Anil Srivastava

Anil Srivastava
National Sales Manager-Medical
Equipment, Nihon Kohden India Private Limited

There are big price wars in the single-channel and 3-channel ECG market segments, which restrict the entry of feature rich, bigger display and inbuilt interpretation machine. Majority of small nursing homes, diagnostic centers and clinics are not willing to pay extra for advanced features and continue to stick to small display and less features machines, says Anil Srivastava, National Sales Manager-Medical Equipment, Nihon Kohden India Private Limited

The most common ECG exam is the standard 12-lead ECG. It is simple to measure, has low burden on the body, and observing the heart from these 12 directions provides a lot of information which has a wide range of clinical applications. However, some areas, especially pathological change in the right ventricle and the posterior wall cannot be observed from the 12-lead ECG.

In order to actually measure the right chest (V3R, V4R, V5R) and back (V7, V8, V9) areas, it is necessary to use different electrode positions than the standard 12-lead ECG. In particular, electrodes must also be attached to the patients back so that normal suction cup electrodes cannot be used. Also, the patient must be turned over in some cases and in an emergency it is often difficult to use back electrodes. This complicates the exam procedure.

As per American Heart Associations (AHA) Guidelines for Right Ventricular Infarction, patients with inferior STEMI & hemodynamic compromise should be assessed with right precordial V4R lead to detect ST segment elevation and an echocardiogram to screen for RV infarction. Also, as per the AHA “ True posterior Myocardial Infarction (MI) may be manifested by tall R waves in right precordial leads and ST segment depression in leads V1 through V4 especially when T waves are upright. Repeat ECGs and incorporation of additional leads such as V7 through V9 are more specific for the detection of posterior infarction.

Possibilities of missing MI decreases from 11.6 percent to 3.2 percent drastically by using 18 leads compared to standard 12 lead ECGs.

Synthesised 18-Lead ECG with right-sided and posterior precordial leads (V3R-V5R and V7-V9) is useful in the rapid diagnosis of STEMI within 10 minutes of ED arrival especially in the early detection of right ventricular infarction. Synthesised 18-lead ECG uses the 12-lead ECG waveforms to mathematically derive the waveforms of the right chest leads (V3R, V4R, V5R) and back leads (V7, V8, V9).

India is undergoing a rapid health transition with rising burden of coronary heart disease (CHD). Among adults over 20 years of age, the estimated prence of CHD is around 3-4 per cent in rural areas and 8-10 per cent in urban areas, representing a two-fold rise in rural areas and a six-fold rise in urban areas between the years 1960 and 2000. Deaths due to acute myocardial infarction (AMI) in South Asians occur at 5-10 years earlier than western population.

In 18-lead synthesised ECG measurement procedure is the same as the standard 12-lead ECG but more information can be obtained. 18-lead synthesised ECG is expected to be useful in detecting right side and posterior infarction.

ECG diagnosis has not gained momentum among tier-III and rural healthcare facilities due to poor hospital infrastructure, insufficient transport facilities, understaffed hospitals, and a lack of awareness about cardiovascular diseases. There is a big challenge to introduce newer technology like 16 or 18 lead ECG, as market is still growing for 3- 6 channel ECG. There is an urgent need of market upgardation to 12 lead ECG systems.

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