SUMMARY NOTES IN THE RECORD s30661 (Duration: 23:44:32.984) Starting time, recording date: 12:15:00 11/02/1999 Lead 0: V4 Lead 1: V3 Lead 2: II Age: 72 Sex: M Comments: This patient with extensive CAD shows a number of ST depressions associated with paroxysms of atrial tachycardia (PAT). Some ischemic changes were also seen in associations with increased heart rate which was not PAT. The patient has high-grade atrial ectopic activity with many bursts of PAT. Ischemia is most prominent in signal 0 (V4). Symptoms during Holter recording: No data Diagnoses: 2-vessel coronary artery disease Unstable angina Previous coronary artery bypass grafting Left internal mammary artery graft to left anterior descending coronary artery Chronic obstructive pulmonary disease Hypertension Benign prostatic hypertrophy Treatment: Medications: Aspirin Enalapril Metoprolol Prilosec Cardura Azmacort Ventolin Ipratropium Balloon Angioplasty: No Coronary Artery bypass Grafting: Four grafts in 1995 History: Unstable angina and coronary artery bypass grafting in 1995 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: No Previous Myocardial Infarction: No Previous tests: ECG stress test: Yes Date: October, 1998 Findings: 2 mm ST depression, stopped due to dyspnea Thallium/Stress echo: 1993 - no ischemia Left ventricular function: Normal - ejection fraction = 60% Echocardiogram: Normal left ventricular function Coronary Arteriography: 1992: lesions in left anterior descending coronary artery, right coronary artery disease Baseline ECG: Normal sinus rhythm Nonspecific ST changes Atrial premature beats Holter Recording: Date: 11/02/1999 Recorder: Zymed ST ANNOTATIONS A. Criteria of 30 seconds and 75 microVolts (s30661.sta) Lead 0: Ischemic episodes: 21 Duration: 5:17:04 22.26% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 3 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 19 Duration: 4:53:26 20.60% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 4 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 2: Ischemic episodes: 8 Duration: 4:19:24 18.21% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 1 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 48 Duration: 14:29:54 20.35% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 8 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 22 Duration: 5:19:42 22.44% 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: 22 Duration: 5:19:42 22.44% Unreadable intervals: 0 Duration: 0:00 0.00% B. Criteria of 30 seconds and 100 microVolts (s30661.stb) Lead 0: Ischemic episodes: 13 Duration: 5:03:22 21.30% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 3 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 12 Duration: 4:44:54 20.00% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 4 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 2: Ischemic episodes: 6 Duration: 4:03:16 17.08% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 1 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 31 Duration: 13:51:32 19.46% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 8 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 13 Duration: 5:04:02 21.34% 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: 13 Duration: 5:04:02 21.34% Unreadable intervals: 0 Duration: 0:00 0.00% C. Criteria of 60 seconds and 100 microVolts (s30661.stc) Lead 0: Ischemic episodes: 11 Duration: 4:58:02 20.92% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 3 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 9 Duration: 4:41:08 19.73% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 4 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 2: Ischemic episodes: 6 Duration: 4:03:16 17.08% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 1 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 26 Duration: 13:42:26 19.24% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 8 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 11 Duration: 4:58:42 20.97% 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: 11 Duration: 4:58:42 20.97% Unreadable intervals: 0 Duration: 0:00 0.00% QRS ATRUTH ANNOTATIONS (s30661.atr) Total number of beats 144447 Normal beats 122769 Aberrated atrial premature beats 133 Premature ventricular contractions 60 Fusions of ventricular and normal beat 3 Supraventricular premature or ectopic beats 21482