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  • 1. Dellborg, M
    et al.
    Herlitz, Johan
    [external].
    Emanuelsson, H
    Swedberg, K
    ECG changes during myocardial ischemia. Differences between men and women1995In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 27, no suppl., p. 42-45Article in journal (Refereed)
    Abstract [en]

    Women have a higher short-term mortality in acute myocardial infarction (MI) compared with men. This may be partly explained by differences in risk factors such as age and diabetes. However, several reports have focused on the occurrence of a sex bias making women less likely to be subjected to angiography and revascularization as well as aggressive pharmacologic treatment of acute MI. The decision to initiate these procedures is often based on ischemic changes of the electrocardiogram. It was therefore investigated whether differences between men and women in magnitude of electrocardiographic changes during myocardial ischemia could explain some of the differences previously reported. A total of 178 patients with chest pain suggestive of MI (135 men and 43 women) included in a study of thrombolytics were monitored for 24 hours with continuous vectorcardiography. Also, 81 patients with stable angina pectoris undergoing elective angioplasty were monitored during the procedure. In patients admitted with suspicion of MI, the initial summated ST deviation was 178 +/- 146 microV for men as compared with 105 +/- 91 microV for women (P = .002). During angioplasty, men had significantly more pronounced maximum ST deviation during inflation of the balloon (235 +/- 165 vs 156 +/- 89 microV; P = .036). In conclusion, men have more pronounced ST changes than women during myocardial ischemia. When fixed magnitudes of ST deviation are required for initiating therapy such as thrombolytics, this will favor treatment of men. A sex-adjusted limit for administrating thrombolytic drugs may be warranted in the light of the above findings.

  • 2.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    The relationship between electrocardiographic changes and early mortality rate in acute myocardial infarction1984In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 17, no 2, p. 139-144Article in journal (Refereed)
    Abstract [en]

    In 587 patients with acute myocardial infarction (AMI) and no previous MI, electrocardiographically estimated infarct size was related to three-month mortality. Mortality was found to be higher in patients with transmural MI (Q or R-wave changes in standard ECG) than in patients with subendocardial infarction (ST-T wave changes in standard ECG). In patients with anterior MI, precordial mapping with 24 chest electrodes was analyzed four days after arrival in hospital (n = 197). Neither the sum of R-waves, the sum of Q-waves, nor the number of Q-waves correlated significantly with early mortality, although there was a trend towards higher mortality among patients with more pronounced ECG changes. Finally, in patients with inferior AMI (n = 230), neither the sum of R-waves nor the sum of Q-waves in leads II, III and aVF on the fourth day influenced three-month mortality. However, when subtracting the sum of Q-waves from the sum of R-waves, there was a significant correlation between the estimated infarct size and the early mortality.

  • 3.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Waldenström, J
    Relationship between electrocardiographically and enzymatically estimated size in anterior myocardial infarction1984In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 17, no 4, p. 361-370Article in journal (Refereed)
    Abstract [en]

    In 179 patients with anterior myocardial infarction the electrocardiographically estimated infarct size was related to serum enzyme activity. A precordial map containing 24 precordial positions and the peak activity of heat stable dehydrogenase (LD; EC 1.1.1.27) were used. A positive correlation was found between the area at risk (initial sum of ST-elevation) and the peak LD activity (r = 0.48 - 0.55; p less than 0.001). When the final Q-and R-wave amplitude were related to peak enzyme activity a better correlation was observed (r = 0.56 - 0.68; p less than 0.001). The sum of R-waves (sigma R) and the sum of Q-waves (sigma Q) in the 24 precordial leads were related to sigma R and sigma Q in five precordial standard leads. A good correlation was found between the two ECG methods (r = 0.75 - 0.83; p less than 0.001), indicating that an increased number of precordial leads gives information regarding the extent of infarction similar to that obtained with the routinely used standard leads. It is concluded that in the individual patient, serum enzyme activity and the final Q-and R-wave changes can give different information about infarct size. If, however, these two independent methods are used in a large number of patients in intervention studies they will probably give similar information about relative influence of the intervention on the mean infarct size.

  • 4.
    Herlitz, Johan
    et al.
    [external].
    Sillfors, L
    Hjalmarson, Å
    Experiences from the use of twenty-four precordial chest leads in suspected acute myocardial infarction1986In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 19, no 4, p. 381-388Article in journal (Refereed)
    Abstract [en]

    In 671 patients with suspected acute myocardial infarction (MI) and no previous MI, precordial mapping with a grid containing 24 chest leads was performed within a few hours (mean = 4.8 hours; range 0-42 hours) after arrival in hospital and four days later. In 76% of the patients the criteria for definite MI, based on serum enzymes and a 12 lead standard electrocardiogram, were fulfilled. Among patients classified as having no definite MI, 2% had abnormal Q-waves on mapping on the fourth day; among patients classified as having a subendocardial MI (no abnormal Q-waves in the 12 standard leads), 7% had abnormal Q-waves on mapping on the fourth day. In patients who subsequently developed anterior MI, changes in the sum of Q-waves and the sum of R-waves were observed for more than 12 hours after onset of pain. ST-elevations defined from a normal population were seen in the initial recording in 60% of patients with anterior MI. Among those in whom the first recording was performed less than or equal to 4 hours after onset of pain, ST elevation was initially seen in 72%. A positive correlation was observed between the initial ST elevation and severity of chest pain, incidence of congestive heart failure and two-year mortality rate. We thus conclude that some further information regarding presence of Q-waves can be obtained in about 5% of patients with suspected acute MI from an increased number of precordial leads.

  • 5. Lingman, M
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, J
    University of Borås, School of Health Science.
    Rubulis, A
    Caidahl, K
    Bergfeldt, L
    Transient repolarization alterations dominate the initial phase of an acute anterior infarction-a vectorcardiography study2014In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 47, no 4, p. 478-485Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography. METHODS: Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and >24h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111-303 vs. 362; 165-1359min after symptom onset). RESULTS: At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41μVs; p<0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48μV; p<0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p<0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM. CONCLUSIONS: Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed.

  • 6.
    Soroudi, Azadeh
    et al.
    University of Borås, Faculty of Textiles, Engineering and Business.
    Hernández, Niina
    University of Borås, Faculty of Textiles, Engineering and Business.
    Berglin, Lena
    University of Borås, Faculty of Textiles, Engineering and Business.
    Nierstrasz, Vincent
    University of Borås, Faculty of Textiles, Engineering and Business.
    Electrode placement in electrocardiography smart garments: A review2019In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 57, p. 27-30Article in journal (Refereed)
    Abstract [en]

    Wearable Electrocardiography (ECG) sensing textiles have been widely used due to their high flexibility, comfort, reusability and the possibility to be used for home-based and real-time measurements. Textile electrodes are dry and non-adhesive, therefor unlike conventional gel electrodes, they don't cause skin irritation and are more user-friendly especially for long-term and continuous monitoring outside the hospital. However, the challenge with textile electrodes is that the quality and reliability of recorded ECG signals by smart garments are more sensitive to different factors such as electrode placement, skin humidity, user activities and contact pressure. This review will particularly focus on the research findings regarding the influence of electrode placement on the quality of biosignal sensing, and will introduce the methods used by researchers to measure the optimal positions of the electrodes in wearable ECG garments. The review will help the designers to take into account different parameters, which affect the data quality, reliability and comfort, when selecting the electrode placement in a wearable ECG garment.

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