ECG

The module ECG (electrocardiogram) is used to document important parameters from ECG and long-term ECG measurements.
The measurements ought to be performed according to DZHK-SOP-K-03 .

Content

General information relating to the examination
ECG
Long-term ECG

General information relating to the examination

Was the ECG performed?

  Fieldname: ekg_janein
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Was the long-term ECG performed?

  Fieldname: lzekg_janein
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Quality level

Level 1: The examination is performed in accordance with the guidelines of the medical associations.

Level 2: The examination is performed in accordance with the specifications of the DZHK SOP. Minimum requirements to ensure the quality of the implementation and the examiners are defined in the SOP.

Level 3: The examination is performed in accordance with the specifications of the DZHK SOP and certification of the examiners: Definition of intr-observer and interobserver-variability (standard of epidemiological studies).

DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_qlevel
  Data type: Integer with following options
    1
    2
    3

ECG

Date of examination

  Fieldname: ekg_date
  Data type: Timestamp with day, month and year

Insufficient ECG recording

  Fieldname: ekg_qualit
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Use of DAL-Square

Precise Determination of Electrode Positions C1-C6

Accurate positioning of the pre-cordial leads is critical for accurate diagnostic evaluation of the ECG. Deviations of just a few centimetres on the surface of the thorax result in significant changes in the ECG waveform. Therefore the so-called “Angle of Louis“ can be used to determine electrode positions C1 –C6 accurately

(1) Use the middle finger of the right hand to palpate the first intercostal space at the left sternal border.
(2) Count while successively palpating the subsequent intercostal spaces up to the 4th intercostal space.
(3) Place the C2 electrode on the left sternal border of the 4t intercostal space.
(4) Place the C1 electroce on the right sternal border or the 4th intercostal space.
(5) Place electrodes C5 and C6 as shwon in the illustration using visual judgement.

Record a 12-lead ECG strip for a period of 10 seconds, if possible, with an additional rhythm strip. If the quality of the ECGrecording is insufficient, check the condition of the system and the subject (see Technical problems, suboptimal recording quality section) and, after optimizing the conditions, record the ECG again. If the quality of the recording is still poor, inform the study doctor.

DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_thorax
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Comment

  Fieldname: ekg_comment
  Note in CRF: Möglichkeit zu generellem Kommentar zum EKG 
  Data type: Free text

Heart rate

  Fieldname: ekg_frequenz
  Data type: Integer with maximum 3 digits in /min

Rhythm

  Fieldname: ekg_rhythmus
  Data type: String with following options
    sinus rhythm
    atrial fibrillation
    atrial flutter
    other rhythm
    unknown
    not assessed

  Fieldname: ekg_rhythm_andere
  Note in CRF: Please specify
  Data type: Free text

Pacemaker

Pacemaker stimulation

  Fieldname: ekg_schritstimu
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Atrial excitation following pacemaker stimulation

  Fieldname: ekg_vorerregschritt
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Ventricular excitation following pacemaker stimulation

  Fieldname: ekg_ereg_kammer
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Others

  Fieldname: ekg_schritt_andere
  Data type: String with following options
    yes
    no
    unknown
    not assessed

  Fieldname: ekg_schr_andere_spez
  Note in CRF: Please specify
  Data type: Free text

PQ, QRS, QT time

PQ time

Begins where P leaves the isoelectric line. Ends at the beginning of the Q wave. If there is no Q wave present, the measurement ends at the beginning of the R wave upstroke. Measured in Lead II, otherweise in the lead with the best representation.
DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_pq_zeit
  Note in CRF: Beginn: P verlässt die isoelektrische Line; Ende: Beginn der Q-Zacke. Bei fehlender Q-Zacke endet die Messung am Beginn des R-Aufstrichs. Messung in Ableitung II, ansonsten in Ableitung mit optimaler Darstellung.
  Data type: Integer with maximum 3 digits in ms

QRS duration

Begins where Q leaves the isoelectric line. Ends where S meets the isoelectric line. If there is no Q wave present, measurement begins at the R wave upstroke. Measured in Lead II, otherweise in the lead with the best representation.
DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_qrs_dauer
  Note in CRF: Beginn: Q verlässt die isoelektrische Linie; Ende: S trifft auf die isoelektrische Linie. Bei fehlender Q-Zacke Beginn der Messung bei R-Aufstrich. Messung in Ableitung II, ansonsten in Ableitung mit optimaler Darstellung.
  Data type: Integer with maximum 3 digits in ms

QT time

Begins where Q leaces the isoelectric line. Ends where T meets the isoelectric line. Measured in Lead II, otherweise in the lead with the best representation. The QT time is the measured, not the corrected, QT time.
DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_qt_zeit
  Note in CRF: Beginn: Q verlässt die isoelektrische Linie; Ende: T trifft auf die isoelektrische Linie. Messung in Ableitung II, ansonsten in Ableitung mit optimaler Darstellung.
  Data type: Integer with maximum 3 digits in ms

AV-Block, Bundle branch block, Hemiblock

AV block

1st degree: PQ interval > 0,20 seconds

2nd degree: Includes Type 1 (Wenckebach) and Type 2 (Mobitz)

Typ I, Wenckebach: in each cycle the PR interval is prlongued until a QRS complex is blocked.

Typ II, Mobitz: intermittent blocking of a QRS complex with no prior increase in the PR interval.

3rd degree: P waves appear independent of the QRS complexes, mostly with a higher frequency than the ventricular escape rhythm.

DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_av_block
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Degree

  Fieldname: ekg_grad
  Note in CRF:Grad I: PQZeit > 0,20 Sekunden
Grad II: Umfasst Typ I, Wenckebach und Typ II, Mobitz
Typ I, Wenckebach: bei jedem Zyklus verlängert sich die PQZeit, bis ein QRSKomplex ausfällt.
Typ II, Mobitz: intermittierender Ausfall eines QRSKomplexes ohne vorherige Zunahme der PQZeit.
Grad III: PWellen erscheinen unabhängig von den QRSKomplexen, meistens mit höherer Frequenz als der Kammerersatzrhythmus.
  Data type: String with following options
    I
    II
    III
    unknown
    not assessed

Bundle branch block

Left bundle branch block: Prolongation of the QRS complex up to the last negativ deflection in V5 or V6 or the pre-cordial leads to ≥0,06 sec.

Incomplete: QRS width ≤0,12 sec

Complete: QRS width >0,12 sec

Right bundle branch block:

Prolongation of the QRS complex up to the last negative delfection in >30 sec.

Incomplete: RBB morphology with QRS complex ≤0,12 sec

Complete: QRS complex >0,12 sec, wide, notched Rwaves in v1-v2, S waves in v5-v6

DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_schenkelblock
  Data type: String with following options
    LBBB
    RBBB
    none
    unknown
    not assessed

  Fieldname: ekg_lsb_rsb
  Note in CRF: 
Linksschenkelblock: Verlängerung QRSKomplex bis zur endgültigen Negativitätsbewegung in v5 oder v6 oder linken Brustwandableitungen auf ≥0,06 sec.
Inkomplett: QRSBreite ≤0,12 sec
Komplett: QRSBreite >0,12 sec
Rechtsschenkelblock:
Verlängerung QRSKomplex bis zur endgültigen Negativitätsbewegung in >0,030 sec.
Inkomplett: RSBMorphologie mit QRSKomplex ≤0,12 sec
Komplett: QRSKomplex >0,12 sec, breite, gekerbte RZacken in v1v2, SZacken in v5v6
  Data type: String with following options
    completed
    incomplete
    none
    unknown
    not assessed

Hemiblock

Left anteriorer hemiblock: extreme left axis deviation in the pre-cordial leads, deep S wave in V5-V6, QRS is not widened. Left posteriorer hemiblock: right to extreme right axis deviation. In cases of atrial fibrillation or irregular rhythm on the ECG,the intervals are measured three times in total, each time during a different cycle. The mean value is entered.
DZHK-SOP-K-03: Resting 12-Lead Surface Electrocardiogram (ECG), Version: V1.0, Valid as of: 01.09.2014

  Fieldname: ekg_hemiblock
  Note in CRF:Linksanteriorer Hemiblock: Überdrehter Linkstyp in den Brustwandableitungen, tiefe SZacke v5v6, QRS nicht verbreitert
Linksposteriorer Hemiblock: Rechtstyp bis überdrehter Rechtstyp
  Data type: String with following options
    LAH
    LPH
    none
    unknown
    not assessed

ECG findings

Discordant negative T-waves

  Fieldname: ekg_dis_t_negativ
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads I, aVL, V6

  Fieldname: ekg_lokal_1
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads II, III, aVF

  Fieldname: ekg_lokal_2
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads V2, V3, V4, V5

  Fieldname: ekg_lokal_3
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Pathological ST segments

  Fieldname: ekg_st_streck
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads I, aVL, V6

  Fieldname: ekg_streck_1
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads II, III, aVF

  Fieldname: ekg_streck_2
  Data type: String with following options
    yes
    no
    unknown
    not assessed

At least two of leads V2, V3, V4, V5

  Fieldname: ekg_streck_3
  Data type: String with following options
    yes
    no
    unknown
    not assessed

  Fieldname: ekg_streck_andere
  Note in CRF: Infarkttypisch (Gemessen am J Punkt in mindestens 2 benachbarten Ableitungen ≥0.25 mV bei Männern ≤40 Jahre, ≥0.2 mV bei Männern >40 Jahren oder ≥0.15 mV bei Frauen in Ableitungen v2v3 oder ≥0.1 in anderen Ableitungen bei Abwesenheit eines Linksschenkelblocks.),
  Data type: Freetext

Q waves as indictor of previous infarction

Qwaves as an indicator of a prior infarction

  Fieldname: ekg_q_welle
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Q-wave in leads v2-v3>=0.02 sec or QS complex in leads v2 and v3

  Fieldname: ekg_q_welle_1
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Q-wave >= 0.03 sec and >=0.1mV deep or QS complex in leads I, II, aVL, aVF or v4-v6 in at least 2 neighbouring leads (I, aVL; v1-v6; II, III, aVF)

  Fieldname: ekg_q_welle_2
  Data type: String with following options
    yes
    no
    unknown
    not assessed

Long-term ECG

Date of examination

  Fieldname: ekg_lang_date
  Data type: Timestamp with day, month and year

Duration of recording

  Fieldname: ekg_lang_dauer
  Data type: Timestamp with hours and minutes

Average heart rate

  Fieldname: ekg_lang_mittfreq
  Data type: Integer with maximum 3 digits in /min

Minimum heart rate

  Fieldname: ekg_lang_minfreq
  Data type: Integer with maximum 2 digits in /min

Maximum heart rate

  Fieldname: ekg_lang_maxfreq
  Data type: Integer with maximum 3 digits in /min

VES/ SVES

Number of VES

  Fieldname: ekg_lang_ves
  Note in CRF: VES: Ventrikulären Extrasystolen im Aufzeichnungszeitraum
  Data type: Integer with maximum 5 digits

Number of SVES

  Fieldname: ekg_lang_sves
  Note in CRF: SVES: Supraventrikulären Extrasystolen im Aufzeichnungszeitraum
  Data type: Integer with maximum 5 digits

VT

Duration of the longest ventricular tachycardia

  Fieldname: ekg_lang_lvt_s
  Data type: Integer with maximum 3 digits in seconds

Rate of longest ventricular tachycardia

  Fieldname: ekg_lang_lvt_m
  Data type: Integer with maximum 3 digits in /min

Duration of fastest ventricular tachycardia

  Fieldname: ekg_lang_svt_s
  Data type: Integer with maximum 3 digits in seconds

Rate of fastest ventricular tachycardia

  Fieldname: ekg_lang_svt_m
  Data type: Integer with maximum 3 digits in /min

SDNN

  Fieldname: ekg_lang_sdnn
  Note in CRF: Standardabweichung der NN-Intervalle (zur Hilfe der RR-Intervalle)
  Data type: Integer with maximum 3 digits in ms

Pauses

Pauses >3 seconds

  Fieldname: ekg_lang_pause
  Data type: String with following options
   yes
   no
   unknown
   not assessed

Number of pauses >3 seconds

  Fieldname: ekg_lang_pause_anz
  Data type: Integer with maximum 2 digits

Duration of longest pause >3 seconds

  Fieldname: ekg_lang_pause_daur
  Data type: Integer with maximum 3 digits

Time of longest pause >3 seconds

  Fieldname: ekg_lang_pause_zeit
  Data type: Timestamp with hours and minutes