The Minnesota Code Manual of Electrocardiographic Findings

The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurement and Classification

Contents

Preface to the Second Edition

Preface to the First Edition

Acknowledgements

Chapter 1

What Is the Electrocardiogram or ECG1?

The Electricity Part of the ECG

Chapter 2

ECG Leads

Bipolar Limb Leads (I, II, III)

Unipolar Limb Leads (aVR, aVL, aVF)

Chest Leads (V1, V2, V3, V4, V5, V6)

Chapter 3

Measuring Devices

Recording Paper Grid

Measuring Loupe

Plastic Ruler

Calibration Deflection

Beats to Be Measured

Mathematical Symbols

Differences in Measurement between Visual and Electronic Measurements

Reference

Chapter 4

Q-QS Waves (1-Codes)

Chapter 5

Frontal Plane QRS Axis (2-Codes)

Frontal Plane T-Wave Axis

Reference

Chapter 6

High R-Waves (3-Codes)

Chapter 7

ST Segment Depression (4-Codes) and Negative T-Waves (5-Codes)

Chapter 8

Atrioventricular (A-V) Conduction Defects (6-Codes)

Chapter 9

Intraventricular Conduction Defects (7-Codes)

References

Chapter 10

Arrhythmias, 8-Codes

Chapter 11

Miscellaneous Codes (9-Codes)

Lead Reversals

References

Chapter 12

Exact Measurements

References

Chapter 13

Coding the Whole ECG

Coding Hierarchy

Data Recording

Chapter 14

ECG Data Acquisition Procedures and Maintenance of Recording Quality Including Technician Training

Preparation of Study Participant

Participant Position

Fasting State

Single Channel Electrocariographs

Machine Standardization

Electrodes and Electrode Placement

Electrode Position Measurement and Marking

Application of Electrodes

ECG Recording

Mounting Electrocardiograms

Twelve-Lead ECG Using Multichannel Electrocardiographs

Electrode Position Measuring and Marking

Electrode Placement

Attaching the electrodes

Fault Detection Procedures

Self-Evaluation of Technical Performance

Continued Quality Assurance for Electrocardiographs

ECG Quality Grading for Electronic ECGs

Training of Clinic Site ECG Technicians Helps to Maintain High Quality ECG Recording

Quality Control of ECG Data Collection and Processing Procedures

Quality Control at Field Centers

Quality Trend Monitoring

Minimizing Biologic Variability

Rest ECG

References

Chapter 15

Criteria for Significant Electrocardiographic Change

Evolving ECG-LVH (Minnesota Code 3-1 and 3-3 or ECG Measures for LVH)

Serial Change for Acute Myocardial Infarction

Categories of Significant ECG Waveform Change Determined by Minnesota Code Serial Comparison

References

Chapter 16

ECG Indices that Add to Independent Prognostication for Cardiovascular Disease Outcomes

QRS/T Angle and Spatial T Axis

(A) The spatial QRS/T angle from X, Y, and Z leads by a matrix transformation methods – “QRS/T matrix”

(B) The spatial QRS/T angle by using the net QRS and T amplitudes in 3 standard leads – “QRS/T simple”

(C) The frontal plane QRS/T angle defi ned as the absolute value of the difference between the frontal plane QRS axis and T axis in the route ECG report directly – “QRS/T frontal”

(D) Spatial T-wave axis based on areas of the wave components of the QRS complex and T wave

Heart Rate Variability

References

Chapter 17

Quality Control of Visual and Electronic Coding

Visual Coding

Analysis of Repeatability Tests

Qualitative Variables

Kappa Statistics

Quantitative Variables

The Minimum Accepted Standard for Repeatability Tests

Quality Control of Electronically Processed ECGs

Trend Analysis

References

Appendix A

MINNESOTA CODE 2009

Q and QS Patterns

QRS Axis Deviation

High Amplitude R Waves

ST Junction (J) and Segment Depression

T-Wave Items

A-V Conduction Defect

Ventricular Conduction Defect

Arrhythmias

ST Segment Elevation

Miscellaneous Items

Incompatible Codes

ECG Criteria for Signifi cant Serial ECG Change

Evolving Q-wave

Evolving ST-Elevation

Evolving ST-Depression / T Wave Inversion

Evolving Bundle Branch Block

Evolving ECG – LVH 5

Appendix B

The Novacode Criteria for Classifi cation of ECG Abnormalities and Their Clinically Signifi cant Progression and Regression

The Structure of the Novacode -- Coding Categories for Prevalent ECG Abnormalities

Measurement

Dictionary of Variables and Novacode Defi nitions of ECG Wavesa

Defi nitions of ECG Waveform Variables

General Defi nitions Related to Rhythm Codes

Codes for Prevalent ECG Abnormalities

1. Rhythm Codes

2. Atrioventricular Conduction Abnormalities

3. Prolonged Ventricular Excitation

4. Prolonged Ventricular Repolarization

5. ECG Categories Associated with Prevalent Myocardial Infarction/Ischemia (MI Likelihood)

6. Left Ventricular Hypertrophy

7. Left Atrial Enlargement

8. Right Ventricular Hypertrophy

9. Right Atrial Enlargement

10. Fascicular Blocks

11. Other Clinically Signifi cant Abnormalities

Defi nitions of Supplementary Codes (S)

The Novacode Criteria for Classifi cation of Myocardial Infarction and Ischemic Abnormalities

Waveform Pattern Labels for Coding of Q Wave Abnormalities

Lead Groups for Coding of Myocardial Infarctions and Ischemic Abnormalities

Coding of Repolarization Abnormalities

Classifi cation Criteria for Prevalent Myocardial Infarction and Categorization for Risk Stratifi cation

Classifi cation of Incident Myocardial Infarctions

Criteria for Other (than Incident MI) Incident or Progressing EGG Abnormalities

I 0 Serial Change Uncodable (Totally or Partially) Due to Suppression Code

I 1 Incident Arrhythmias

I 2 Incident AV Conduction Abnormalities

I 3 Incident Prolonged Ventricular Excitation

I 4 Incident Prolonged Ventricular Repolarization

I 5 Incident ECG Abnormalities Related to Myocardial Infarction and Ischemia

I 6 Incident Left Ventricular Hypertrophy (LVH)

I 7 Incident Left Atrial Enlargement (LAE)

I 8 Incident Right Ventricular Hypertrophy (RVH)

I 9 Incident Right Atrial Enlargement (RAE)

I 10 Incident Fascicular Block

References

Appendix C

Major and Minor ECG Abnormalities for Population Comparisons with Minnesota Code and Novacode Equivalents

Index