An electrocardiogram (ECG) is used to determine how the heart is functioning. Knowing how to read an ECG is of importance for most medical professionals since an early detection of a cardiac disorder can save lives.²

 

Prospective, multicentre validation of a simple, patient-operated electrocardiographic
system for the detection of arrhythmias and electrocardiographic changes³

Electrocardiographic changes, such as arrhythmias causing syncope or palpitations, are often brief and therefore difficult to diagnose. Systematic and symptom-activated ECG recordings can increase diagnostic advantage in such patients. This study evaluated the diagnostic accuracy of a simple, leadless, patient-operated ECG device compared with a standard 12-lead ECG. Recordings made by this patient-operated ECG device allow to detect arrhythmias and other ECG changes with high accuracy compared with a standard ECG. It may help to improve accurate diagnosis of transient ECG changes such as paroxysmal Atrial fibrillation (AFib) in palpitations or other unexplained cardiac symptoms.

Atrial fibrillation (AFib) is the most common type of arrhythmias which is detected via an electrocardiogram (ECG). AFib can occur with hypertension and is associated with a 5x greater risk of stroke. With effective treatment, the risk of stroke can be reduced.⁵

 

Atrial fibrillation: diagnosis and management NICE guideline⁶

This guideline covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding. The recommendations in this guideline represent the view of NICE, which is arrived at after careful consideration of the evidence available.

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)⁵

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. This publication will assist healthcare professionals in streamlining the care of patients with AFib in daily clinical practice. The complexity of AFib requires a multifaceted, holistic, and multidisciplinary approach to the management of AFib patients. This is a challenging but essential requirement for effective management of AFib.

Diagnostic Value of Atrial Fibrillation by Built-in Electrocardiogram Technology in a Blood Pressure Monitor⁷

The Complete blood pressure (BP) monitor (Omron Healthcare, Kyoto, Japan) was developed as the first BP monitor with electrocardiogram (ECG) capability in a single device to simultaneously monitor ECG and BP readings. This study investigated whether the Complete can accurately differentiate sinus rhythm (SR) from AFib during BP measurement. The study concluded that the Complete can indeed accurately differentiate SR from AFib during BP measurement.

A bradycardia is a type of arrhythmia in which the heart rate is too low (under 60 beats/minute). Pathology that produces it may occur within the sinus node, atrioventricular (AV) nodal tissue, and the specialized His-Purkinje conduction system.⁸

 

First Degree Heart Block⁹

The definition of first-degree atrioventricular (AV) block is a PR interval of greater than 0.20 seconds on electrocardiography (ECG) without disruption of atrial to ventricular conduction. The normal measurement of the PR interval is 0.12 seconds to 0.20 seconds. When the PR interval prolongs more than 0.30 seconds, the first-degree atrioventricular block is called "marked."  Regular evaluation is essential, as affected patients have demonstrated an increased risk of developing atrial fibrillation or higher degree AV block. 

Atrioventricular Block Second-Degree¹⁰

A delay in conduction between the atria and ventricles results in an atrioventricular conduction block. This is indicated by a prolongation of the PR interval on electrocardiogram. Conduction blocks are classified as either first-degree, second-degree, or third-degree blocks. There are two types of second-degree atrioventricular blocks: Mobitz type I, also known as Wenckebach and Mobitz type II. This article examines when this condition should be considered on differential diagnosis and how to properly evaluate for it. It highlights the role of the interprofessional team in caring for patients with this condition.

Third-Degree Atrioventricular Block¹¹

An atrioventricular block is a loss of the regular function of the cardiac electroconductive pathways linking the sinoatrial node (SA node) and the ventricles via conduction through the atrioventricular node (AV node). Third-degree AV block indicates a complete loss of communication between the atria and the ventricles. Without appropriate conduction through the AV node, the SA node cannot act to control the heart rate, and cardiac output can diminish secondary to loss of coordination of the atria and the ventricles. The condition can be fatal if not promptly treated. The objective of this paper is to describe when third-degree atrioventricular block should be in the differential diagnosis, explain the treatment considerations and review the importance of the interprofessional team in the monitoring and evaluation of patients in a third-degree atrioventricular block. 

Athlete's Heart and Cardiovascular Care of the Athlete¹²

The heart of the athlete has intrigued clinicians and scientists for more than a century. Scientific understanding of the association between sport participation and specific cardiac abnormalities has paralleled advances in cardiovascular diagnostic techniques. This review provides an up-to-date summary of the science of cardiac remodelling in athletes and an overview of common clinical issues that are encountered in the cardiovascular care of the athlete.

Athletic heart syndrome¹³

Athletic heart syndrome (AHS) is a benign condition consisting of physiologic adaptations to the increased cardiac workload of exercise. Its primary features are biventricular hypertrophy and bradycardia associated with normal systolic and diastolic function. In addition, the alterations in cardiac structure are related to the type of training, with dynamic training causing proportionally greater dilation and static training primarily increased wall thickness. AHS is associated with abnormalities in ECG, radiograph, and echocardiographic findings. It is important to be aware of these changes so that they are not misinterpreted to represent pathologic states.

The heart is usually faster during exercise or stress. However, it can be concerning if this occurs during rest. Tachycardia is a faster heartbeat than normal which could be an early sign of a serious pathology.¹⁴

 

Postural tachycardia syndrome (POTS)¹⁵

This chapter describes postural tachycardia syndrome (POTS) as a syndrome of orthostatic tachycardia associated with symptoms of cerebral hypoperfusion and autonomic activation. POTS is best considered a condition rather than a disease so that the same patient may or may not fulfil criteria at different times. A variety of approaches have been used to alleviate symptoms in POTS. This study will review these approaches and provide some recommendations in treating the symptoms of POTS.

Supraventricular Tachycardia: Mechanisms and Management¹⁶

The phrase paroxysmal supraventricular tachycardia describes a group of arrhythmias with similar electrocardiographic features but different mechanisms that have been clarified in recent years with specialized intracardiac recording and pacing techniques. This study will address these mechanisms and gives recommendation on the management of supraventricular tachycardia.

Heart Arrhythmias

Arrhythmias can lead to severe cardiac conditions or even sudden cardiac death if left untreated.¹

Early detection of heart arrhythmias through ECG can save lives.¹

A simple, leadless, patient-operated ECG device allows to detect arrhythmias and other ECG changes with high accuracy.³

AFib is the most common type of arrhythmia and can often occur with hypertension.⁵

It is important to be aware of changes in ECG readings to recognize the correct type of arrhythmia and provide appropriate treatment.⁹ ¹⁰ ¹¹