Often no heart attack diagnosis by ECG

High error rate in cardiac infarction examinations by means of electrocardiograms (ECG): Majority of infarcts are detected too late or not at all

17/05/2011

So far, two thirds of all myocardial infarctions in an electrocardiogram (ECG) are not recognized, but now offers the „Cardiogoniometry“ (CGM) a new investigation method. While the ECG showed no signs of impending heart attack (myocardial infarction), the CGM has delivered clear results, explained „World Online“. With this new examination technique, a threatening heart attack would be reported immediately and appropriate countermeasures could be initiated at an early stage.

Heart attacks are often not recognized on the ECG
The infarction diagnosis based on the classical electrocardiogram (ECG) is „World Online“ According to extremely faulty. About two out of three heart attacks would not be detected by the ECG or not in time. This has the consequence that many patients - despite prior investigation - unprepared to have an infarct, which often ends fatally. Remedy could be the new diagnostic procedure of the „ Cardiogoniometry“ offer that is currently being tested at Herzzentrum Bad Segeberg. CGM was used to detect an imminent heart attack in a patient who had no signs of impending heart attack during the previous ECG scan. Immediately after the diagnosis, the patient actually suffered a myocardial infarction, but since the doctors were prepared, the closed vessel could be opened without wasting time and the patient survived the heart attack without further complications and long-term consequences, reported „World Online“.

Improved diagnosis of heart attacks by CMG
Frequently, patients with nonspecific chest pain undergo treatment with their family doctor, who then usually performs an ECG and possibly a lung function test. When patients complain of severe chest pain, tightness and shortness of breath, they are often signs of a heart attack. However, if the results of the investigation remain within limits, there is usually no reason for physicians to initiate further action or investigation. But with the help of ECG, only 30 percent of heart attacks are detected „World Online“. Therefore, doctors have been looking for some time for an alternative method to diagnose an impending heart attack early. The procedure tested in the Herzzentrum Bad Segeberg „ Cardiogoniometry“ has now put his performance under proof. Although the ECG was unremarkable, the CGM in one patient could be used to detect an imminent heart attack that actually occurred minutes later. The new procedure could allow a much more accurate diagnosis of infarction in the future, writes „World Online“.

High death rate due to incorrect diagnoses
If a heart attack has been overcome by the patient, it can be treated relatively well today. Every year, around 210,000 people suffer a heart attack for the first time, of which 60,000 are still dying. By today's standards, the death rate is far too high. According to many cardiologists, co-responsibility carries the about 100-year-old electrocardiogram (ECG).

ECG: No accurate diagnostic technique for heart attacks
The ECG is by far not as accurate as many patients and physicians believe. Often the results of a measurement are completely unremarkable, although a heart attack has taken place. This has the consequence that two out of three heart attacks by the ECG are not recognizable at all or only very late. If there is an acute myocardial infarction, it takes every minute to minimize consequential damage and the risk of sudden cardiac death. If the doctor gives a hasty all-clear because the patient otherwise shows inconspicuous EGK values ​​and the symptoms are rather atypical, this can have fatal consequences for the patient. It can cause irreparable damage to the heart muscle and the person can die suddenly because life-saving measures have not been initiated.

By means of a blood test of the biomarkers (troponin), a myocardial infarction can be detected in about 50 percent of the cases. However, this proof usually succeeds only after hours, after the infarction already took place. The blood test shows certain inflammatory reactions of the body, which may indicate a heart attack. Also, this method is inaccurate and usually serves only as an additional measure to include a suspicion or exclude or discover another inflammatory value.

Cardiogoniometry detects harbingers and recognize infarcts
With the relatively new method CGM (cardiogoniometry), 70 percent of all hidden heart attacks as well as precursors such as acute circulatory disturbances in the heart can now be detected. Thus, the method is approximately twice as accurate as compared to the ECG. Similar to the conventional diagnostic ECG electrodes are placed on the skin of the suspected patient. A total of five pieces, each placed on the chest and on the back. By means of measured heart muscle signals, the software can show a three-dimensional graphic representation, on which changes of the heart muscle tissue are well readable. Emergency physicians or primary care physicians can detect a heart attack faster or even diagnose precursors such as angina pectoris or cardiac circulatory disorders almost certainly. A first result of the investigation is reported after a good twelve seconds. When the first 2010 study on the new technology was presented at the European congress of cardiologists in Stockholm, the results caused quite a stir. Now, a new comparative study shows that the validity of the procedure is two and a half times more accurate compared to the conventional ECG. Another advantage of the new diagnostic technology is the ease of use. The device can also be used in patients with disabilities or physical limitations.

Use especially for family doctors to support decision-making
After completing the study, one of the researchers reported: „Observations have, to our great surprise, also shown a very high degree of agreement between the fast-acting and inexpensive CGM on the one hand and the highly complex magnetic resonance tomograph on the other hand. This suggests a lot for the future of cardiogoniometry.“ As a result, every family doctor would be in the comfortable position of being able to diagnose an impending cardiovascular disease almost accurately or, in the case of an acute myocardial infarction, to initiate immediate emergency measures. In addition, the diagnostic procedure could be simplified because serious heart disease can be quickly ruled out and further therapy or studies can be continued. Because often in young people stinging in the chest does not stem from the heart, but, for example, from the muscles and are actually tense or back pain.

Accordingly, the new CGM cardiac diagnostic technology is to be used primarily by general practitioners in structurally weak or rural areas. Heart specialists expect that the devices in the established area will be an important decision-making aid for physicians. This allows the family doctor to decide more quickly whether the patient should be hospitalized in a hospital or whether further outpatient therapy is sufficient. (fp, sb)

Read about:
Anti-inflammatory protein after myocardial infarction
Heart attack worse in the morning than in the evening
Lack of sleep favors stroke & heart attack
Stress at work increases heart attack risk

Image: Michael Bührke