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Related Concept Videos

Electrocardiogram01:29

Electrocardiogram

An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
Cardiac Action Potential01:30

Cardiac Action Potential

Cardiac action potentials are essential for proper heart function, enabling the rhythmic contractions needed for adequate blood circulation. Nodal cells and Purkinje fibers, specialized for electrical conduction, generate these action potentials.
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
Holter Monitor: 24-Hour Monitoring01:23

Holter Monitor: 24-Hour Monitoring

Holter monitoring is a continuous electrocardiography (ECG) recording that tracks the heart's electrical activity over an extended period, generally 24 to 48 hours. This noninvasive diagnostic tool detects irregular heart rhythms that may not be captured during a standard ECG performed in a clinical setting.DeviceThe Holter monitor is a portable, small device connected to several electrodes on the patient's chest. These electrodes detect the heart's electrical signals and transmit them to the...
Electrophysiology of Normal Cardiac Rhythm01:19

Electrophysiology of Normal Cardiac Rhythm

The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase of...
Pulse rhythm01:30

Pulse rhythm

Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...
Correlation between ECG and Cardiac Cycle01:25

Correlation between ECG and Cardiac Cycle

The electrical signals recorded on an electrocardiogram (ECG) occur before the mechanical processes of contraction and relaxation during the cardiac cycle.
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Intermittent heart rate-dependent early repolarization pattern (J-point ST elevation) demonstrated on Holter

Shlomo Stern1

  • 1Emeritus Professor, The Hebrew University of Jerusalem, Jerusalem, Israel. sh_stern@netvision.net.il.

Cardiology Journal
|August 31, 2013
PubMed
Summary

Early repolarization (ER) patterns, identified by J-point ST elevation, are often intermittent. This study found ER commonly appears at lower heart rates and disappears as heart rate increases, highlighting its dynamic nature.

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Early repolarization (ER) is typically diagnosed using resting 12-lead ECG.
  • The diagnostic criteria usually involve J-point ST segment elevation.

Purpose of the Study:

  • To investigate the occurrence and characteristics of the early repolarization pattern on 24-hour Holter recordings.
  • To determine the relationship between heart rate and the presence of the ER pattern under physiological conditions.

Main Methods:

  • Analysis of 24-hour Holter recordings from 9,200 consecutive individuals.
  • Evaluation of J-point ST elevation (≥ 1 mm in ≥ 2 leads, lasting ≥ 3 min) across various heart rates.
  • Correlation of ER pattern appearance/disappearance with heart rate fluctuations.

Main Results:

  • The ER pattern was observed in 4.9% of individuals (410 out of 9,200).
  • In 93.1% of those with ER, the pattern was intermittent, predominantly occurring at heart rates below approximately 70 beats/min.
  • The ER pattern typically disappeared as heart rate increased above 75 beats/min and reappeared upon slowing.
  • Only 6.9% of individuals with ER showed the pattern consistently at higher heart rates.

Conclusions:

  • The early repolarization pattern is frequently dynamic and heart rate-dependent.
  • ER observed on a resting ECG at a slow heart rate may not be present during periods of increased heart rate.
  • Absence of ER on a 12-lead ECG at a higher heart rate does not exclude its transient appearance when heart rate decreases.