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European Heart Journal 1989 10(Supplement G):9-12; doi:10.1093/eurheartj/10.suppl_G.9
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Multiple lead monitoring during and after PTCA

A. Stäblein, A. von Pölnitz, E. Reuschel-Janetschek, T. Von Arnim and B. Höfling

Medizinische Klinik I, Klinikum Grosshadern der Universität München FRG

Address for correspondence: Prof. Dr med. B. Höfling, Medizinische Klinik I, Klinikum Grosshadern der Universität München, Marchioninistr. 15, 8000 München 70, FRG

We investigated whether optimized ischaemia monitoring during and after PTCA using continuous recording of standardized 12-lead ECG provides additional information regarding the presence and localization of ischaemia. We studied 50 patients undergoing PTCA who received a total of 173 balloon inflations. Chest leads showed not only significantly more frequent ischaemic changes compared with routine limb lead monitoring (116/173 (67%) vs 88/173 (51%)), but in addition, a significantly earlier appearance of changes; 15·4 ± 6·2 s after the start of balloon inflation compared with 17·5 ± 6·8 s in the limb leads. Anginal pain, however, first occurred at 35 ± 14 s after vessel occlusion in 74/173 (43%) of inflations. The changes in ECG monitoring correlated well with the coronary wedge pressure; at coronary wedge pressures below 20 mmHg, 97% of inflations caused ischaemic ECG changes; at pressures >40 mmHg, changes were noted in only 42% of inflations.

PostPTCA, 6/36 (16·7%) patients undergoing continuous 12-lead monitoring showed ischaemic ST-segment changes (asymptomatic in five cases), which helped in decision-making regarding interventional measures.

In summary, we have found standardized 12-lead monitoring both during and after PTCA to be more precise and reliable in ischaemia detection and useful for clinical decision making.

Key Words: ECG • ischaemia • PTCA


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