Early repolarization: an underinvestigated misnoner.
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Biomedical subjects
Publications and source records attributed to D H Spodick.
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Right and left atrial electromechanical intervals and onsets of active right and left ventricular filling were measured in patients with interatrial block and compared with control patients. Left atrial mechanical activity is significantly delayed by interatrial block.
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Leads V1, V2 and sometimes V3 are omnibus leads that are "overburdened" because they monitor the left ventricular anterior wall, the left ventricular posterior wall, and the right ventricle; because they are the only leads normally expressing the ventricular gradient (QRS-T discordance); and because they consequently reflect numerous anatomic and electrical abnormalities and apparently normal variants. These require familiarity with and differentiation among a variety of pathologic and normal conditions.
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Conventional rate limits for sinus rhythm--100/min as the tachycardia threshold and 60/min as the bradycardia threshold--were established by consensus and never formally examined. Because clinical experience indicated that both figures were too high, we investigated this formally in 500 normal individuals. Results were consistent with normal data from the Framingham Study 5,000-subject cohort and the EPICORE Center cohort of more than 18,000 normal persons. Therefore, rounded tachycardia and bradycardia thresholds of 90/min and 50/min for normal sinus rhythm should improve the sensitivity of tachycardia detection and the specificity of bradycardia detection. The appropriate rate range (rounded) for sinus rhythm is 50/min to 90/min.
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