The Minnesota code manual of electrocardiographic findings : including measurement and comparison with the Novacode : standards and procedures for ECG measurement in epidemiologic and clinical trails

The electrocardiogram (ECG) is most often used in clinical and hospital settings for diagnosis and prognosis, but it is also used for systematic population studies and clinical trials where a repeatable, valid, and quantitative method is required for classification of ECG findings related to disease. Useful classification depends, in turn, on standardized methods of acquiring the data, on mounting (sampling), and on efficient and effective reading and measurement of the ECG. This new edition of the classic reference Minnesota Manual of Electrocardiographic Findings has been prompted by the continuous refinements and extensions to the Minnesota Code that allow a greater range of abnormalities to be coded; there are even clearer means of demonstrating correct and standardized methods of measurements, which are incorporated into this extensively revised second edition; some minor coding rules have been changed; and now the use of the code has been greatly expanded and is used in countless epidemiologic studies and clinical trials worldwide. While the contents of the coding chapters of this manual need not be mastered in one reading, the manual should be used as a reference when there is doubt about how to measure a particular wave form. The manual should be an important addition to the libraries of electrocardiographers, all clinical trialists and experienced investigators to teach measurement and coding of ECGs. The information contained within these pages is also key reading for all trainee physicians in internal medicine and cardiology, and nurses, technicians and other professionals involved in the management of patients needing ECG evaluation. The manual is suitable for training electrocardio- without digital recording and that are accompanied graphers and technicians and can be accompanied by other uniquely rich data. Despite my expectations by sets of training ECGs already coded by trainers. during the 1960s that such archives would cease to It is our expectation that the manual will serve as a be used after the introduction of digital recording, reference, guide, and training source for those con- the tide of such treasures has hardly ebbed. ducting studies that require objective evidence of The changes included in this edition arise from cardiac disease, both prevalent and incident, by non- more than a quarter of a century of directing central invasive, highly standardized, inexpensive record- ECG reading and research centers and collectively ing of the electrocardiogram. In our own ECG Read- 60+ large and small epidemiologic studies and m- ing Center, this has included epidemiologic studies ticenter national and international clinical trials. The among healthy populations, diabetics, psychiatric changes include the description of a new measuring patients, pregnant women, cohorts of patients with loupe in Chap. 3, developed over the past decade, to clinical heart disease, populations exposed to envi- better serve a more ef? cient and a more extensive ronmental contaminants such as arsenic, populations span for measurement of relevant durations, voltages, exposed to Chagas disease, and in clinical trials of and deviations from the isoelectric line. In Chap. Front Matter....Pages i-xiii What Is the Electrocardiogram or ECG?....Pages 1-5 ECG Leads....Pages 6-9 Measuring Devices....Pages 10-15 Q-QS Waves (1-Codes)....Pages 16-48 Frontal Plane QRS Axis (2-Codes)....Pages 49-54 High R–Waves (3–Codes)....Pages 55-59 ST Segment Depression (4-Codes) and Negative T-Waves (5-Codes)....Pages 60-97 Atrioventricular (A–V) Conduction Defects (6-Codes)....Pages 98-110 Intraventricular Conduction Defects (7-Codes)....Pages 111-133 Arrhythmias, 8-Codes....Pages 134-158 Miscellaneous Codes (9-Codes)....Pages 159-186 Exact Measurements....Pages 187-202 Coding the Whole ECG....Pages 203-205 ECG Data Acquisition Procedures and Maintenance of Recording Quality Including Technician Training....Pages 206-225 Criteria for Significant Electrocardiographic Change....Pages 226-262 ECG Indices that Add to Independent Prognostication for Cardiovascular Disease Outcomes....Pages 263-269 Quality Control of Visual and Electronic Coding....Pages 270-276 Back Matter....Pages 277-328 The Minnesota Code Manual presents a systematic, objective measuring system for electrocardiographic findings in clinincal trials and population studies of cardiovascular disease. The first edition published in 1982 classifies endpoints of clinical trials and characterizes arrhythmias and conduction defects. This edition also provides standard procedure for the codes application by trained medical or technical personnel. In addition, it is used by experienced investigators to teach measurement and coding of the ECG in the Core ECG Lab. The Minnesota Code incorporates standardized measurement r