Figure 1 - uploaded by Neil Herring
Content may be subject to copyright.
A demonstration to the Royal Society by Waller’s pet bulldog ‘Jimmie’ ( Illustrated London News, May 22nd 1909 ). The Times newspaper of July 9, 1909 reported that the demonstration had caused debate in parliament over whether the Cruelty to Animals Act (1876) had been contravened. On being questioned on this ‘public experiment’ on a dog with ‘a leather strap with sharp nails secured around the neck, his feet being immersed in glass jars containing salts . . . connected by wires with galvanometers’, the Secretary of State replied as follows: Mr Gladstone ‘ I understand the dog stood for some time in water to which sodium chloride had been added or in other words a little common salt. If my honourable friend has ever paddled in the sea he will understand the sensation. (Laughter) The dog—a finely developed bulldog—was neither tied nor muzzled. He wore a leather collar ornamented with brass studs. Had the experiment been painful the pain would no doubt have been immediately felt by those nearest the dog. (Laughter) ’ Mr MacNeill (MP Donegal South) ‘ Will the right honourable gentleman inform the person who furnished him with his jokes that there are members in this House who regard these experiments on dogs with abhorrence?’ (Hear) Mr Gladstone ‘ I certainly shall not. The jokes, poor as they are, are mine own’ (Laughter and cheers) (from Levick JR, An Introduction to Cardiovascular Physiology , 4 th edn Reprinted by permission of Edward Arnold). 

A demonstration to the Royal Society by Waller’s pet bulldog ‘Jimmie’ ( Illustrated London News, May 22nd 1909 ). The Times newspaper of July 9, 1909 reported that the demonstration had caused debate in parliament over whether the Cruelty to Animals Act (1876) had been contravened. On being questioned on this ‘public experiment’ on a dog with ‘a leather strap with sharp nails secured around the neck, his feet being immersed in glass jars containing salts . . . connected by wires with galvanometers’, the Secretary of State replied as follows: Mr Gladstone ‘ I understand the dog stood for some time in water to which sodium chloride had been added or in other words a little common salt. If my honourable friend has ever paddled in the sea he will understand the sensation. (Laughter) The dog—a finely developed bulldog—was neither tied nor muzzled. He wore a leather collar ornamented with brass studs. Had the experiment been painful the pain would no doubt have been immediately felt by those nearest the dog. (Laughter) ’ Mr MacNeill (MP Donegal South) ‘ Will the right honourable gentleman inform the person who furnished him with his jokes that there are members in this House who regard these experiments on dogs with abhorrence?’ (Hear) Mr Gladstone ‘ I certainly shall not. The jokes, poor as they are, are mine own’ (Laughter and cheers) (from Levick JR, An Introduction to Cardiovascular Physiology , 4 th edn Reprinted by permission of Edward Arnold). 

Source publication
Article
Full-text available
A century has passed since Einthoven published his description of the human electrocardiogram (ECG), recorded using a string galvanometer. The basic principles of this technique have remained unchanged, and it has revolutionized the diagnosis and management of cardiac pathology. At present, its sensitivity in diagnosing life-threatening myocardial...

Context in source publication

Context 1
... and labelled the P, Q, R, S and T waves of the ECG, his choice of letters reflecting a tradition in mathematics first used by Rene Descartes in the 17th century. The string galvanometer remains the basis by which ECGs are recorded today. Einthoven recognized the clinical potential of his invention and built a one mile cable from the University hospital to his research laboratory in order to study pathological traces in man. 8 Subsequent work by Einthoven and Sir Thomas Lewis, one of the first to use a commercially available string galvanometer from the Cambridge Scientific Instrument Company, led to the electrocardiographic description of sinus arrhythmia, heart block, atrial fibrillation and hypertrophy (e.g. reference 9). Although Waller initially maintained that ‘the finger tips of the physician will hardly be helped by an instrument as difficult to manage and to interpret as is the string galvanometer‘, his many demonstrations using the ECG (Figure 1) ...

Citations

... For patients with critical conditions, the initial MI diagnostic tool is the ECG, as it is a non-invasive and economical primary tool that is frequently available inside ambulances and emergency rooms and can be used to identify cardiac abnormalities [12]. The ECG signal provides critical information about the heart's function and rhythm, and as the heart suffers from episodes of ischemia, infarction, arrhythmia, morphological alterations in the ECG signal are directly reflected as irregularities in waves or rhythm [13,14]. Furthermore, when used and interpreted appropriately, the ECG provides a quick and highly reliable diagnosis of heart failure [15]. ...
Article
Full-text available
An automatic electrocardiogram (ECG) myocardial infarction detection system needs to satisfy several requirements to be efficient in real-world practice. These requirements, such as reliability, less complexity, and high performance in decision-making, remain very important in a realistic clinical environment. In this study, we investigated an automatic ECG myocardial infarction detection system and presented a new approach to evaluate its robustness and durability performance in classifying the myocardial infarction (with no feature extraction) under different noise types. We employed three well-known supervised machine learning models: support vector machine (SVM), k-nearest neighbors (KNN), and random forest (RF), and tested the performance and robustness of these techniques in classifying normal (NOR) and myocardial infarction (MI) using real ECG records from the PTB database after normalization and segmentation of the data, with a suggested inter-patient paradigm separation as well as noise from the MIT-BIH noise stress test database (NSTDB). Finally, we measured four metrics: accuracy, precision, recall, and F1-score. The simulation revealed that all of the models performed well, with values of over 0.50 at lower SNR levels, in terms of all the metrics investigated against different types of noise, indicating that they are encouraging and acceptable under extreme noise situations are are thus considered sustainable and robust models for specific forms of noise. All of the methods tested could be used as ECG myocardial infarction detection tools in real-world practice under challenging circumstances.
... Patients must also convene two criteria for CVD diagnosis: elevated serum indicator values, typical muscle aches, a diagnostic Electrocardiogram (ECG) changes. However, 50% of subjects with CVD brought to emergency rooms had a normal ECG rhythm, making CVD detection further challenging [78]. As a result, there is an urgent need for an even more specific, efficient, yet less expensive screening tool that could also aid in the legitimate evaluation of patients of CVD sufferers' wellbeing [77]. ...
Article
Full-text available
Clinical analysis necessitates the use of rapid and dependable diagnostic methodologies and approaches. Biomarkers may be an appropriate choice to fulfil this objective, as they are designed uncomplicated in using, specialized for the desired metabolite, susceptible of ongoing analysis and providing excellent outcomes, relatively affordable in the budget, and easily accessible. Biosensing devices are increasingly extensively utilized for treatment, and therefore a variety of applications such as prudence treatment and illness advancement surveillance, environment sensing, product standard, medicine development, toxicology, and scientific engineering. Biosensors can be developed using a wide variety of ways. Its combination with high-affinity macromolecules enables them to monitor a diverse variety of solutes in a specific as well as responsive manner. Enhanced sensing innovation leads the detection of infection as well as the monitoring of the people's reaction after treatment. Sensing tools is essential for a range of low and better implantable implants. Nanosensors offer a lot of prospects because they are simple, flexible, yet economical to develop. This article presents a detailed overview of breakthroughs in the subject and demonstrations of the variety of biosensors and the extension of nanoscience and nanotechnology methodologies that are applicable today.
... In 1902 Einthoven published the first electrocardiogram recorded by his string galvanometer. In 1924 for his invention Einthoven won the Nobel Prize 21,22 .The use of current 12-leads ECG with 3 unipolar, 3 bipolar limb leads and 6 unipolar chest leads became accepted practice since the 1950s 21 .The temporal changes in ST segment morphology during myocardial ischaemia and infarction were first described by Pardee in 1920 21 . At first, his findings did not gain complete acceptance. ...
Article
Full-text available
Cardiovascular disease is the leading cause of mortality and morbidity worldwide. The 2011 annual report from the World Health Organization mentioned that, coronary heart disease and cerebro-vascular disease which were reported as the top two causes of mortality in 2004, are predicted to remain the major cause of death in the next 20 years. Coronary heart disease(CHD) and atherosclerosis were once thought to be a disease of modern humankind linked to modern lifestyle. However, researchers dispute this and has confirmed that atherosclerosis was common in preindustrial inhabitants too. Further, vascular system studies of mummies give substantial evidence of atherosclerosis as ancient human disease and clinical syndrome of angina pectoris existed in ancient Egypt. In 1768 the paper presented at the Royal College of Physicians in London on “Some account of a disorder of the breast” was an eye opener to medical professionals and later this excruciating “disorder of breast” was linked to the “hardening of the arteries’’. In the past it was generally believed that MI virtually always resulted in death and identified in postmortem. In1878, the first case of coronary occlusion diagnosed during life was described. ECG was used to diagnose the condition in 1912 and the use of current 12-leads ECG became accepted practice since the 1950s. In addition to clinical evaluation and ECG, cardiacbiomarkers play a pivotal role in diagnosis and management of acute coronary syndrome. Aspartateaminotransferase became the first biomarker used to diagnose and subsequently CK-MB isoenzyme, lactatedehydrogenase and myoglobin played very significant roles. Troponin is now considered the ‘gold standard’biochemical test for the diagnosis. The definition, diagnosis, management and prognosis of coronary heartdisease have changed over the decades with the development of medical science and knowledge. It istherefore interesting to appraise the historical aspect of evolution of CHD definitions and diagnosis. Moreover,clinicians should have updated knowledge on the evolution of definition, diagnosis, management andprognosis of this condition.
... Electrocardiography (ECG), invented by Willem Einthoven nearly 120 years ago, remains one of the essential diagnostic modalities in cardiology [1], shaping the elementary division of acute coronary syndromes into those with and without persistent ST-segment depression, affecting the timing and mode of management and adding to short-and long-term risk stratification [2][3][4]. ...
... number of leads with pathological Q-waves [19], 9. Sclarovsky-Birnbaum ischemia score [2], 10. QRS complex duration. ...
Article
Full-text available
Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
... However, traditional ECG systems (e.g., 12-lead ECG, 3lead VCG) only employ a limited number of ECG sensors on the thorax and thus the resulted cardiac electrical distribution is with low spatial resolution. Accurate diagnosis of heart diseases such as acute ischemia calls upon the high-resolution ECG mapping [3] that is capable of capturing a comprehensive 3D view of the cardiac electrical signals. Thus, body surface potential mapping (BSPM) has been developed by deploying an increased number (i.e., 32-231) of ECG electrodes to record the high-resolution spatiotemporal cardiac electrodynamics projected on the body surface [4]- [7]. ...
Preprint
The rapid developments in advanced sensing and imaging bring about a data-rich environment, facilitating the effective modeling, monitoring, and control of complex systems. For example, the body-sensor network captures multi-channel information pertinent to the electrical activity of the heart (i.e., electrocardiograms (ECG)), which enables medical scientists to monitor and detect abnormal cardiac conditions. However, the high-dimensional sensing data are generally complexly structured and realizing the full data potential depends to a great extent on advanced analytical and predictive methods. This paper presents a physics-constrained deep learning (P-DL) framework for high-dimensional inverse ECG modeling. This method integrates the physical laws of the complex system with the advanced deep learning infrastructure for effective prediction of the system dynamics. The proposed P-DL approach is implemented to solve the inverse ECG model and predict the time-varying distribution of electric potentials in the heart from the ECG data measured by the body-surface sensor network. Experimental results show that the proposed P-DL method significantly outperforms existing methods that are commonly used in current practice.
... [10] There are several factors which limit the ability of ECG to detect transient ischemia. [11] The higher false positivity and false negativity makes it a nonideal test for the detection of CAD in various settings. As per the ischemic cascade [ Figure 5], [1] ischemia at cellular level first leads to diastolic and then systolic dysfunction which is followed by ECG changes and lastly symptoms of angina. ...
Article
Background: Stress echocardiography is a very useful diagnostic and prognostic test in the evaluation of significant coronary artery disease (CAD) causing inducible myocardial ischemia. Stress echocardiography has higher sensitivity and specificity as compared to exercise stress electrocardiography, and therefore, the guidelines recommend opting for the former modality over the latter. There are data suggesting that the incidence of major cardiac events is
... It led to the successful event of recording the electrical activity of the heart in 1887 using Lipmann Capillary Electrometer [16], [17]. The ECG wave obtained by Waller [18] and the experimental setup at Royal Society [19] is shown in Fig. 4. This event was widely publicized in local London Newspapers. ...
Article
Full-text available
Over the years, researchers have studied the evolution of Electrocardiogram (ECG) and the complex classification of cardiovascular diseases. This review focuses on the evolution of the ECG and covers the most recent signal processing schemes with milestones over the last 150 years systematically. Development phases of ECG, ECG leads, portable ECG monitors, Signal Processing schemes and Complex Transformations are discussed. This paper summarizes the development of ECG features detection for cardiac anomalies and the history of the development of ECG monitors, beginning from String Galvanometer. It also discusses the automated detections on ECG, beginning from 1960 to the most recent signal processing techniques. Additionally, this paper provides recommendations for future research directions.
... There was no significant difference between numbers of new myocardial infarction or ST changes on ECG (Table 1). However, studies have shown that ECG changes may be limited or absent despite significant ischaemia with an estimated sensitivity of only 45% in acute myocardial infarction diagnosed by troponin and CK-MB assays [4]. Furthermore, it is not known whether these studies achieved the therapeutic range for lidocaine as dosing was not weight based and there was no measurement of serum levels. ...
Article
Full-text available
A best evidence topic was constructed using a described protocol. The three-part question addressed was: In patients undergoing cardiac surgery, does intravenous lidocaine exert a cardioprotective effect against postoperative myocardial ischaemia and reperfusion injury? Using the reported search, 461 papers were found, of which 5 studies represented the best evidence to answer the question. In 3 studies, lidocaine was associated with a postoperative fall in biomarkers of myocardial injury. An additional study lacked power, but the difference in biomarkers was marginally non-significant with a trend in favour of lidocaine. A final study evaluating ischaemic changes on continuous and 12 lead ECG found no benefit with lidocaine. The limited evidence suggests that lidocaine may be cardioprotective, although no study has demonstrated improvement in clinical outcomes. Furthermore, all trials were small studies with a multitude of dosing regimens in heterogenous patient populations. There is insufficient data to correlate dose with effect and not all studies measured plasma lidocaine concentration. The narrow therapeutic index and our current evidence base does not support lidocaine prophylaxis.
... Conventional ECG systems place ECG sensors at a very limited number of locations over the thorax and provide the cardiac electrical information with low spatial resolution. It has been suggested that high-resolution ECG mapping is more conducive to the diagnostic assessment of heart diseases such as acute cardiac ischemia (Herring & Paterson, 2006). ECG sensors placed at different locations on the torso surface respond to the cardiac electrodynamics differently. ...
Article
Full-text available
Advanced sensing such as the wearable sensor network provides an unprecedented opportunity to capture a wealth of information pertinent to space-time electrical activity of the heart, and facilitate the inverse electrocardiographic (ECG) modeling with the readily available data of body surface potential mapping. However, it is often challenging to derive heart-surface potentials from body-surface measurements, which is called the “inverse ECG problem”. Traditional regression is not concerned about spatiotemporal dynamic variables in complex geometries, and tends to be limited in the ability to handle high-dimensional spatiotemporal data for solving the inverse ECG problem. This paper presents a comparison study of regularization methods in the performance to achieve robust solutions of the inverse ECG problem. We first introduce the forward and inverse ECG problems. Second, we propose two spatiotemporal regularization (STRE) models to increase the robustness of inverse ECG modeling. Finally, case studies are conducted on the two-sphere geometry, as well as a real-world torso-heart geometry to evaluate the performance of different regularization methods. Experimental results show that STRE models effectively tackle the ill-conditioned inverse ECG problem and yield 56.3% and 67.3% performance improvement compared to the traditional Tikhonov regularization in the two-sphere and the torso-heart geometries, respectively. The spatiotemporal regularization methodology is shown to have strong potential to achieve robust solutions for high-dimensional predictive modeling in the inverse ECG problem.
... ONITORING ECG is a key clinical tool for health care providers since it can provide a wide range of information about the patient with a relatively simple hardware setup. The clinically standard protocol for acquiring one's ECG is to apply a number of adhesive hydrogel-based electrodes on the patient and wire them to a data acquisition unit, which is typically secured to the patient's body by a strap for long-term, ambulatory recordings [1,2]. For hospitalized patients, the acquisition unit is placed bed-side but the cables still extend from the body, significantly compromising patient mobility and comfort. ...
Article
Continuous cardiac monitoring using electrocardiograms (ECG) provides a range of patient information, essential for making clinical decisions, to healthcare providers. Unfortunately, the clinical standard of ECG recording requires the use of rigid metal electrodes, conductive gels, and wired electronic devices, which often cause skin injuries and health risks for pediatric patients with underdeveloped, fragile skin. Here, we introduce a wireless, soft, comfortable electronic system that obviates the need for skin preparation, electrolyte gels, or aggressive tapes. The low-profile device incorporates a thin-film circuit and nanomembrane sensors, encapsulated in a hyperelastic elastomer. The soft elastomeric membrane offers an optimized adhesion that ensures a conformal lamination of stretchable electrodes on the skin for recording of high-fidelity biopotentials. The combined set of on-board Bluetooth module, front-end amplifier, and voltage regulator enables a real-time, long-range, wireless monitoring of physiological data, including ECG, heart rate (HR) and respiratory rate (RR). A pilot study with pediatric patients demonstrates the clinical feasibility of the device as a comfortable, reliable biopotential monitor, suggesting a new standard for safe and effective pediatric care.