Online monitoring of multiple precordial leads in high risk patients with coronary artery disease–A pilot study

Abstract

In a pilot study, a computerized precordial mapping system monitored ischaemia on-line in 50 patients (40 with acute myocardial infarction and 10 with unstable angina, class IV (Canadian Cardiovascular Society). All had ST-segment depression or elevation greater than or equal to 0.2 mV in one or more precordial leads when they were admitted to our coronary care unit. After preliminary precordial mapping with 48 electrodes to localize the area of ischemia, 5 to 8 electrodes were placed in and around the centre of the ST-segment changes. The patients were monitored between 24 and 48 h (mean 35.5 h). To minimize problems caused by artifacts, ECG signal quality was improved by the averaging technique. Thereafter, the ECG was evaluated with respect to Q and R wave amplitudes and ST-segment changes. At 3 min intervals, Q and R wave amplitudes and ST segment elevations or depressions, summed for all leads were plotted as a histogram. ECG signal quality was excellent and there were no problems with the attachment of the electrodes. All patients were treated with nitroglycerine intravenously and high doses of heparin and, in several cases, nifedipine as well. Some patients received thrombolytic therapy with streptokinase. Despite therapy, 21 ischaemic attacks were documented in five patients. Seventeen attacks were seen in patients with acute infarction but who were not treated with streptokinase. All attacks were accompanied by chest pain. The duration of ischaemia ranged from 18 to 87 min. Several attacks were stopped immediately by therapy.(ABSTRACT TRUNCATED AT 250 WORDS)