The "old" electrocardiogram continues to provide new variables for medical care and education

EDUMECENTRO 2023;15:e2749

RESEARCH PAPER

 

The "old" electrocardiogram continues to provide new variables for medical care and education

El "vetusto" electrocardiograma sigue aportando nuevas variables para la asistencia y la educación médicas

 

Fernando Rodríguez González1* https://orcid.org//0000-0002-8135-3902
Elibet Chávez González1 https://orcid.org//0000-0003-2246-2137
Raimundo Carmona Puerta2 https://orcid.org//0000-0003-2246-1089

 

1 University of Medical Sciences of Villa Clara. Cardiocentro University Hospital "Ernesto Guevara". Department of Electrophysiology and Cardiac Pacing. Villa Clara. Cuba.
2 Catholic University of Cibao. Dominican Republic.

 

*Author for correspondence. Email: fernandocardiologo@gmail.com

 

 

ABSTRACT

The discovery of electrocardiography marked a milestone for medicine: it offered a better understanding of cardiovascular physiology and has been an essential tool for the diagnosis, evaluation, and prognostic stratification of almost all cardiovascular diseases, and it has been an irreplaceable component of cardiology research in contemporary medicine. Important investigations of the Cardiology professorship of the "Ernesto Guevara" University Hospital have had it as an object of study in line with the guidelines of the health system, for its application in assistance and updating of specialty programs, which have been enriched with new electrocardiographic variables called "non-classical". It is the objective of the authors to communicate some novel scientific results of investigations related to this ancient aid of diagnosis, which have been published in high-impact journals.

MeSH: Cardiology; electrocardiography; quality of health care; education, medical.

RESUMEN

El descubrimiento de la electrocardiografía marcó un hito para la medicina: ofreció una mejor comprensión de la fisiología cardiovascular, es una herramienta imprescindible para el diagnóstico, evaluación y estratificación pronóstica de casi la totalidad de las enfermedades cardiovasculares, y ha sido un componente insustituible de las investigaciones cardiológicas de la medicina contemporánea. Importantes investigaciones de la cátedra de Cardiología del Hospital Universitario Cardiocentro "Ernesto Guevara" la han tenido como objeto de estudio en consonancia con las directrices del sistema de salud, para su aplicación en la asistencia y la actualización de los programas de la especialidad, los que se han enriquecido con nuevas variables electrocardiográficas denominadas como "no clásicas". Es objetivo de los autores comunicar algunos resultados científicos novedosos de investigaciones relacionadas con este vetusto medio de diagnóstico, los que han sido publicadas en revistas de alto impacto.

DeSC: Cardiología; electrocardiografía; calidad de la atención de salud; educación médica.

 

 

Submitted: 20/07/2023
Accepted: 31/07/2023

 

 

As part of the policies implemented in research in the health sciences, it has been oriented that scientific activity offers an answer to the main health problems, with an intersectoral, multisectoral approach and that does not presuppose excessive costs. In this context, relevant research carried out by professionals from the Academic Committee of Cardiology responds to these guidelines, many of them use the electrocardiogram as a fundamental tool in their studies.(1)

In modern medicine, plagued by multiple biological markers and increasingly sophisticated diagnostic tests, a simple and ancient tool: the electrocardiogram, is still making its way safely in its care application and strengthening specialty programs with new and updated variants in various branches of Cardiology, both in first world and developing countries.

With more than a century, electrocardiography continues to be a fundamental part of contemporary medicine. It is the best interpreter of many conditions both genetic and acquired. Its universal availability, low cost and simplicity, constitutes a basic tool "at the patient's bedside", which offers highly important information, and also early. There is no doubt that, among the numerous diagnostic methods used for the study of the heart, the electrocardiogram constitutes one of the essential resources, which is true especially in ischemic heart disease; a study of a patient with suspected coronary disease would be considered incomplete without its corresponding electrocardiographic study.

When used correctly for the diagnosis of chest pain, the electrocardiogram takes second place immediately after the examination of pain. Electrocardiographic analysis is essential for the classification of acute coronary syndromes; on the other hand, the electrocardiogram plays an important role in the treatment of an acute myocardial infarction, while the presence of ST segment elevation is one of the main criteria for starting thrombolytic therapy and helps to predict those cases that will probably benefit more from the indication of coronary reperfusion.(2)

Investigations carried out in care centers of Villa Clara, Cuba, have been interested in the study of electrocardiographic variables called "non-classical", such as the corrected QT interval for the diagnosis of acute coronary syndromes; gaining special relevance in patients with delayed electrocardiographic changes, or in whom they cannot be classified taking into account the classic electrocardiographic changes.(3)

The use of less expensive techniques does not detract from the quality of scientific research. Elite jobs with international recognition can be achieved using these procedures. In the clinical cardiac electrophysiology laboratory of the "Ernesto Guevara" University Hospital, various studies have been carried out that illustrate the above statements.

The P wave and its dispersion have been widely studied for the diagnosis, control, and evaluation of complications in the heart as a target organ in adult patients; however, for the pediatric population there were no reference values, which was the reason for investigation by specialists from the aforementioned department. The presence of an increase in the duration of the P wave was able to presage myocardial damage in pediatric hypertensive patients.(4)

Through the electrocardiogram (possibly the cheapest test that exists) and using digital signal amplification techniques, one of the electrocardiography paradigms was collapsed: the uneven conduction of the electrical impulse, which had been the most accepted theory by researchers to explain the mechanistic bases of dispersion, was weakened.(5)

The demonstration that the vector theory is the most robust support for the dispersion phenomena in the electrocardiogram constitutes a great contribution to his theories. Important investigations carried out by Carmona Puerta et al.(6,7) dethroned the local theory that supported the dispersion of the P wave as a result of the heterogeneity in the conduction of the atrial impulse. Another example of an important result published in an impact journal was the contribution to science of a new fibrillation predictor based on the P wave.(8)

These results have demonstrated their diagnostic utility with alternative variables or variables that have not been deeply studied; universally accepted theories have also been dethroned or modified, contributing new concepts and a more complete understanding of this discipline. They prove that having less expensive resources in certain scenarios is by no means a justification that slows down personal and institutional scientific development.

 

BIBLIOGRAFIC REFERENCES

1. Ministerio de Salud Pública. Dirección Nacional de Estadísticas. Anuario Estadístico de Salud 2019. [Internet]. La Habana: Minsap; 2020. Disponible en: http://files.sld.cu/bvscuba/files/2020/04/anuario-estadistico-de-salud-2019.pdf

2. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald. Tratado de Cardiología: Texto de medicina cardiovascular. España: Elsevier Health Sciences; 2019.

3. Rodríguez F, Chávez E, Machín W, Alonso A, González V. Increased QT Interval Dispersion in Diagnosis of Acute Coronary Syndrome with Atypical Symptoms and EKG. MEDICC Review [Internet]. 2014 [citado 12/01/2023];16(3-4):[aprox. 5 p.]. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=64162

4. Chávez-González E, González-Rodríguez E, Llanes-Camacho M, Gari-Llanes M, García-Nóbrega Y, Garcia-Sáez J. Dispersión de la onda P incrementada en niños dependiendo de la presión arterial, del peso, talla, de la estructura y función cardiaca. Arch Cardiol Mex [Internet]. 2014 [citado 16/01/2023];84(3):[aprox. 9 p.]. Disponible en: https://www.scielo.org.mx/scielo.php?pid=S1405-99402014000300003&script=sci_abstract

5. Carmona Puerta R, Chávez González E, Rabassa López-Calleja MA, Lorenzo Martínez E, Cruz Elizundia JM, Padrón Peña G, et al. Atrial conduction explains the occurrence of the P-wave dispersion phenomenon, but weakly. J Arrhythm [Internet]. 2020 [citado 25/01/2023];36(6):[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733575/

6. Carmona-Puerta R, Chávez-González E, Padrón-Peña G, Cruz-Elizundia JM, Rodríguez-González F, Lorenzo-Martínez E. Uneven vectorial projection is the best explanation for QRS dispersion, not the asynchronic ventricular activation. J Electrocardiol [Internet]. 2022 [citado 12/01/2023];74:[aprox. 6 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36183521/

7. Carmona Puerta R, Lorenzo Martínez E, Rabassa López-Calleja M, Padrón Peña G, Cruz Elizundia JM, Rodríguez González F, et al. Vectorial theory surpasses the local theory in explaining the origin of P-wave dispersion. J Electrocardiol [Internet]. 2021 [citado 23/01/2023];66:[aprox. 9 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33962125/

8. Carmona Puerta R, Lorenzo Martínez E, Rabassa López-Calleja MA, Padrón Peña G, Castro Torres Y, Cruz Elizundia JM, et al. New parameter of the second half of the P-Wave, P-wave duration, and atrial conduction times predict atrial fibrillation during electrophysiological studies. Med Princ Pract [Internet]. 2021 [citado 25/01/2023];30(5):[aprox. 8 p.]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34348309/

 

 

Declaration of interests

It is declared that there is no conflict of interest.

 

 

Contribution of the authors

The three authors located the bibliography, analyzed it and formed the final text, in addition, having applied the new variables described in the exercise of their profession.

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