Journal of electrocardiology
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The presence of early repolarization (ER) pattern in the 12-lead ECG, defined as elevation of the QRS-ST junction (J point) often associated with a late QRS slurring or notching (J wave), is a common finding in the general population, particularly in the inferior and precordial lateral leads. In young and healthy individuals, particularly in males, blacks and athletes, this pattern has commonly been considered to represent an innocent finding. However, experimental studies, case reports and studies on healthy subjects surviving a cardiac arrest or with primary ventricular fibrillation (VF) have suggested an association between J-point elevation and/or QRS slurring in the inferior and lateral ECG leads and the risk of VF. ⋯ The conflicting data regarding the prognostic role of ER patterns can be partly due to different definitions of ER used. This emphasizes the need for standardized methods of measurements of QRS end-J point-ST segment and for detailed definitions. The knowledge of the true significance in clinical setting of the various aspects of ER is still unclear and warrants prospective, long-term epidemiological studies.
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To improve patient outcome, point-of-care (POC) cardiac troponin I/T (cTn I/T) tests applied in a prehospital setting and/or emergency department might play a role as a substitute for central hospital laboratory high-sensitivity (hs) cTn I/T testing if their analytical and clinical performance are equivalent to central hospital laboratory hs cTn I/T tests and if they fulfill an unmet clinical need in the diagnostic work-up of patients with acute coronary syndrome (ACS). To date, current point-of-care (POC) cTn I/T tests are not yet sufficiently analytically sensitive and do not provide accurate and precise values in the reference range nor at the 99th percentile of a healthy reference population. ⋯ Although patients with acute ST-segment elevation myocardial infarction (STEMI) are generally diagnosed by ischemic symptoms and ECG only, hospitalized patients with non-STEMI and unstable angina pectoris (UAP) should preferentially be tested with ECG and central hospital laboratory hs cTn I/T tests unless the ECG has already demonstrated diagnostic changes. More evidence and future trials are needed to find out whether in patients with NSTE ACS hs cTn I/T tests should be combined with other tests, such as a test of B-type natriuretic peptide or NT-proBNP.
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Electrocardiogram artifacts are common and can lead to confusion and misdiagnoses. Here, we present an unusual example of an artifact that has not previously been well described.