SUMMARY NOTES IN THE RECORD s20271 (Duration: 23:43:59.988) Starting time, recording date: 09:45:00 27/05/1992 Lead 0: 0 Lead 1: 1 Age: 61 Sex: M Comments: Records s20271, s20272, s20273 and s20274 are from the same patient. This is the first record. Lead 0: This record shows multiple episodes of ischemia which typically show T-wave peaking followed by significant ST depression. Some episodes trigger the ischemic episode definition during the ST elevation, while others trigger only at the onset of ST-depression. In still other cases there is a short interval of "near-baseline" ST between the elevations (peaking of Ts) and depressions which causes a double counting of the biphasic episode as two separate episodes. This occurs at: 6:41:32, 16:48:58, 18:33:00, 21:21:48, 21:36:10 and 23:36:22. Physiologically each of these represents a single episode of ischemia. At 15:18:52, there is a short axis shift which interrupts the terminal portion of an ischemic episode, resulting in artifactual early termination of the ischemic episode, and the definition of a second episode. Lead 1: At approximately 6:41:36 the terminal portion of the ischemic episode is split into additional episodes - but all represent the resolution phase of the ischemic episode. T wave peaks, T-wave peaking decreases, and finally ST depression resolve. At 7:21:20, double positive peak in ST trend at beginning of this episode is created by the superposition of rate-related ST-depression. At 15:18:52, see note above for lead 0. At the end of this record the data has a number of episodes labeled as "rate-related". At 16:52:48, axis shift annotation set between the end of ischemic episode and local reference. Electrode locations were not recorded. Symptoms during Holter recording: No data Diagnoses: Coronary artery disease Treatment: Medications: Isordil Nitroglycerine Calcium channel blocker Aspirin Balloon Angioplasty: Yes Coronary Artery bypass Grafting: No History: Angina Hypertension: No Left ventricular hypertrophy: No Cardiomyopathy: No Valve disease: No Electrolyte abnormalities: No Hypercapnia, anemia, hypotension, hyperventilation: No Atrioventricular nodal conduction delay: No data Intraventricular conduction block: No data Previous Myocardial Infarction: No Previous tests: ECG stress test: No data Thallium/Stress echo: No data Left ventricular function: No data Echocardiogram: No data Coronary Arteriography: Lesions in left anterior descending coronary artery, left circumflex coronary artery Baseline ECG: No data Holter Recording: Date: 27/05/1992 Recorder: No data ST ANNOTATIONS A. Criteria of 30 seconds and 75 microVolts (s20271.sta) Lead 0: Ischemic episodes: 63 Duration: 5:31:16 23.26% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 20 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 62 Duration: 6:45:02 28.44% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 32 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 125 Duration: 12:16:18 25.85% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 52 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 63 Duration: 7:06:52 29.98% 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: 63 Duration: 7:06:52 29.98% Unreadable intervals: 0 Duration: 0:00 0.00% B. Criteria of 30 seconds and 100 microVolts (s20271.stb) Lead 0: Ischemic episodes: 52 Duration: 5:00:06 21.07% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 20 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 56 Duration: 6:30:58 27.46% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 32 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 108 Duration: 11:31:04 24.26% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 52 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 56 Duration: 6:46:32 28.55% 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: 56 Duration: 6:46:32 28.55% Unreadable intervals: 0 Duration: 0:00 0.00% C. Criteria of 60 seconds and 100 microVolts (s20271.stc) Lead 0: Ischemic episodes: 51 Duration: 4:59:10 21.01% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 20 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 54 Duration: 6:28:46 27.30% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 32 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 105 Duration: 11:27:56 24.15% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 52 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 54 Duration: 6:44:20 28.39% 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: 54 Duration: 6:44:20 28.39% Unreadable intervals: 0 Duration: 0:00 0.00% QRS ATRUTH ANNOTATIONS (s20271.atr) Total number of beats 114201 Normal beats 106252 Premature ventricular contractions 7890 Atrial premature beats 38 Supraventricular premature or ectopic beats 1 Ventricular escape beats 3 Atrial escape beats 17