Letter: Stress on the nurse and therapist in the intensive-care unit and the coronary-care unit.
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Biomedical subjects
Publications and source records attributed to H J Marriott.
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One hundred fifteen ECGs from a hospital service were interpreted by 2 primary care physicians and 2 expert electrocardiographers. When their interpretations were compared with one another and with the Marquette MAC II ECG Interpretation Program, there was great variability. Computer ECG interpretations appeared to benefit primary care physicians most by providing a backup opinion. This second opinion was also of use to expert electrocardiographers. Additional long-term benefits that may be derived from computer systems include improvement of physician interpretation ability, reduction in interpretation time, and standardization of electrocardiographic nomenclature and criteria.
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There are several reasons why an atrial impulse may not reach the ventricles; only one of them is A-V block. Widespread failure to appreciate this simple truth is mainly responsible for the persisting confusion in the diagnosis and treatment of heart block. We have defined and illustrated the various "degrees" of A-V block; applied our definitions in analyzing the examples of block encountered among 300 consecutive incidents of acute myocardial infarction; listed, discussed, and illustrated the several factors that determine conduction ratios and, therefore, the "degree" of block; and used references and illustrations from widely accepted authorities to substantiate our claim that diagnostic and, therefore, therapeutic chaos reigns.
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