heart condition, ages 0 to 39 years. The cohort was divided into 16 age groups by sex. Median, interquartile range, and range were calculated for each variable adjusted to body surface area. RESULTS: Normative standards were developed for all 102 ECG variables including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QRS duration, QT, and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental Z-score values between -2.5 and 2.5 were calculated to establish upper and lower limits of normal. Historical ECG interpretative concepts were reassessed and new concepts observed. CONCLUSIONS: Electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Expression of ECG variables by Z-scores lends an objective and reproducible evaluation without interpreter bias that can lead to more confident establishment of ECG-disease correlations and improved automated ECG readings in high-volume cardiac screening efforts in the young. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Eletrocardiografia/normas , Sistema de Condução Cardíaco/fisiologia , Frequência Cardíaca , Adolescente , Adulto , Fatores Etários , Superfície Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Adulto Jovem
2.
PLoS One ; 15(4): e0232606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353083

RESUMO

INTRODUCTION: The examination of the fetal heart in mid-pregnancy is by ultrasound examination. The quality of the examination is highly dependent on the skill of the sonographer, fetal position and maternal body mass index. An additional tool that is less dependent on human experience and interpretation is desirable. The fetal electrocardiogram (ECG) could fulfill this purpose. We aimed to show the feasibility of recording a standardized fetal ECG in mid-pregnancy and explored its possibility to detect congenital heart disease (CHD). MATERIALS AND METHODS: Women older than 18 years of age with an uneventful pregnancy, carrying a healthy singleton fetus with a gestational age between 18 and 24 weeks were included. A fetal ECG was performed via electrodes on the maternal abdomen. After removal of interferences, a vectorcardiogram was constructed. Based on the ultrasound assessment of the fetal orientation, the vectorcardiogram was rotated to standardize for fetal orientation and converted into a 12-lead ECG. Median ECG waveforms for each lead were calculated. RESULTS: 328 fetal ECGs were recorded. 281 were available for analysis. The calculated median ECG waveform showed the electrical heart axis oriented to the right and inferiorly i.e. a negative QRS deflection in lead I and a positive deflection in lead aVF. The two CHD cases show ECG abnormalities when compared to the mean ECG of the healthy cohort. DISCUSSION: We have presented a method for estimating a standardized 12-lead fetal ECG. In mid-pregnancy, the median electrical heart axis is right inferiorly oriented in healthy fetuses. Future research should focus on fetuses with congenital heart disease.


Assuntos
Eletrocardiografia/normas , Coração Fetal/fisiologia , Cardiopatias Congênitas/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Estudos de Casos e Controles , Estudos Transversais , Eletrocardiografia/instrumentação , Estudos de Viabilidade , Feminino , Idade Gestacional , Cardiopatias Congênitas/fisiopatologia , Frequência Cardíaca Fetal/fisiologia , Humanos , Lactente , Países Baixos , Projetos Piloto , Gravidez , Segundo Trimestre da Gravidez , Valores de Referência
3.
PLoS Med ; 17(4): e1003082, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32243458

RESUMO

BACKGROUND: The evaluation of the credibility of results from a meta-analysis has become an important part of the evidence synthesis process. We present a methodological framework to evaluate confidence in the results from network meta-analyses, Confidence in Network Meta-Analysis (CINeMA), when multiple interventions are compared. METHODOLOGY: CINeMA considers 6 domains: (i) within-study bias, (ii) reporting bias, (iii) indirectness, (iv) imprecision, (v) heterogeneity, and (vi) incoherence. Key to judgments about within-study bias and indirectness is the percentage contribution matrix, which shows how much information each study contributes to the results from network meta-analysis. The contribution matrix can easily be computed using a freely available web application. In evaluating imprecision, heterogeneity, and incoherence, we consider the impact of these components of variability in forming clinical decisions. CONCLUSIONS: Via 3 examples, we show that CINeMA improves transparency and avoids the selective use of evidence when forming judgments, thus limiting subjectivity in the process. CINeMA is easy to apply even in large and complicated networks.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia/normas , Teste de Esforço/normas , Imagem Cinética por Ressonância Magnética/normas , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Intervalos de Confiança , Doença da Artéria Coronariana/epidemiologia , Eletrocardiografia/métodos , Teste de Esforço/métodos , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
4.
GMS J Med Educ ; 37(1): Doc11, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32270025

RESUMO

Objective: ECG interpretation is prone to errors that can lead to relevant misdiagnoses and incorrect treatment. Prompts are one way in lectures to encourage learning from one's own mistakes and to reduce error rates. Prompts are measures such as questions, hints, and suggestions of content-related or metacognitive nature, which can lead to self-explanation in the learner and thus to a deeper understanding of an issue. The aim of the study was therefore to investigate whether the use of prompts can reduce the error rate in ECG interpretation among students. Method: In a 2x2 experimental test and control group design, N=100 final year medical students carried out ECG interpretation tasks in the form of online case vignettes in CASUS®. In these tasks, justification prompts (B) and error analysis prompts (F) were systematically varied in four groups and the learning success was measured using a knowledge test. In addition, prior knowledge in ECG interpretation, motivation, interest in the topic, subjective confidence in ECG interpretation, and cognitive load was collected. Results: Neither error analysis prompts nor justification prompts had a significant effect on the correct ECG interpretation by students, F(1,96)=1.03, p=.31. Justification prompts seemed to have a positive effect on the confidence of answering the questions, F(1,96)=10.15, p=.002, partial η 2 =.10; and a negative effect on student motivation, F(1,96)=8.13 , p=.005, partial η 2 =.08; but both with comparable diagnostic accuracy. Conclusion: The present study could not confirm the positive effects of prompts on the error rate in ECG interpretation reported in the literature but showed significant effects on subjective confidence and motivation which should be investigated in further studies.


Assuntos
Eletrocardiografia/métodos , Aprendizagem , Estudantes de Medicina/psicologia , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Eletrocardiografia/normas , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Masculino , Motivação , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
5.
Intern Med ; 59(11): 1351-1359, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132336

RESUMO

Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We increased the medication dosage in four patients. An ICD was implanted in two patients, including one with refractory spasm and one with left main trunk spasm. One patient died due to pulseless electrical activity without ventricular fibrillation, while the remaining four patients survived. Conclusion Spasm provocation tests under medication in patients with ASCD due to coronary spasm may be an option when deciding on medical or mechanical therapy.


Assuntos
Vasoespasmo Coronário/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/normas , Eletrocardiografia/normas , Ergonovina/normas , Ergonovina/uso terapêutico , Injeções Intra-Arteriais/normas , Idoso , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Ocitócicos/normas , Ocitócicos/uso terapêutico , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
6.
Midwifery ; 83: 102655, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036193

RESUMO

BACKGROUND: The STan Australian Randomised controlled Trial (START), the first of its kind in Australia, compares two techniques of intrapartum fetal surveillance (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram (STan+CTG) with CTG alone) with the aim of reducing unnecessary obstetric intervention. It is also the first comprehensive intrapartum fetal surveillance (IFS) trial worldwide, including qualitative examination of psychosocial outcomes and cost-effectiveness. In evaluating and implementing healthcare interventions, the perspectives and experiences of individuals directly receiving them is an integral part of a comprehensive assessment. Furthermore, the added value of using qualitative research alongside randomised controlled trials (RCTs) is becoming widely acknowledged. OBJECTIVE: This study aimed to examine women's experiences with the type of IFS they received in the START trial. METHODS: Using a qualitative research design, a sample of thirty-two women were interviewed about their experiences with the fetal monitoring they received. Data were analysed using thematic analysis. FINDINGS: Six themes emerged from analysis: reassurance, mobility, discomfort, perception of the fetal Scalp Electrode (FSE), and overall positive experience. CONCLUSION: Interestingly, it was found that women who had an FSE in the CTG alone arm of the trial reported very similar experiences to women in the STan+CTG arm of the trial. Despite STan and CTG differing clinically, from women's perspectives, the primary difference between the two techniques was the utilisation (or not) of the FSE. Women were very accepting of STan+CTG as it was perceived and experienced as a more accurate form of monitoring than CTG alone. Findings from this study have significant implications for health professionals including midwives and obstetricians and implications for standard practice and care. The study has demonstrated the importance and significance of incorporating qualitative enquiry within RCTs.


Assuntos
Cardiotocografia/normas , Eletrocardiografia/normas , Gestantes/psicologia , Adulto , Austrália , Cardiotocografia/métodos , Cardiotocografia/psicologia , Eletrocardiografia/métodos , Eletrocardiografia/psicologia , Feminino , Humanos , Entrevistas como Assunto/métodos , Gravidez , Pesquisa Qualitativa
8.
Am J Med ; 133(5): 582-589.e7, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31647913

RESUMO

BACKGROUND: The Fourth Universal Definition of Myocardial Infarction defines electrocardiographic Q waves as duration ≥30 ms and amplitude ≥1 mm or QS complex in 2 contiguous leads. However, current taskforce criteria may be overly restrictive. Therefore, we investigated the association of isolated, lenient, or strict Q waves with long-term outcome. METHODS: From 2001 to 2015, we included Danish primary care patients with digital electrocardiograms (ECGs) that were evaluated for Q waves. If none occurred, patients had no Q waves. If no other contiguous Q wave occurred, patients had isolated Q waves. If another contiguous Q wave occurred meeting only 1 criterion (≥30 ms and <1 mm or <30 ms and ≥1 mm), patients had lenient Q waves. If another contiguous Q wave occurred, patients had strict Q waves. RESULTS: Of 365,206 patients, 87,957 had isolated, lenient, or strict Q waves (24%; median age, 61 years; male, 48%), and 277,249 had no Q waves (76%; median age, 53 years; male, 42%). Mortality risk was increased with isolated (all-cause adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.29-1.37; cardiovascular-cause aHR, 1.78; 95% CI, 1.70-1.87), lenient (all-cause aHR, 1.41; 95% CI, 1.33-1.50; cardiovascular-cause aHR, 1.78; 95% CI, 1.63-1.94), or strict (all-cause aHR, 1.64; 95% CI, 1.57-1.72; cardiovascular-cause aHR, 2.70; 95% CI, 2.52-2.89) Q waves compared with no Q waves. Highest mortality risk was associated with lenient or strict Q waves in anteroseptal leads. CONCLUSIONS: This large contemporary analysis suggests that less-stringent Q-wave criteria carry prognostic value in predicting adverse outcome among primary care patients.


Assuntos
Eletrocardiografia , Infarto do Miocárdio/diagnóstico , Idoso , Dinamarca , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Prognóstico , Sistema de Registros , Fatores de Risco
9.
Nurs Crit Care ; 25(1): 37-44, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30969471

RESUMO

BACKGROUND: Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards. AIM: The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time. STUDY DESIGN: A comparative study design was applied, and data were obtained by survey methodology. METHODS: Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively). RESULTS: In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P < .001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P = .001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P < .001). Overall, 64% always informed patients of the purpose of cardiac monitoring. CONCLUSION: A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required. RELEVANCE TO CLINICAL PRACTICE: Improved in-hospital telemetry practice is required to ensure patient safety and better care outcomes.


Assuntos
Enfermagem Cardiovascular , Guias de Prática Clínica como Assunto/normas , Telemetria/normas , Adulto , Arritmias Cardíacas/diagnóstico , Enfermagem Cardiovascular/normas , Enfermagem Cardiovascular/estatística & dados numéricos , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Noruega , Segurança do Paciente , Inquéritos e Questionários
10.
Br J Sports Med ; 54(12): 739-745, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31278087

RESUMO

AIM: To investigate the accuracy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players. METHODS: 11 168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram; 10 581 (95%) of the players were male and 10 163 (91%) were white. ECGs were retrospectively analysed according to (1) the 2010 European Society of Cardiology (ESC) recommendations, (2) Seattle criteria, (3) refined criteria and (4) the international recommendations for ECG interpretation in young athletes. RESULTS: The ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.8%, respectively). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% vs 12.9%; Seattle: 5.9% vs 4.2%; refined: 3.8% vs 2.8%; international 3.6% vs 1.6%; p<0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria identified a lower number of abnormal ECGs-by 67%, 78% and 86%, respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%. CONCLUSIONS: The 2017 international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes to detect serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent soccer players.


Assuntos
Grupo com Ancestrais do Continente Africano , Eletrocardiografia/normas , Grupo com Ancestrais do Continente Europeu , Cardiopatias/diagnóstico , Cardiopatias/etnologia , Programas de Rastreamento/normas , Futebol/fisiologia , Adolescente , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores Sexuais
11.
Acad Emerg Med ; 27(1): 15-23, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31854141

RESUMO

BACKGROUND: Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non-low-risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non-low-risk patients with syncope in the ED. METHODS: This prospective multicenter observational study included adult patients presenting to the ED after syncope. Patients without an obvious etiology after ED evaluation who were classified by ED physicians as being at non-low risk of adverse events underwent ECG monitoring. We assessed sensitivity, specificity, and diagnostic yield (defined as the proportion of patients with true-positive ECG monitoring findings) of ECG monitoring in the identification of 7- and 30-day adverse and arrhythmic events according to monitoring duration. RESULTS: Of 242 patients included in the study, 29 patients had 7-day serious outcomes. Ten additional patients had serious outcomes at 30 days. The overall sensitivity, specificity, and diagnostic yield of ECG monitoring in the identification of 7-day adverse events were 0.55 (95% confidence interval [CI] = 0.36 to 0.74], 0.93 (95% CI = 0.89 to 0.96), and 0.07 (95% CI = 0.04 to 0.10), respectively. The sensitivity, specificity, and diagnostic yield of >12-hour ECG monitoring in the identification of 7-day adverse events were 0.89 (95% CI = 0.65 to 0.99), 0.78 (95% CI = 0.67 to 0.87), and 0.18 (95% CI = 0.12 to 0.28), respectively. Similar results were observed for 30-day adverse events. The median (interquartile range) ECG monitoring time was 6.5 (6 to 15) hours. ECG monitoring findings were positive in 31 patients. CONCLUSIONS: Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours' duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non-low-risk patients with syncope in the ED.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/normas , Síncope/etiologia , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/complicações , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
12.
J Neurointerv Surg ; 12(6): 632-636, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31699886

RESUMO

​BACKGROUND AND PURPOSE: Intracranial aneurysms are a frequently occurring disease, with an estimated prevalence of 2-5% in the general population. They usually remain silent until rupture occurs, with a mortality rate of 35-50% and a high rate of morbidity, including long-term disability. However, preventative treatments have their own risk of complications and morbi-mortality rates, including stroke and hemorrhage. ECG-gated four-dimensional CT angiography (4D-CTA) allows the acquisition of time-resolved three-dimensional reconstructions. The aim of our study was to evaluate different intracranial aneurysm metrics over the cardiac cycle using ECG-gated 4D-CTA. ​MATERIALS AND METHODS: ECG-gated 4D-CTA datasets were acquired in patients presenting with intracranial aneurysms. Seven aneurysm metrics, including aneurysm height, aneurysm length, ostium width, aspect ratio, ostium area, volume, and volume-to-ostium ratio, were analysed over different cardiac phases. Intra-reader agreement, inter-reader agreement, and inter-cycle agreement were calculated through the intraclass correlation coefficient. ​RESULTS: Twenty-one aneurysms from 11 patients were considered for inclusion. Post-processing failed for three aneurysms, and 18 aneurysms were finally analysed. There was good intra-reader agreement for each metric (ICC >0.9). Agreements among three consecutive cardiac cycles were calculated for six aneurysms and were especially good for the volume metric (ICC >0.9). Volume variation appears to be the most relevant metric and seems especially perceptible for aneurysms larger than 5 mm. ​CONCLUSIONS: Quantification of aneurysm volume changes during the cardiac cycle seems quantitatively possible and reproducible, especially for aneurysms larger than 5 mm. Further studies need to be conducted to validate this parameter for intracranial aneurysm assessment.


Assuntos
Angiografia Cerebral/métodos , Eletrocardiografia/métodos , Tomografia Computadorizada Quadridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angiografia Cerebral/normas , Eletrocardiografia/normas , Feminino , Tomografia Computadorizada Quadridimensional/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Med Syst ; 44(2): 35, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31853698

RESUMO

With age, our blood vessels are prone to aging, which induces cardiovascular disease. As an important basis for diagnosing heart disease and evaluating heart function, the electrocardiogram (ECG) records cardiac physiological electrical activity. Abnormalities in cardiac physiological activity are directly reflected in the ECG. Thus, ECG research is conducive to heart disease diagnosis. Considering the complexity of arrhythmia detection, we present an improved convolutional neural network (CNN) model for accurate classification. Compared with the traditional machine learning methods, CNN requires no additional feature extraction steps due to the automatic feature processing layers. In this paper, an improved CNN is proposed to automatically classify the heartbeat of arrhythmia. Firstly, all the heartbeats are divided from the original signals. After segmentation, the ECG heartbeats can be inputted into the first convolutional layers. In the proposed structure, kernels with different sizes are used in each convolution layer, which takes full advantage of the features in different scales. Then a max-pooling layer followed. The outputs of the last pooling layer are merged and as the input to fully-connected layers. Our experiment is in accordance with the AAMI inter-patient standard, which included normal beats (N), supraventricular ectopic beats (S), ventricular ectopic beats (V), fusion beats (F), and unknown beats (Q). For verification, the MIT arrhythmia database is introduced to confirm the accuracy of the proposed method, then, comparative experiments are conducted. The experiment demonstrates that our proposed method has high performance for arrhythmia detection, the accuracy is 99.06%. When properly trained, the proposed improved CNN model can be employed as a tool to automatically detect different kinds of arrhythmia from ECG.


Assuntos
Algoritmos , Arritmias Cardíacas/classificação , Arritmias Cardíacas/diagnóstico , Eletrocardiografia/normas , Frequência Cardíaca , Humanos , Redes Neurais de Computação , Processamento de Sinais Assistido por Computador
14.
GMS J Med Educ ; 36(6): Doc72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31844644

RESUMO

Purpose: The study takes a qualitative and explorative approach to capture the concepts that German medical students have of the physiological electrocardiogram (ECG) which they acquired during their preclinical training. These concepts are then considered for possible misconceptions. Afterwards a theory-based intervention which allows subjects to see the connection of the curve progression with the spatial spreading of excitation (animated vector loop) is put to the test. Methods: In the course of a diagnosis of learning potentials, individual students participated in problem-centred, guided interviews. The developed intervention was tested in separately conducted teaching experiments using thinking aloud protocols. The data evaluation was done through qualitative content analysis. Based on the conceptual metaphor theory, conceptions and their underlying embodied cognition were analysed. Results: One of the subjects' typical misinterpretations is taking the progression of the ECG tracing for a mere increase and decrease of the myocardium's electrical activity, rather than connecting it with its spatial and temporal aspects. The data evaluation has shown that the newly developed theory-based intervention can lead to re-learning. Reconstructed metaphorical concepts illustrate this process of understanding. It is exemplarily shown how, through the course of the interviews, students are enabled to appropriately explain ECGs as the two-dimensional representation of the spatial excitation propagation in the heart. Conclusion: By capturing typical misconceptions of the physiological electrocardiogram and demonstrating interventions that support learning, the study provides a contribution to comprehensive learning which can be used in the basic education of medical students.


Assuntos
Educação Médica/métodos , Eletrocardiografia/normas , Aprendizagem Baseada em Problemas/métodos , Competência Clínica , Compreensão , Humanos , Pesquisa Qualitativa , Estudantes de Medicina/psicologia
15.
J Clin Hypertens (Greenwich) ; 21(12): 1863-1871, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31693279

RESUMO

Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost-effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost-effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Eletrocardiografia/métodos , Coração/fisiopatologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Aorta/anatomia & histologia , Aorta/patologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Morte , Dilatação Patológica/fisiopatologia , Diagnóstico Precoce , Eletrocardiografia/normas , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Humanos , Hipertensão/complicações , Masculino , Programas de Rastreamento/métodos , Infarto do Miocárdio/epidemiologia , Narração , Padrões de Prática Médica/normas , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
16.
Presse Med ; 48(12): 1393-1400, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471091

RESUMO

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).


Assuntos
Atletas , Eletrocardiografia , Cardiopatias/diagnóstico , Esportes , Cardiologia/métodos , Cardiologia/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/normas , Eletrocardiografia/métodos , Eletrocardiografia/normas , Exercício Físico/fisiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Padrões de Referência , Esportes/normas
17.
Pacing Clin Electrophysiol ; 42(9): 1191-1196, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31400010

RESUMO

BACKGROUND: Mobile electrocardiograms (mECGs) utilizing smartphone applications are an emerging technology. Typically, a Lead I rhythm strip is recorded. However, interpretation can be difficult in patients with sinus rhythm and low amplitude P-waves (SR-LAP) or atrial flutter (AFL). We hypothesized that patients could independently obtain multi-lead tracings using a commercial mECG device, and that cardiologists who interpreted the multi-lead tracings would make more accurate diagnoses and have more confidence in their interpretation compared to a single lead only. METHODS: Thirty sets of recordings were obtained from 10 patients with either SR-LAP or AFL that was not apparent on Lead I on a standard ECG. Patients recorded Lead I, Lead II, and Lead V1 tracings using AliveCor's KardiaMobile mECG device. Twenty-nine cardiologists reviewed each patient's Lead I tracing, multi-lead tracings (Leads I, II, V1), and 12-lead ECG. Accuracy was noted and each cardiologist rated their level of confidence in their interpretation. RESULTS: All patients were able to record their own single and multi-lead tracings. Single lead, multi-lead, and the 12-lead ECG yielded 36.4%, 84.3%, and 97.7% agreement with the established diagnosis, respectively (P < .01 for each comparison). Overall mean confidence scores (out of a score of 5) were 2.95, 3.50, and 4.47 for single lead, multi-lead, and the 12-lead ECG, respectively (P < .01 for each comparison). CONCLUSIONS: Patients were able to record their own multi-lead mECG tracings. Compared to a single lead recording, multi-lead mECGs significantly improved cardiologists' diagnostic accuracy and confidence in their interpretation approaching that of a standard 12-lead ECG.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/instrumentação , Eletrocardiografia/normas , Aplicativos Móveis , Idoso , Técnicas de Diagnóstico Cardiovascular/normas , Eletrodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
18.
Rev Bras Enferm ; 72(3): 609-616, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269123

RESUMO

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


Assuntos
Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Idoso , Pressão Sanguínea/fisiologia , Alarmes Clínicos , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
19.
Physiol Meas ; 40(7): 075011, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31216525

RESUMO

OBJECTIVE: This study proposes a reference database, composed of a large number of simulated ECG signals in atrial fibrillation (AF), for investigating the performance of methods for extraction of atrial fibrillatory waves (f-waves). APPROACH: The simulated signals are produced using a recently published and validated model of 12-lead ECGs in AF. The database is composed of eight signal sets together accounting for a wide range of characteristics known to represent major challenges in f-wave extraction, including high heart rates, high morphological QRST variability, and the presence of ventricular premature beats. Each set contains 30 5 min signals with different f-wave amplitudes. The database is used for the purpose of investigating the statistical association between different indices, designed for use with either real or simulated signals. MAIN RESULTS: Using the database, available at the PhysioNet repository of physiological signals, the performance indices unnormalized ventricular residue (uVR), designed for real signals, and the root mean square error, designed for simulated signals, were found to exhibit the strongest association, leading to the recommendation that uVR should be used when characterizing performance in real signals. SIGNIFICANCE: The proposed database facilitates comparison of the performance of different f-wave extraction methods and makes it possible to express performance in terms of the error between simulated and extracted f-wave signals.


Assuntos
Fibrilação Atrial/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia/normas , Processamento de Sinais Assistido por Computador , Humanos , Padrões de Referência
20.
PLoS One ; 14(6): e0218784, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31226142

RESUMO

OBJECTIVE: Pulse transit time (PTT) refers to the time it takes a pulse wave to travel between two arterial sites. PTT can be estimated, amongst others, using the electrocardiogram (ECG) and photoplethysmogram (PPG). Because we observed a sawtooth artifact in the PTT while using standard patient monitoring equipment for ECG and PPG, we explored the reasons for this artifact. METHODS: PPG and ECG were simulated at a heartrate of both 100 and 160 beats per minute while using a Masimo PPG post-processing module and a Philips patient monitor setup at the neonatal intensive care unit. Two different post-processing modules were used. PTT was defined as the difference between the R-peak in the ECG and the point of 50% increase in the PPG. RESULTS: A sawtooth artifact was seen in all simulations. Both length (59.2 to 72.4 s) and amplitude (30.8 to 36.0 ms) of the sawtooth were dependent on the post-processing module used. Furthermore, the absolute PTT value differed up to 250 ms depending on post-processing module and heart rate. The sawtooth occurred because the PPG wave continuously showed a minimal prolongation during the length of the sawtooth, followed by a sudden shortening. Both artifacts were generated in the post-processing module containing Masimo algorithms. CONCLUSION: Post-processing of the PPG signal in the Masimo module of the Philips patient monitor introduces a sawtooth in PPG and derived PTT. This sawtooth, together with a large module-dependent absolute difference in PTT, renders the thus-derived PTT insufficient for clinical purposes.


Assuntos
Artefatos , Eletrocardiografia/instrumentação , Monitorização Fisiológica , Fotopletismografia/instrumentação , Análise de Onda de Pulso , Algoritmos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Simulação por Computador , Eletrocardiografia/normas , Frequência Cardíaca/fisiologia , Humanos , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Fotopletismografia/normas , Análise de Onda de Pulso/instrumentação , Análise de Onda de Pulso/métodos , Análise de Onda de Pulso/normas , Padrões de Referência , Processamento de Sinais Assistido por Computador/instrumentação
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