[73. The diagnostic value of the work load ECG in ischemic heart disease].
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Biomedical subjects
Publications and source records attributed to I Tomov.
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The diagnostic value of ST-T changes in working ECG on veloergometer with submaximal loading is assessed in 286 cases--83 with coronary disease, 44--healthy, 112 with indistinct precordial pains and neurovegetative dystonia and 46 with some other non-coronary heart diseases. The reduction of ST-segment 1 mm with horizontal or descending form is the most accurate criterium in the differentiation of pathological and normal ECG-reactions. An appropriate criterium for coronary disease diagnosis is also the negative T wave with an amplitude of 2 mm or more in at least three leads, regardless of its form and time of appearance. The reduction of ST segment with ascending form gives a considerable opportunity for positive false diagnosis. The false negative diagnosis is 24%. The causes are to be found in the appearance of rhythm and lead disturbances and insufficient loading.
The Bulgarian digitalis preparation Digilanid C for venous application has a satisc factory effect on the majority of the patients (67 per cent) with light and moderate chronic cardia insufficiency and espically in case of tachycardia in auricular fibrillation. The comparison of the results between the group of 46 patients, treated with Digilanid C and the control group of 20 patients treated with Isolanid (Richter) do not reveal essential differences in the major part of the results obtained.
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The sensitivity, specificity and diagnostic accuracy of 34 ECG-indices for right ventricular hypertrophy was checked up in 131 individuals--40 healthy, 59 with post mortem confirmed right ventricular hypertrophy and 32 with clinical and X-ray data for right ventricular hypertrophy. The following indices showed the best diagnostic value: AQSR to the right of + 90 degrees (in adults over 30); RV1 greater than or equal to 5 mm; SV5 or V6 greater than or equal to 7 mm: R/SV1 greater than or equal to 1 and/or R/SV5, V6 less than or equal to 1: RV1 + + SV5 or V6 greater than 10,5 mm; SV1 less than 2 mm: pathological progression of R/S in precordial leads to the right of the intermediate zone; R/S less than 1 and S greater than 4 mm in 1 st lead: TV1--V3--negative; P-pulmonale. That complex reveals accurately 60--70 per cent of the cases wi h right ventricular hypertrophy in mitral stenosis and chronic right heart. The false positive diagnosis is 5--10 per cent.
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