Detection of unexpected ischaemia due to left main disease during tele-rehabilitation using 12-lead electrocardiogram monitoring: a case report.

BACKGROUND: Cardiac rehabilitation (CR) reduces mortality and improves quality of life. Unfortunately, participation in CR remains low and studies have examined the use of home-based tele-monitoring to improve participation in CR. These studies generally utilized single- or three-lead electrocardiogram (ECG) channels with limited sensitivity to detect ischaemic changes. In this report, we describe detection of unexpected, significant left main coronary disease in a patient participating in a home CR programme using a unique 12-lead ECG monitoring system. CASE SUMMARY: A 68-year-old man was referred for CR after acute coronary syndrome and stent implantation to the obtuse marginal. Three months following this intervention, he began complaining of chest pain. Repeat coronary angiogram showed a borderline lesion in the left main not felt to be clinically significant. The patient performed CR and was monitored with the Master Caution® System, a digital platform including a garment with 10 textile electrodes (Master Caution garment) configuring a device which enables 12 lead ECG. While being monitored, the ECG technician detected 1-2 mm ST-depression in leads 1, L V2-V5. The patient was asymptomatic at the time the ST-depressions were noted. Repeat angiography revealed a significant increase in the severity of the left main lesion and the patient was referred for bypass surgery. DISCUSSION: This life-threatening diagnosis could easily have been missed using conventional ECG monitoring and our case demonstrates the potential clinical utility of tele-monitoring with a 12-lead digital home ECG monitoring device.

Eating management and functional outcome of elderly patients with symptomatic ischemic stroke undergoing inpatient rehabilitation.

AIM: The purpose of this study was to investigate whether, and to what extent, post-stroke eating management (EM) at admission to a rehabilitation ward is associated with functional outcome. METHODS: This was a retrospective study comprising 716 consecutive elderly patients with first ever symptomatic ischemic stroke. Level of eating management was determined by Functional Independence Measurement (FIM) subscale scores relevant to eating management, where scores ≤ 5 points define low-eating management (Low-EM) ability and scores >5 indicate independent eating management. Data was analyzed by t-test, χ(2) -test, Pearson's correlation and by multiple linear regression analysis. RESULTS: A total of 418 and 298 Low-EM and High-EM patients, respectively, were eligible for final analysis. Compared with High-EM, Low-EM patients were slightly older (P=0.04), had longer rehabilitation stays (P<0.001) and lower Mini-Mental State Examination (MMSE) scores (P<0.001). Total FIM at admission and discharge were lower in Low-EMS, yet there was no statistically significant difference in total FIM gain on discharge between the two groups. Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-EM at admission (ß-coefficient= -0.389, P<0.001). Low-EM scores were independently predictive for higher total FIM gain at discharge (ß-coefficient=0.125, P=0.005). CONCLUSION: The findings suggest that impaired eating management on admission is associated with adverse functional outcome. However, patients presenting to rehabilitation with impaired eating management do obtain significant functional gains and should not be deprived of rehabilitation.

Automatic noninvasive measurement of systolic blood pressure using photoplethysmography.

BACKGROUND: Automatic measurement of arterial blood pressure is important, but the available commercial automatic blood pressure meters, mostly based on oscillometry, are of low accuracy. METHODS: In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1) determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2) discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments. RESULTS: Comparison of the photoplethysmographic-based automatic technique to sphygmomanometry, the reference standard, shows that the standard deviation of their differences was 3.7 mmHg. For subjects with systolic blood pressure above 130 mmHg the standard deviation was even lower, 2.9 mmHg. These values are much lower than the 8 mmHg value imposed by AAMI standard for automatic blood pressure meters. CONCLUSION: The photoplethysmographic-based technique for automatic measurement of systolic blood pressure, and the algorithm which was presented in this study, seems to be accurate.

Modified alternating current defibrillation: a new defibrillation technique.

AIMS: Defibrillation is the only clinically effective treatment for ventricular fibrillation (VF). Early defibrillation improves the outcome and increases the chance of survival with full recovery. Immediate availability of a home-based defibrillator using mains-derived alternating current (AC) current will drastically improve the outcome. The aim was to develop a defibrillator based on the modulated AC, resembling biphasic configuration, and compare its efficacy, in a pig model, with a standard direct current (DC) defibrillator. METHODS AND RESULTS: A computer controlled, modulated AC defibrillation system was developed using a high-voltage switch and a high-voltage transformer. The efficacy and safety was evaluated in five pigs (30-40 kg), under general anaesthesia with ketamine and isoflouran. A single quadripolar-pacing catheter was inserted percutaneously. Ventricular fibrillation was induced with rapid ventricular burst pacing, and stable VF was defibrillated after 15 s. Defibrillation threshold (DFT) was determined in each animal with AC and standard DC shock using the step-down protocol. A biphasic-like shock was used with a short isoelectric stage between the phases. The DFT with AC was 70.83 +/- 24.81 J and with DC was 65.83 +/- 12.41 J (P = 0.49). No macroscopic damage was observed after AC or DC defibrillation. CONCLUSION: Modulated AC defibrillation is safe and effective as the commercially available DC defibrillation. The defibrillator is built from an inexpensive high-voltage transformer, without the need for capacitor, batteries, or routine maintenance, delivers repeated shock without any delay, and provides pacing as well. It may be an ideal platform for automatic home defibrillator.