Welch-allyn Means ECG Physicians Manual for CP Series Electroc User Manual

MEANS ECG Physicians’ Manual for Welch Allyn CP Series Electrocardiographs Welch Allyn 4341 State Street Road PO Box 220 Skaneateles

MEANS Physicians Manual Welch Allyn 10 2.2 Dextrocardia and arm electrodes reversal Skip tests if: QRS area in I > 0 or top-top QRS amplit

MEANS Physicians Manual Welch Allyn 11 2.4 Left Bundle Branch Block (LBBB) The primary condition for the diagnosis of a complete block is prolon

MEANS Physicians Manual Welch Allyn 12 2.5 Right Bundle Branch Block (RBBB) The ECG abnormality in RBBB consists of a late, protracted QRS activ

MEANS Physicians Manual Welch Allyn 13 2.6 Incomplete Right Bundle Branch Block (IRBBB) For IRBBB, comparable conditions apply the same as RBBB,

MEANS Physicians Manual Welch Allyn 14 2.8 Atrial overload The diagnosis of right or left atrial overload (RAO and LAO) will be considered in th

MEANS Physicians Manual Welch Allyn 15 2.10 Axis deviations and fascicular blocks Axis deviations are distinguished in vertical, right, marked ri

MEANS Physicians Manual Welch Allyn 16 2.11 Low QRS voltage Say: “low QRS voltage in extremity leads” if: top-top QRS amplitude  500 µV in al

MEANS Physicians Manual Welch Allyn 17 2.13 Left ventricular hypertrophy (LVH) The diagnosis of LVH rests on three types of parameters: voltage,

MEANS Physicians Manual Welch Allyn 18 2.14 Right ventricular hypertrophy The diagnosis RVH is not subdivided in such an elaborate way as LVH is.

MEANS Physicians Manual Welch Allyn 19 2.15 Infarction This section of the program classifies an infarction according to location and estimates t

MEANS Physicians Manual Welch Allyn 2 Caution Federal US law restricts sale of the device identified in this manual to, or on the order of, a lic

MEANS Physicians Manual Welch Allyn 20 Septal infarction Say: “septal infarct” if: Q duration  35 ms and Q/R ratio  1/3 in V1 or V2 or Q dur

MEANS Physicians Manual Welch Allyn 21 Anterior infarction Say: “anterior infarct” if: Q duration  35 ms and Q/R ratio  1/3 in V3 or V4 or Q

MEANS Physicians Manual Welch Allyn 22 Lateral infarction Say: “lateral infarct” if: Q duration  35 ms and Q/R ratio  1/3 in V5 or V6 or Q d

MEANS Physicians Manual Welch Allyn 23 High-lateral infarction An abnormal Q wave in both leads I and aVL is necessary to diagnose high-lateral i

MEANS Physicians Manual Welch Allyn 24 Posterior infarction Skip tests if: test RBBB passed or test IRBBB passed Say: “possible posterior in

MEANS Physicians Manual Welch Allyn 25 2.16 Pulmonary disease Skip tests if: QRS duration  126 ms or positive QRS amplitude in V5  950 µV or

MEANS Physicians Manual Welch Allyn 26 2.18 ST and T abnormalities Skip tests if: test LBBB passed Say: “consider pericarditis” if: positive

MEANS Physicians Manual Welch Allyn 27 2.19 Repolarization The negativity of the T wave in all leads except aVR and V1 is classified in one of th

MEANS Physicians Manual Welch Allyn 28 2.20 Miscellaneous Skip tests if: test RBBB passed or test IRBBB passed or test RVH passed Say: “RSR

MEANS Physicians Manual Welch Allyn 29 2.21 Interaction of statements When the classification process leads to coexisting diagnostic statements,

MEANS Physicians Manual Welch Allyn 3 Contents 1 INTRODUCTION ...

MEANS Physicians Manual Welch Allyn 30 In the presence of ST elevation, repolarization disturbance statements at corresponding locations are supp

MEANS Physicians Manual Welch Allyn 31 2.22 Combination of statements The program distinguishes six basic infarct locations: septal, anterior, la

MEANS Physicians Manual Welch Allyn 32 3 Rhythm analysis 3.1 Introduction In this section of the algorithm a wide range of diagnoses is offered

MEANS Physicians Manual Welch Allyn 33 Basic parameters such as the consistency of the RR interval, the P/QRS ratio, and the consistency of the P

MEANS Physicians Manual Welch Allyn 34 3.3 Decision tree The decision tree for the rhythm analysis is shown in Figure 1 on page 36. The program

MEANS Physicians Manual Welch Allyn 35 Table 3. Grouping of arrhythmias as used in the rhythm analysis program. Group Description 1 Rhythms with

MEANS Physicians Manual Welch Allyn 36 artificial pacemaker? yes group 1 no non-dominant complexes?

MEANS Physicians Manual Welch Allyn 37 3.4 Group 1: Rhythms with artificial pacemaker spikes Artificial pacemaker spikes may have been detected

MEANS Physicians Manual Welch Allyn 38 Run of non-dominant complexes Say: “with run of multiform premature ventricular complexes” if: more tha

MEANS Physicians Manual Welch Allyn 39 Doublet or sequence of non-dominant complexes Say: “doublets of multiform premature ventricular complexes

MEANS Physicians Manual Welch Allyn 4 1 Introduction Computers and humans interpret ECG signals in fundamentally different ways. The principal d

MEANS Physicians Manual Welch Allyn 40 Alternating dominant and non-dominant complexes Say: “bigeminal rhythm, consider escape-capture bigeminy”

MEANS Physicians Manual Welch Allyn 41 Isolated non-dominant complexes Say: “premature ventricular complexes with variable coupling intervals,”

MEANS Physicians Manual Welch Allyn 42 Modification of statements The program classifies the non-dominant complexes before it classifies the rhyt

MEANS Physicians Manual Welch Allyn 43 3.6 Group 3: Rhythms with atrial flutter or tachycardia In atrial flutter, the atrial activity is represe

MEANS Physicians Manual Welch Allyn 44 3.7 Group 4: Regular rhythms with P/QRS  0.15 Say: “idioventricular rhythm (no atrial activity detected

MEANS Physicians Manual Welch Allyn 45 3.8 Group 5: Regular rhythms with 0.15<P/QRS1.0 and PR range > 60 ms Say: “sinus rhythm with comp

MEANS Physicians Manual Welch Allyn 46 3.9 Group 6: Regular rhythms with P/QRS > 1.0 and PR range  30 ms Say: “atrial flutter” if: shortes

MEANS Physicians Manual Welch Allyn 47 3.10 Group 7: Regular rhythms with P/QRS > 1.0 and PR range > 30 ms Say: “atrial tachycardia” if:

MEANS Physicians Manual Welch Allyn 48 3.11 Group 8: Irregular rhythms with P/QRS  0.15 Say: “atrial fibrillation with slow mean ventricular re

MEANS Physicians Manual Welch Allyn 49 3.13 Group 10: Irregular rhythms with 0.15 < P/QRS  0.9 and PR range  30 ms First, a test is made on

MEANS Physicians Manual Welch Allyn 5 1.2 Pattern recognition This part deals with the analysis of the various waveforms. First of all, the QRS

MEANS Physicians Manual Welch Allyn 50 3.14 Group 11: Irregular rhythms with 0.15 < P/QRS  0.9 and PR range > 30 ms If the number of P wav

MEANS Physicians Manual Welch Allyn 51 3.15 Group 12: Irregular rhythms with 0.9 < P/QRS  1.2 and PR range > 30 ms The presence of a secon

MEANS Physicians Manual Welch Allyn 52 3.17 Group 14: Irregular rhythms with P/QRS > 1.0 and PR range  30 ms The irregularity of the ventricu

MEANS Physicians Manual Welch Allyn 53 3.18 Group 15: Rhythms with constant PR interval In this group rhythms with constant PR interval are class

MEANS Physicians Manual Welch Allyn 54 Say: “sinus bradycardia” if: 40  heart rate < 50 BPM and rate variation  20% Say: “sinus rhythm

MEANS Physicians Manual Welch Allyn 55 4 Statement index A aberrantly conducted complexes ...

MEANS Physicians Manual Welch Allyn 56 consider pericarditis ...

MEANS Physicians Manual Welch Allyn 57 left-precordial ST depression ...

MEANS Physicians Manual Welch Allyn 58 R RBBB ...

MEANS Physicians Manual Welch Allyn 59 U undetermined atrial rhythm with block and/or interference in the AV junction ...

MEANS Physicians Manual Welch Allyn 6 1.4 Diagnostic classification The diagnostic logic operates on the parameters and produces both a rhythm c

MEANS Physicians Manual Welch Allyn 60 5 The Performance of MEANS Development of the Modular ECG Analysis System (MEANS) is an ongoing process.

MEANS Physicians Manual Welch Allyn 61 Results Waveform recognition Table 1. Interval measurements on biological ECGs - mean differences and stan

MEANS Physicians Manual Welch Allyn 62 Table 3. Accuracy of diagnostic interpretative statements on the CSE contour diagnostic database vs. combi

MEANS Physicians Manual Welch Allyn 7 1.6 References In several publications, the program structure and signal analysis part of MEANS have been

MEANS Physicians Manual Welch Allyn 8 2 Contour analysis 2.1 Contour parameters All parameters that are used in the diagnostic criteria of the

MEANS Physicians Manual Welch Allyn 9 The parameters that are computed for each lead separately, are shown in Table 2. All amplitudes are taken a