CardioSecur provides additional information for the diagnosis of coronary heart disease!

Dr. Peter Kenedi

CardioSecur is a vector-derived 12-lead ECG, with the clinical diagnosis corresponding to that of a classic 12-lead ECG in 95-98% of cases. In comparison to a classic ECG, a CardioSecur ECG can provide additional information, therefore making a diagnosis possible. CardioSecur provides up to 22 leads (additional right precordial leads and left lateral leads), which helps strengthen the diagnostic power, in particular for a posterior wall infarct (i.e. a strictly posterior infarct or right ventricular infarct). The following two examples serve to elucidate these situations.

 
Case #1

Case History: 76 year old patient admitted to the intensive care unit of a Budapest Heart Clinic complaining of progressive chest pain over the past 48 hours. He had a previous proximal LAD (left anterior descending artery) stenosis dilated and treated with a drug-eluting stent.

Diagnosis: suspicion of acute coronary syndrome

Cardiac Risk Factors: hypertension, hypercholesterolemia, nicotine abuse

The classic 12 lead ECG (image 1) is unremarkable and does not show any sign of infarction.

Image 1: Classic 12-lead ECG – no pathologic findings

The CardioSecur ECG (image 2) was performed at the same time and shows a 0.1 mV horizontal ST depression in leads V3-5, indicating myocardial ischemia.

Image 2: CardioSecur ECG – ischemia evident in V3-5.

Troponin test: positive

Diagnosis: NSTEMI

Coronary Angiography (image 3) on the following day showed a patent stent of the LAD (left anterior descending artery) and high-grade stenosis of the LCX (left circumflex artery). The stenosis was treated with a drug-eluting stent.

Image 3: Coronary angiography – high-grade stenosis of the LCX.

It is commonly known that the first ECG in the setting of a fresh infarct can be unremarkable. In this situation, the CardioSecur ECG made a diagnosis possible. The LAD (left anterior descending artery) stenosis was proven, and therefore treated with dilatation and stent placement via cardiac catheterization.

 
Case #2

Case History: 58 year old patient presented to the clinic complaining of retrosternal chest pain radiating to the lower jaw, lasting 5-10 minutes and requiring him to stop when walking quickly, which had been present for the past few days.

Cardiac Risk Factors: family history (father died at 69 years of age due to a heart attack), hypercholesterolemia (cholesterol 260 mg/dl, LDL 184 mg/dl), no hypertension, non-smoker

Troponin-Test: negative

The classic 12-lead ECG (image 1) showed sinus bradycardia at a rate of 52 beats per minute with left axis deviation. Findings: rs-complex in leads III and aVF. Negative T-wave in lead III, positive T-wave in lead aVF.

Image 1: classic 12-lead ECG – no clear indication of infarction

The CardioSecur ECG (image 2) showed sinus bradycardia at a rate of 49 beats per minute with left axis deviation. Findings: q-wave in lead II, qrs-complex in leads III and aVF.

Image 2: CardioSecur ECG – evidence of scarring from a previous posterior wall infarct

Findings: old inferior posterior wall infarct

Coronary angiography (image 3) showed severe 3-vessel coronary artery disease. Intermediate mainstem stenosis. LAD (left anterior descending artery): proximal and distal stenosis. RCX (Right circumflex artery): narrow, no stenosis. RCA (right coronary artery): high-grade tandem stenosis.

Image 3: Coronary Angiography – severe 3-vessel coronary artery disease

The Cardiac MRI (image 4) showed fibrosis, indicating a previous posterior wall infarct.

Image 4: Cardiac MRI – inferior fibrosis

Severe 3-vessel coronary artery disease was present in the second case. The classic 12-lead ECG showed only an rS-complex (not an obvious sign of a posterior wall infarct). However, as evidenced by a Q-wave in leads III and aVF as well as r-wave reduction, the CardioSecur ECG indicated a previous posterior wall infarction. An MRI confirmed this diagnosis.

Both cases show that CardioSecur has a high-sensitivity not only for recognizing ST-changes in the setting of an acute infarct, but also for providing information pertaining to an old infarct.