SUMMARY NOTES IN THE RECORD s20551  (Duration: 23:38:00.000)

Starting time, recording date:  14:24:00 19/01/1999

Lead 0: MLIII
Lead 1: V4

Age: 77  Sex: F
Comments: 
  This record, from a patient with known CAD, shows LBBB, and
  includes 3 ischemic episodes and several axis shifts. There
  were two conduction changes (increased degree of intra-ventricular
  conduction block) that occurred in the midst of the final
  ischemic episode.
Symptoms during Holter recording: No data
Diagnoses: 
  Coronary artery disease
  Left bundle branch block
  Hypertension
Treatment:
  Medications: 
    Diltiazem
    Nitrates
    Heparin
  Balloon Angioplasty: No data
  Coronary Artery bypass Grafting: No data
History: 
  Unstable angina
  Hypertension: Yes
  Left ventricular hypertrophy: No
  Cardiomyopathy: No
  Valve disease: No
  Electrolyte abnormalities: No
  Hypercapnia, anemia, hypotension, hyperventilation: No
  Atrioventricular nodal conduction delay: No
  Intraventricular conduction block: Yes, LBBB
  Previous Myocardial Infarction: No
  Previous tests:
    ECG stress test: No
    Thallium/Stress echo: Positive
    Left ventricular function: 
      Abnormal - Left ventricular ejection fraction 41%
    Echocardiogram: No data
    Coronary Arteriography: 
      Left anterior descending coronary artery 100% stenosis, right coronary artery 100% stenosis, left circumflex coronary artery 100% stenosis
    Baseline ECG: 
      Left bundle branch block
Holter Recording:
  Date: 19/01/1999
  Recorder: Remco


ST ANNOTATIONS

A. Criteria of 30 seconds and  75 microVolts (s20551.sta)

Lead 0:
Ischemic episodes:           4   Duration:    1:44:12   7.35% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 1 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Lead 1:
Ischemic episodes:           1   Duration:    1:09:24   4.89% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 4 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Total:
Ischemic episodes:           5   Duration:    2:53:36   6.12%
Rate-related episodes:       0   Duration:       0:00   0.00%
Axis shifts:                 5 
Conduction-change shifts:    4 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined:
Ischemic episodes:           3   Duration:    1:45:04   7.41% 
Rate-related episodes:       0   Duration:       0:00   0.00%
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined [ischemic or rate-related]:
ST segment episodes:         3   Duration:    1:45:04   7.41%
Unreadable intervals:        0   Duration:       0:00   0.00%

B. Criteria of 30 seconds and 100 microVolts (s20551.stb)

Lead 0:
Ischemic episodes:           3   Duration:    1:39:46   7.04% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 1 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Lead 1:
Ischemic episodes:           1   Duration:    1:09:24   4.89% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 4 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Total:
Ischemic episodes:           4   Duration:    2:49:10   5.96%
Rate-related episodes:       0   Duration:       0:00   0.00%
Axis shifts:                 5 
Conduction-change shifts:    4 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined:
Ischemic episodes:           2   Duration:    1:40:38   7.10% 
Rate-related episodes:       0   Duration:       0:00   0.00%
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined [ischemic or rate-related]:
ST segment episodes:         2   Duration:    1:40:38   7.10%
Unreadable intervals:        0   Duration:       0:00   0.00%

C. Criteria of 60 seconds and 100 microVolts (s20551.stc)

Lead 0:
Ischemic episodes:           3   Duration:    1:39:46   7.04% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 1 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Lead 1:
Ischemic episodes:           1   Duration:    1:09:24   4.89% 
Rate-related episodes:       0   Duration:       0:00   0.00% 
Axis shifts:                 4 
Conduction-change shifts:    2 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00% 

Total:
Ischemic episodes:           4   Duration:    2:49:10   5.96%
Rate-related episodes:       0   Duration:       0:00   0.00%
Axis shifts:                 5 
Conduction-change shifts:    4 
Noisy events:                0 
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined:
Ischemic episodes:           2   Duration:    1:40:38   7.10% 
Rate-related episodes:       0   Duration:       0:00   0.00%
Unreadable intervals:        0   Duration:       0:00   0.00%

Combined [ischemic or rate-related]:
ST segment episodes:         2   Duration:    1:40:38   7.10%
Unreadable intervals:        0   Duration:       0:00   0.00%


QRS ATRUTH ANNOTATIONS                   (s20551.atr)

Total number of beats                          100629

Normal beats                                    94024
Premature ventricular contractions                111
Fusions of ventricular and normal beat              2
Supraventricular premature or ectopic beats        16
Bundle branch block beats (unspecified)          6476