A brief review: history to understand fundamentals of electrocardiography
The last decade of the 19th century witnessed the rise of a new era in which physicians used technology along with classical history taking and physical examination for the diagnosis of heart disease. The introduction of chest x-rays and the electrocardiograph (electrocardiogram) provided objective information about the structure and function of the heart. In the first half of the 20th century, a number of innovative individuals set in motion a fascinating sequence of discoveries and inventions that led to the 12-lead electrocardiogram, as we know it now. Electrocardiography, nowadays, is an essential part of the initial evaluation for patients presenting with cardiac complaints. As a first line diagnostic tool, health care providers at different levels of training and expertise frequently find it imperative to interpret electrocardiograms. It is likely that an understanding of the electrical basis of electrocardiograms would reduce the likelihood of error. An understanding of the disorders behind electrocardiographic phenomena could reduce the need for memorizing what may seem to be an endless list of patterns. In this article, we will review the important steps in the evolution of electrocardiogram. As is the case in most human endeavors, an understanding of history enables one to deal effectively with the present. [1]
Fundamentals of Electrocardiography Interpretation
The use of dynamic electrocardiogram (ECG) monitoring is regarded as a standard of care during general anesthesia and is strongly encouraged when providing deep sedation. Although significant cardiovascular changes rarely if ever can be attributed to mild or moderate sedation techniques, the American Dental Association recommends ECG monitoring for patients with significant cardiovascular disease. The purpose of this continuing education article is to review basic principals of ECG monitoring and interpretation. [2]
A History of the origin, evolution, and impact of electrocardiography
The invention of the electrocardiograph by Dutch physiologist Willem Einthoven in 1902 gave physicians a powerful tool to help them diagnose various forms of heart disease, especially arrhythmias and acute myocardial infarction. The discovery of x-rays in 1895 and the invention of the electrocardiograph 7 years later inaugurated a new era in which various machines and technical procedures gradually replaced the physician’s unaided senses and the stethoscope as the primary tools of cardiac diagnosis. These sophisticated new approaches provided objective information about the structure and function of the heart in health and disease. This review summarizes the origins and development of electrocardiography and addresses its role in defining cardiology as a specialty. [3]
Nstemi “But” Stemi-De Winters Sign
Anterior ST elevation myocardial infarction can present with a specific electrocardiographic (ECG) pattern without ST segment elevations, known as De Winter sign. Recognizing this ECG pattern is important since it is considered an equivalent to ST elevation myocardial infarction (STEMI), hence may require thrombolysis when primary PCI facilities are not available or delayed. We report a28 year old male who presented to us with de winters ecg pattern. Subsequent coronary angiogram showed Proxmial left anterior descending (LAD) artery occlusion. [4]
Severe Coronary Artery Ectasia with ST Elevation MI: A Challenging Situation
Aim: To report a case of huge coronary artery ectasia presenting with acute myocardial infarction; a relatively rare finding encountered during coronary angiography.
Presentation of Case: A young male presented with chest pain and profuse sweating at a local hospital. Electrocardiogram showed Infero-posterior STEMI. Patient received streptokinase. His symptoms settled however the electrocardiogram changes did not resolve. He presented at our hospital after 24 hours with chest discomfort. He was vitally stable and a murmur of MR was audible. His Troponin-I was raised and electrocardiogram showed ST elevations with Q waves. Coronary angiogram showed giant ectasia and occluded right coronary artery (RCA). Percutaneous coronary intervention of RCA was done; with TIMI II flow but still had some residual thrombus. The patient was kept on Tirofiban infusion. His CRP and homocysteine levels were raised. Dual antiplatelet, statin, ACE Inhibitor, beta blocker with vitamin B12 and folic acid supplement were continued.
Discussion: Coronary artery ectasia is a form of atherosclerosis seen in 0.3–4.9% of coronary angiography procedures. It is described as dilation of the coronary arteries >1.5 times compared to adjacent normal vessel. An excessive expansive remodeling with enzymatic degradation of the extracellular matrix is considered to be the major pathophysiologic process. Clinical importance inclines on its association with acute coronary syndrome.
Conclusion: A case of huge coronary artery ectasia presenting with acute myocardial infarction and successfully treated with PCI. [5]
Reference
[1] AlGhatrif, M. and Lindsay, J., 2012. A brief review: history to understand fundamentals of electrocardiography. Journal of community hospital internal medicine perspectives, 2(1), p.14383.
[2] Becker, D.E., 2006. Fundamentals of electrocardiography interpretation. Anesthesia progress, 53(2), pp.53-64.
[3] Fye, W.B., 1994. A history of the origin, evolution, and impact of electrocardiography. The American journal of cardiology, 73(13), pp.937-949.
[4] Krishna Anandan, P., K, S., Patil, S., Rangaraj, R. and Nanjappa Manjunath, C. (2015) “Nstemi ‘But’ Stemi-De Winters Sign”, Cardiology and Angiology: An International Journal, 3(3), pp. 162-166. doi: 10.9734/CA/2015/17599.
[5] Hussain Laghari, A., Yousuf Hasan, K., Shah, I. and Abbas Kazmi, K. (2015) “Severe Coronary Artery Ectasia with ST Elevation MI: A Challenging Situation”, Cardiology and Angiology: An International Journal, 3(4), pp. 203-209. doi: 10.9734/CA/2015/17724.
