Giant negative T waves after treatment of severe hyperkalaemia

We present the case of a 79-year-old female with severe hyperkalaemia and severe prerenal insufficiency due to dehydration and nephrotoxic medications, including spironolactone. The ECG showed AV nodal rhythm and tented T waves. After treatment with fluids, insulin, polystyrene sulphonate and sodium bicarbonate, the serum potassium level and kidney function normalised. Several days later, she developed QT prolongation with giant negative T waves without signs of ischaemia.In this report, we review the effect of hyperkalaemia on cardiac ion channel function and the associated changes on the ECG. In addition, the causes and mechanisms of giant negative T waves are discussed.     

J deflections on ECG in severe hypothermia and hypokalaemia: a case report

The J wave, also known as Osborn wave, is a deflection that can be observed on the surface ECG as a late delta wave, seen at the end of the QRS complex. In this case, a 75-year-old woman, after 1 day of continuous haemodialysis, showed a marked hypothermia (28.5°C) and severe hypokalaemia (1.7 mEq/l). Bradycardia was seen on the monitor and J waves were recognised on the ECG recording. After appropriate replacement of potassium and treatment of hypothermia, the J waves disappeared spontaneously.     

Hypothermia resulting in characteristic ECG changes mimicking an acute myocardial infarction: Osborn waves and atrial fibrillation

Hypothermia can cause several ECG changes which can be mistaken for other cardiac diseases, most importantly acute transmural ischaemia. These ECG changes correlate strongly with the degree of hypothermia and the prognosis of the patient. This brief report presents a 32-year-old male who was seen after a drowning accident. After resuscitation a 12-lead electrocardiogram showed changes typical for hypothermia: atrial fibrillation and Osborn waves. The ECG of the patient normalised after rewarming.     

MIJ和HFJ近交系大鼠心电图表现

目的 测定近交系MIJ、HFJ大鼠心电图,并与Wistar大鼠比较分析,观察MIJ和HFJ大鼠心电图表现.方法 大鼠麻醉后,仰卧位固定于大鼠固定板上,用短针电极刺入皮下2～3 mm位置,麻醉5 min后,用福田青岛FX-102B心电图机做心电图,并对心电图进行分析.结果 三种大鼠均为窦性心律,心律齐整,雄性HFJ、MIJ心率均高于同性别Wistar.HFJ和MIJ品系、性别间心率差异均无显著性.HFJ和MIJ心电轴与Wistar相同,主要在0°～90°间.三种大鼠的P波方向及QRS波群基本相同,但各波振幅和各波时限,在不同品系和性别之间存在较明显的差异.结论 近交系MIJ和HFJ大鼠各有其独特的心电图表现.     

Transmural and apicobasal gradients in repolarization contribute to T-wave genesis in human surface ECG

The cellular basis of the T-wave morphology of surface ECG remains controversial in clinical cardiology. We examined the effect of action potential duration (APD) distribution on T-wave morphology using a realistic model of the human ventricle and torso. We developed a finite-element model of the ventricle consisting of ～26 million elements, including the conduction system, each implemented with the ion current model of cardiomyocytes. This model was embedded in a torso model with distinct organ structures to obtain the standard ECG leads. The APD distribution was changed in the transmural direction by locating the M cells in either the endocardial or epicardial region. We also introduced apicobasal gradients by modifying the ion channel parameters. Both the transmural gradient (with M cells on the endocardial side) and the apicobasal gradient produced positive T waves, although a very large gradient was required for the apicobasal gradient. By contrast, T waves obtained with the transmural gradient were highly symmetric and, therefore, did not represent the true physiological state. Only combination of the transmural and the moderate apicobasal gradients produced physiological T waves in surface ECG. Positive T waves in surface ECG mainly originated from the transmural distribution of APD with M cells on the endocardial side, although the apicobasal gradient was also required to attain the physiological waveform.     

Correlation of repolarization of ventricular monophasic action potential with ECG in the murine heart

Transgenic mice have become important experimental models in the investigation of mechanisms causing cardiac arrhythmias because of the ability to create strains with alterations in repolarizing membrane currents. It is important to relate alterations in membrane currents in cells to their phenotypic expression on the electrocardiogram (ECG). The murine ECG, however, has unusual characteristics that make interpretation of the phenotypic expression of changes in ventricular repolarization uncertain. The major deflection representing the QRS (referred to as "a") is often followed by a secondary slower deflection ("b") and sometimes a subtle third deflection ("c"). To determine whether the second or third deflections or both represent ventricular repolarization, we recorded the ventricular monophasic action potential (MAP) in open-chest mice and correlated repolarization with the ECG. There was no significant correlation by linear regression, between action potential duration to 50% or 90% repolarization (APD(50) or APD(90)), respectively, of the MAP and either the interval from onset of Q to onset of b (Qb interval) or onset of c (Qc interval). Administration of 4-aminopyridine (4-AP) significantly prolonged APD(50) and APD(90) and the Qb interval, indicating that this deflection on the ECG represents part of ventricular repolarization. After 4-AP, the c wave disappeared, also suggesting that it represents a component of ventricular repolarization. Although it appears that both the b and c waves that follow the Q wave on the ECG represent ventricular repolarization, neither correlates exactly with APD(90) of the MAP. Therefore, an accurate measurement of complete repolarization of the murine ventricle cannot be obtained from the surface ECG.     

Sudden unexpected improvement in the atrioventricular conduction. What is the mechanism?

The 12-lead electrocardiogram (ECG) of a 79-year-old male patient with recurrent pre-syncope showed irregular sinus rhythm with constant PR interval and left bundle branch block (LBBB) with intermittently blocked P waves. The beat following the blocked P wave had a narrower QRS with a shorter PR interval. The phenomenon of bilateral bundle branch block explains the sudden improvement in the atrioventricular conduction.     

下体负压对家兔血液动力学的影响

观察了家兔在-20、-40、-60mmHg下体负压下心输出量、心搏量、心率、血压以及心电图、脑电图、视网膜电图的变化。实验结果表明:心搏量与心输出量明显减少,在-60mmHg下作用10分钟两者可下降到负压前对照值的15％。心率大多数加快,以代偿心输出量的下降。如出现持续性心率过缓和心律不齐,标志代偿失调。收缩压、舒张压、平均动脉压、脉压均呈规律性下降。根据血压反应可将动物分为耐力良好、尚好、较差三种类型。心电图变化主要表现为冠脉供血不足,心肌缺氧特征,并伴有高尖状P波。脑电图出现缺氧性慢波、波幅降低。视网膜电图的b波波幅逐渐下降,持续期缩短,80％以上有b负波,这些变化可能与脑部及视网膜供血不足有关。     

A Powerful Algorithm to aid Cardiac Arrhythmia Diagnosis

Abstract

The Electrocardiogram (ECG), represents the electrical activity of the heart. It is characterised by a number of waves P, QRS, T which are correlated to the status of the heart activity. In this paper, the aim is to present a powerful algorithm to aid cardiac diagnosis. The approach used is based on a determinist method, that of the tree decision. However, the different waves of the ECG signal need to be identified and then measured following a signal to noise enhancement. Signal to noise enhancement is performed by a combiner linear adaptive filter whereas P, QRS, T wave identification and measurement are performed by a derivative approach. Results obtained on simulated and real ECG signals are shown to be highly, satisfactory in the aid of cardiac arrhythmia diagnosis, such as junctionnal escapes, blocks, etc.     

A Powerful Algorithm to aid Cardiac Arrhythmia Diagnosis

The Electrocardiogram (ECG), represents the electrical activity of the heart. It is characterised by a number of waves P, QRS, T which are correlated to the status of the heart activity. In this paper, the aim is to present a powerful algorithm to aid cardiac diagnosis. The approach used is based on a determinist method, that of the tree decision. However, the different waves of the ECG signal need to be identified and then measured following a signal to noise enhancement. Signal to noise enhancement is performed by a combiner linear adaptive filter whereas P, QRS, T wave identification and measurement are performed by a derivative approach. Results obtained on simulated and real ECG signals are shown to be highly, satisfactory in the aid of cardiac arrhythmia diagnosis, such as junctionnal escapes, blocks, etc.     

Discrete-wavelet-transform-based noise removal and feature extraction for ECG signals

Nowadays, doctors use electrocardiogram (ECG) to diagnose heart diseases commonly. However, some nonideal effects are often distributed in ECG. Discrete wavelet transform (DWT) is efficient for nonstationary signal analysis. In this paper, the Symlets sym5 is chosen as the wavelet function to decompose recorded ECG signals for noise removal. Soft-thresholding method is then applied for feature detection. To detect ECG features, R peak of each heart beat is first detected, and the onset and offset of the QRS complex are then detected. Finally, the signal is reconstructed to remove high frequency interferences and applied with adaptive searching window and threshold to detect P and T waves. We use the MIT-BIH arrhythmia database for algorithm verification. For noise reduction, the SNR improvement is achieved at least 10 dB at SNR 5 dB, and most of the improvement SNR are better than other methods at least 1 dB at different SNR. When applying to the real portable ECG device, all R peaks can be detected when patients walk, run, or move at the speed below 9 km/h. The performance of delineation on database shows in our algorithm can achieve high sensitivity in detecting ECG features. The QRS detector attains a sensitivity over 99.94%, while detectors of P and T waves achieve 99.75% and 99.7%, respectively.     

A modified Zeeman model for producing HRV signals and its application to ECG signal generation

Developing a mathematical model for the artificial generation of electrocardiogram (ECG) signals is a subject that has been widely investigated. One of the challenges is to generate ECG signals with a wide range of waveforms, power spectra and variations in heart rate variability (HRV)--all of which are important indexes of human heart functions. In this paper we present a comprehensive model for generating such artificial ECG signals. We incorporate into our model the effects of respiratory sinus arrhythmia, Mayer waves and the important very low-frequency component in the power spectrum of HRV. We use a new modified Zeeman model for generating the time series for HRV, and a single cycle of ECG is produced by using a simple neural network. The importance of the work is the model's ability to produce artificial ECG signals that resemble experimental recordings under various physiological conditions. As such the model provides a useful tool to simulate and analyse the main characteristics of ECG, such as its power spectrum and HRV under different conditions. Potential applications of this model include using the generated ECG as a flexible signal source to assess the effectiveness of a diagnostic ECG signal-processing device.     

The Effect of Phenothiazines on the Electrocardiogram

Thioridazine, chlorpromazine and trifluoperazine were administered to six psychiatric patients. Each was used in four dosage levels (thioridazine and chlorpromazine: 200, 400, 800 and 1200 mg. daily; trifluoperazine: 8, 16, 32, 64 mg. daily); and each increase in dosage was effected after four days of drug administration.Before the trial, twice during each drug period and before commencement of the next dose regimen, an electrocardiogram (ECG) was recorded. The findings indicated that thioridazine modifies the terminal portion (S-T segment, T and U waves) of the human ECG. A similar change occurred in three of six subjects while taking chlorpromazine and in one of six while taking trifluoperazine. Thioridazine induced changes in all six subjects studied, viz., blunting and notching of T waves with or without prolongation of QT interval. In some the notching produced a doublehump appearance in which a T wave of reduced voltage formed the proximal hump and a positive U wave of increased voltage formed the distal hump.Thioridazine-induced alterations in the ECG have been described as resembling those caused by quinidine; they also resemble changes associated with hypokalemia.     

Development of SVM based classification techniques for the delineation of wave components in 12-lead electrocardiogram

The automatic detection of electrocardiogram (ECG) waves namely P, QRS and T-wave is important to cardiac disease diagnosis. This paper presents an application of support vector machine (SVM) as a classifier for the delineation of ECG wave components in the 12-lead ECG signal. Digital filtering techniques are used to remove power line interference and baseline wander present in the ECG signal. Gradient of the filtered ECG signal is used as a feature for the detection of QRS-complexes, P- and T-waves. The performance of the algorithm is validated using original 12-lead ECG recordings from the standard CSE ECG database. Significant detection rate is achieved. The percentage of false positive and false negative detection is low. The method successfully detects all kind of morphologies of QRS-complexes, P- and T-waves. The onsets and offsets of the detected QRS-complexes, P- and T-waves are found to be within the tolerance limits given in CSE library.     

Changes in Electrocardiographic Parameters in Males of the European North as Markers of Climate- and Age-Related Effects

Electrocardiographic (ECG) amplitude- and time-related characteristics were determined in 20- to 59-year-old healthy male residents of the European north (the zone from 60° to 70° N). They were found to display increased amplitudes of some ECG waves, as well as prolonged P waves and R–R intervals, as compared to residents of warmer regions. In men, with age, the electrical axis of the heart shifts leftward and the heart tends to rotate counterclockwise about its longitudinal axis. Increased amplitudes of the P and S waves, as well as decreased amplitudes of theQ, R, and T waves, a lower position of the ST segment relative to the isoelectric line, and a prolongation of the P wave; the P–Q, Q–T, and R–R intervals; and the ST segment were observed in most of the leads. A regional variant of the age-specific amplitude- and time-related characteristics of the ECG is suggested for healthy male residents of the north.     

对肾上腺素性心肌缺血模型大鼠相关指标的探讨

目的进一步探讨客观评价大鼠心肌缺血模型的指标。方法观察皮下注射10mg kg异丙肾上腺素(ISO)造成SD大鼠心肌缺血性损伤模型后心电图的变化、检测血清中肌酸激酶(CK)、乳酸脱氢酶(LDH)、游离脂肪酸(FFA)以及心肌组织的坏死面积、超氧化物歧化酶(SOD)、丙二醛(MDA)含量的变化。结果腹腔注射ISO后30s,大鼠心电图的J点开始降低,2min后缓慢回升,但20min后仍未回复到原来的水平,而且20min内各时间点与给药前比较,模型对照组大鼠的J点与生理盐水对照组比较,差异有显著性(P<0.05);T波则在注射异丙肾上腺素30s后开始下降,10min内两组的T波一直保持显著差异(P<0.05),而且注射异丙肾上腺素后30s(P<0.01)以及5min(P<0.05)与给药前比较,T波均有显著差异;模型对照组大鼠血清中CK、LDH、FFA以及心肌组织中MDA浓度均显著高于生理盐水对照组,心肌坏死面积与这些指标呈正相关关系,心肌组织中SOD浓度显著低于生理盐水对照组。结论J点可以作为评价此种动物模型的主要指标,T波可以作为辅助指标,应重点观察20min内心电图的变化;可以选择CK、LDH、FFA、SOD、MDA等生化指标以及心肌坏死面积等来探讨抗心肌缺血药物的作用机理。     

The electrocardiogram of unanesthetized cats fixed in a net

Electrocardiograms by standard limb lead, augumented unipolar limb lead and AB (Apex-Base) lead were recorded from 24 unanesthetized adult cats from a SPF closed colony. The unanesthetized cats were held in the sternal position or in the right lateral recumbent position by means of a net. The mean electrical axes of P, QRS and T waves were calculated on the basis of values of I, II and III leads. The ECG patterns and mean electrical axes were compared between the sternal position and the right lateral recumbent position. The results are summarized as follows. The mean values of RR duration, P wave duration, QRS complex duration, T wave duration, PQ interval and QT interval were 0.432, 0.033, 0.027, 0.101, 0.076 and 0.183 seconds, respectively. The values of duration, interval and amplitude were not prominently influenced by the change in posture. The ECG shape had a definite configuration on each lead except that leads I and a VL showed unstable patterns. Notches and R' waves appeared in every lead in many cases. There was a positive linear correlation between RR and QT duration: r = 0.798 in the sternal position and r = 0.525 in the right lateral recumbent position. The angle of QRS mean electrical axis on the horizontal plane was 66.90 degrees +/- 26.05 (SD) in the sternal position and 41.84 degrees +/- 75.23 (SD) in the right lateral recumbent position. The P and T mean electrical axes showed small variations.     

正常人体表心电图形态的逐拍变化

心电图的各种波形是众多心肌细胞动作电位在体表的综合效应。建立了对体表心电图的形态进行逐拍分析的硬件及软件系统。对５８例健康人体表心电图进行了采集和分析,得到了正常人体表心电图中Ｐ波,ＱＲＳ波,及Ｔ波的形态差异图,并进行了频谱及时域瞬态分析,从而展示了心肌电活动在体表心电图中的逐拍变化现象,体表心电图逐拍形态变化反映了心房肌和心室肌电活动的时变特征。     

体外反搏机用心电和颞脉波发生器

以病员作为信号源对体外反搏装置的控制系统进行检测既不方便又不实际,本研究利用单片机模拟输出多种心电波形和反搏前、反搏中的颞脉波能解决此问题。实验表明研制出的体外反搏机用心电和颞脉波信号发生器运作良好,具有应用开发价值。     

Method for an automatic analysis of the ECG

A method is presented for an analysis of the ECG. Using cubic spline techniques we proceed first to a smoothing of the signal and then to the elimination of baseline drift. The properties of the calculated derivatives are used to establish criteria for the identification of the ECG waves and the measurement of their essential parameters. The complete procedure can be carried out by a computer, without human intervention. The results of this fully automatic procedure can be used directly as a means of classifying the ECG.