ELECTROCARDIOGRAPHY TO DIFFERENTIATE ACUTE MYOCARDIAL INFARCTION FROM BUNDLE BRANCH BLOCK OR LEFT VENTRICULAR HYPERTROPHY

摘要

Acute myocardial infarction (AMI) is diagnosed if: (1) the ECG traces satisfy an ST Elevation Myocardial Infarction (STEMI) criterion and the ECG traces do not indicate the subject has a confounding cardiac condition, or (2) the ECG traces satisfy the STEMI criterion and the ECG traces also indicate the subject has the confounding cardiac condition and a three-dimensional vector cardiograph (3D-VCG) signal generated from the ECG traces includes an ST vector in the ST segment of the 3D-VCG signal and a terminal QRS vector of maximum magnitude in a terminal portion of the QRS complex of the 3D-VCG signal for which the angle between the ST vector and the terminal QRS vector is less than a threshold angle, e.g. in the range [130°,170°] inclusive. The confounding cardiac condition may be bundle branch block (BBB), left ventricular hypertrophy (LVH), or interventricular conduction delay (IVCD).

主权项

1. A cardiac monitoring system comprising:
an electrocardiograph (ECG) monitor configured for operative connection with a plurality of ECG electrodes, the ECG monitor including a display device and an electronic data processing component configured to perform ECG analysis of ECG traces for a plurality of ECG leads acquired by the ECG monitor including the operations of: determining whether the ECG traces satisfy an ST Elevation Myocardial Infarction (STEMI) criterion; analyzing the ECG traces to detect a confounding cardiac condition that is not acute myocardial infarction (AMI) and that produces ST deviation; conditional on the STEMI criterion being satisfied and not detecting the confounding cardiac condition, displaying an AMI alarm on the display device of the ECG monitor; conditional on the STEMI criterion being satisfied and also detecting the confounding cardiac condition, performing the further operations of:
converting the ECG traces to a three-dimensional vector cardiograph (3D-VCG) signal;computing an angle between (1) an ST vector characterizing the ST segment of the 3D-VCG signal and (2) a terminal QRS vector characterizing a terminal portion of the QRS complex of the 3D-VCG signal; andconditional on the computed angle being less than a threshold angle, displaying the AMI alarm on the display device of the ECG monitor.