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ECGmax

Product catalog summary

Editorial Overview
This special edition of corpuls.science highlights advancements in electrocardiogram (ECG) technology, focusing on the 22-lead ECG system. This system enhances the traditional 12-lead ECG by providing a more comprehensive view of cardiac activity without changing electrode placement.

The ACS Algorithm
The ACS (Acute Coronary Syndrome) algorithm is essential for diagnosing myocardial ischemia and infarction, distinguishing between STEMI and NSTEMI based on specific ECG changes. It aids in quick diagnosis and risk assessment, crucial for timely treatment.

ECG Filtering
ECG filtering is vital in emergency medicine to reduce artifacts caused by environmental factors, ensuring accurate ECG interpretation. Corpuls devices offer various filters to minimize these artifacts, enhancing the reliability of ECG readings.

22-Lead ECG System
The 22-lead ECG system includes posterior, right cardiac, and orthogonal leads, providing a more detailed cardiac assessment. It is integrated with the corpuls.mission server for real-time data sharing and analysis.

Cardiac Electrical Biomarker (CEB®)
The CEB® is a novel biomarker offering real-time cardiac injury assessment, comparable to troponin tests, without additional interventions. It simplifies diagnosis with a traffic light system, enhancing clinical decision-making.

Conclusion
Advancements in ECG technology, particularly the 22-lead system and CEB®, represent significant progress in cardiac diagnostics, offering comprehensive and real-time insights into cardiac health.

Introduction to ECG Filtering
ECG filtering is essential for reducing interference and ensuring accurate readings. Notch filters target specific frequencies like mains frequency, while low-pass filters reduce high-frequency noise. High-pass filters address low-frequency interference from breathing. However, filtering can alter ECG morphology, affecting diagnostic accuracy.

Bandpass Filters for ECG
Bandpass filters combine low- and high-pass filters to manage interference. For diagnostic purposes, a high-pass filter of 0.05 Hz and a low-pass filter of 150 Hz are recommended to preserve ECG signal integrity.

ECG Monitoring and Arrhythmia Detection
The primary goal of ECG monitoring is to detect life-threatening arrhythmias like ventricular fibrillation. During patient transport, interference can hinder rhythm detection. A bandpass filter with the smallest frequency bandwidth is advised to minimize noise.

Transmission and Processing of ECG Signals
ECG signals are transmitted via infrared or wireless to devices like corpuls3 TOUCH. The process involves digital filtering, signal processing for VF and QRS detection, and heart rate calculation. The corpuls.mission platform facilitates telemedical communication.

corpuls.mission Platform
corpuls.mission is a medical communication platform designed for preclinical missions, integrating medical data, chat, video, and documentation. It supports telemedical connections, real-time monitoring, and secure data handling.

Advanced ECG Diagnostics with ECGmax
ECGmax enhances traditional 12-lead ECGs by providing 22 leads, aiding in diagnosing conditions like posterior myocardial infarctions. The Cardiac Electrical Biomarker (CEB®) offers a quick assessment of myocardial ischemia.

Conclusion
ECG filtering and advanced diagnostic tools like ECGmax are crucial for accurate cardiac assessments. The corpuls.mission platform enhances communication and data management in medical missions.

Objective: The study aims to derive a 12-lead ECG and a 3-lead vectorcardiogram (VCG) from only 3 measured leads using 5 electrodes, enhancing the efficiency of cardiac monitoring.

Methods: A retrospective blinded study was conducted using a nonlinear optimization model to derive ECG and VCG from leads I, II, and V2. The study involved 367 ECGs and VCGs, with interpretations by two blinded physicians.

Results: High correlations were found between measured and derived ECGs and VCGs, with no clinically significant differences in 98.1% of cases. Electrocardiographic interpretations showed 100% correlation.

Conclusions: The study concludes that accurate derivation of 12-lead ECG and 3-lead VCG from 3 measured leads is possible, offering real-time, cost-effective cardiac monitoring.

Introduction: The study explores the potential of deriving a composite 15-lead ECG from a reduced lead set, aiming to improve the timeliness and efficiency of cardiac monitoring.

Methods: The study used a blinded retrospective observational design, comparing measured ECGs and VCGs with derived ones using a universal patient transformation matrix (UPTM).

Results: The study enrolled 367 cases, showing high Pearson r correlations for various ECG morphologies. The RMSE analysis indicated minimal error in derived leads.

Discussion: This study is the first to describe synthesizing derived ECG and VCG from 3 measured leads using an NLO technique.

Limitations: The study's retrospective design may introduce bias, and the physician reference standards, although blinded, are not perfect.

Introduction
The document discusses advancements in electrocardiography (ECG) and vectorcardiography (VCG), focusing on the derivation of ECG leads from a reduced number of electrodes and the utility of VCG in clinical practice.

Derivation of ECG Leads
The document outlines a method to derive 22 ECG leads from just 3 measured leads using a universal patient coefficient matrix (UPCM).

Methods and Results
A study involving 371 measured ECGs was conducted, showing high correlation with derived ECGs.

Vectorcardiogram (VCG)
The VCG is highlighted as a valuable diagnostic tool, offering more information than conventional ECGs.

Applicability in Clinical Practice
The document emphasizes the reinvigoration of ECG through its association with VCG, providing enhanced diagnostic capabilities.

Conclusion
The integration of derived ECG and VCG techniques represents a significant advancement in cardiac diagnostics.

Introduction
The document discusses the importance of teaching vectorcardiography (VCG) alongside electrocardiography (ECG) to medical students.

Electrovectorcardiogram (ECG/VCG) Association
The combination of ECG and VCG enhances the diagnosis of sophisticated pathologies.

Advantages of VCG
VCG offers greater specificity and sensitivity compared to ECG alone.

Diagnostic Applications
The ECG/VCG association is crucial for identifying myocardial infarction areas, fascicular blocks, and their associations.

End-Conduction Delays
ECG/VCG helps clarify end-conduction delays, which can mimic myocardial infarction areas.

Recent Diagnostic Achievements
Recent advancements include criteria for diagnosing Brugada syndrome and early repolarization patterns.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
ECG/VCG is a definitive tool for diagnosing ARVC.

Conclusion
The document emphasizes the importance of integrating VCG with ECG in clinical practice to improve diagnostic accuracy.

Introduction
The document discusses the use of a novel Cardiac Electrical Biomarker (CEB) for detecting acute myocardial ischemic injury (AMII) in emergency department (ED) settings.

Key Findings
The study highlights high correlations between traditional ECG and derived ECG (dECG), supporting the clinical use of dECG.

Methodology
A retrospective study was conducted involving 411 patients evaluated for acute myocardial infarction (AMI) in the ED.

Results
The CEB indicated myocardial injury in 28.2% of participants.

Conclusion
The CEB demonstrates high diagnostic accuracy and can be a cost-effective tool for identifying AMII in acute care settings.

Statistical Analysis
Statistical methods included linear regression and correlation analysis to evaluate the relationship between CEB and HsTnI.

Study Overview: The study investigates the relationship between high-sensitivity cardiac troponin I (HsTnI) and the Cardiac Electrical Biomarker (CEB) in patients evaluated for acute myocardial injury (AMI) in the emergency department (ED).

Key Findings: Initially, no correlation was found between HsTnI and CEB during the first 3 hours of observation.

Discussion: The study suggests that myocardial injury leads to changes in the cardiac electrical field.

Clinical Implications: Traditional ECG interpretation for AMI diagnosis is complex, whereas the CEB offers a simpler method for quantifying myocardial injury.

Conclusions: The study concludes that increasing HsTnI levels are associated with increasing CEB values.

References: The document cites various studies and guidelines related to myocardial infarction, ECG interpretation, and cardiac biomarkers.

Catalog excerpts

Standard 12-lead ECG plus posterior, right cardiac and orthogonal leads CARDIAC ELECTRICAL BIOMARKER IENCE ** S PE L ED Online calculation, sharing and forwarding of ECGmax Realtime non-invasive indicator for cardiac injury

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SPECIAL EDITION | ECGmax HOW FILTERING INFLUENCES THE ECG MORPHOLOGY HOW THE ECG SIGNAL GETS FROM THE PATIENT TO THE MONITOR DERIVATION OF THE 12-LEAD ELECTROCARDIOGRAM AND 3-LEAD VECTORCARDIOGRAM MATHEMATICAL MODELING AND UTILITY OF THE DERIVED 22-LEAD ELECTROCARDIOGRAM VECTOR LOOPS APPLICABILITY OF THE ELECTRO-VECTORCARDIOGRAM IN CURRENT CLINICAL PRACTICE THE CARDIAC ELECTRICAL BIOMARKER – CEB® DETECTION OF ACUTE MYOCARDIAL ISCHEMIC INJURY BY GENDER USING A NOVEL CARDIAC ELECTRICAL BIOMARKER AUTOMATED ANALYSIS OF THE 12-LEAD ECG IN THE EMERGENCY DEPARTMENT: ASSOCIATION BETWEEN HIGH-SENSITIVITY...

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DEAR LADIES AND GENTLEMEN In the second corpuls.science we have chosen one of our most core technologies. This issue will focus on electrocardiograms. It has become the standard in Emergency Medicine to just attached a bunch of electrodes to the patient for monitoring reasons. For at least 25 years, whenever a patient presents with symptoms possibly indicating that something is not quite right with the heart, the patient receives a diagnostic ECG. Nowadays the 12-lead ECG is part of every guideline and recommendation to do with Acute Coronary Syndromes and is usually referred to as the “gold-standard”....

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SPECIAL EDITION | ECGmax THE ACS ALGORITHM The classic 12-lead ECG represents a snapshot of the electrical activity of the heart. With this snapshot it is possible to diagnose various rhythmological and structural diseases of the heart. Due to this fact, the 12-lead ECG is the most important diagnostic tool for myocardial ischemia and infarction and is the basis for further therapeutic and diagnostic measures (Wagner et al. 2009). Myocardial infarction (MI) leads to muscular injury (scarring) and consequently to a change in the conduction properties in the heart. In the ECG, it is often associated...

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FLOWCHART CORPULS ACS ALGORITHM Version 1.7 START corpuls ACS Algorithm Female Patient Male Patient Therapy Suggestion „No advice (invalid ECG)“ Patient’s age or gender not submitted ST-elevation > 200µV in V2/V3; ST-elevation > 100µV in other leads ST-elevation > 250µV in V2/V3; ST-elevation > 100µV in other leads ST-elevation > 150µV in V2/V3; ST-elevation > 100µV in other leads ST-elevation > 150µV in V2/V3; ST-elevation > 100µV in other leads Therapy Suggestion “ECG meets specific STEMI criteria, consider abnormal ECG” Therapy Suggestion “ECG meets specific STEMI criteria” ALARM STEMI possible...

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SPECIAL EDITION | ECGmax NSTEMI CHECK YES NSTEMI-Critera 2/2 Inverted T-wave > 100µV in Wilson Leads Therapy Suggestion “ECG shows acute ischemic changes, ECG meets NSTEMI criteria, consider abnormal ECG” ALARM NSTEMI possible Therapy Suggestion “ECG shows acute ischemic changes, ECG meets NSTEMI criteria” ALARM NSTEMI NO Therapy Suggestion “No advice, ECG doesn’t meet specific STEMI or NSTEMI criteria, consider abnormal ECG” Therapy Suggestion “No advice, ECG doesn’t meet specific STEMI criteria” NOTIFICATION Consider that each STEMI- / NSTEMI-Criterion has to be met by at least two leads of...

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ECG FILTERING With the increase in diseases of the cardiovascular system, the electrocardiogram (ECG) is an essential tool for preclinical diagnostics in modern emergency medicine. It is recommended to continuously monitor patients with such diseases so to quickly detect life-threatening arrhythmias. [1] In the preclinical setting, the recorded ECG may show artifacts due to various environmental factors. These can affect the interpretation of the ECG signal. [5] Artifacts can be caused by the patient’s muscle activity, transport movements or electrical coupling of the mains frequency, for example....

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SPECIAL EDITION | ECGmax HOW FILTERING INFLUENCES THE ECG MORPHOLOGY HOW FILTERING INFLUENCES THE ECG MORPHOLOGY The influence of different bandpass filters on displayed ECG morphology Native ECG without noise Diagnostic Bandpass-Filter Monitoring Bandpass-Filter Filtered with diagnostic bandpass filter Figure 1 (as referred to in the text ECG FILTERING) Filtered with monitoring bandpass filte

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HOW THE ECG SIGNAL GETS FROM THE PATIENT TO THE MONITOR HOW THE ECG SIGNAL GETS FROM THE PATIENT TO THE MONITOR A change in electrical potential arising from the heart’s myocardial tissue can be detected on the skin Electrodes link the human body to the corpuls3 TOUCH / corpuls3 CLASSIC • Calculation of augmented ECG leads Analog amplification Analog filtering Detection of pacemaker spikes Analog to digital conversion • Digital filtering (notch filter, high-pass and low-pass filter) • General signal processing (VF Detection, QRS Detection, Heart Rate calculation) Transmission via infrared or...

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SPECIAL EDITION | ECGmax corpuls.mission is a medical communication platform designed with the patient as the main focus. It enables knowledge to be collected where it can be best utilised: during a mission. Above anything else, adequate patient treatment requires specific knowledge, often stemming from different disciplines and selected experts. However, this complexity of medicine cannot rest on the shoulders of a single specialist. By combining medical data, chat, video and documentation, all relevant information is found in one place – one software, intuitive and central. Available for web,...

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KAPITEL TITEL Safety is the top priority at corpuls.mission. By encrypting all patient data, conformity with the strict data protection requirements is guaranteed. The servers are operated according to relevant standards, such as ISO 27001. In addition, the development of the entire product is subject to strict observation by an external control authority and is in compliance with the latest standards for IT security.

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