SUMMARY NOTES IN THE RECORD s20041 (Duration: 23:54:26.000) Starting time, recording date: 12:06:00 21/05/1997 Lead 0: 0 Lead 1: 1 Age: 60 Sex: M Comments: This is a difficult record. The baseline ST segment is abnormal, it is scooped and slightly depressed. There are a number of episodes of ST depression associated with increased heart rate, some of which are quite prolonged. These events were suggestive of ischemia, and were so labeled. Lead 0 shows many ischemic episodes and a few axis shifts. Lead 1 shows many ischemic episodes, and the morphology of the QRST complexes is quite similar to those of lead 0. Electrode locations were not recorded. Symptoms during Holter recording: None reported Diagnoses: Coronary artery disease Previous coronary artery bypass grafting, 1986 Congestive heart failure Chronic obstructive pulmonary disease Previous transurethral resection of the prostate Chronic renal failure (serum creatinine = 2.2) Treatment: Medications: Nifedipine Isordil Metoprolol Captopril Lasix KCl Restoril Aspirin Balloon Angioplasty: No Coronary Artery bypass Grafting: Yes, 1986 History: Exertional angina, dyspnea on exertion Hypertension: No Left ventricular hypertrophy: Yes Cardiomyopathy: No Valve disease: No Electrolyte abnormalities: No Hypercapnia, anemia, hypotension, hyperventilation: No Atrioventricular nodal conduction delay: No Intraventricular conduction block: Incomplete right bundle branch block Previous Myocardial Infarction: Yes, unknown date Previous tests: ECG stress test: No Thallium/Stress echo: No Left ventricular function: No data Echocardiogram: No data Coronary Arteriography: June, 1997 - 99%left main coronary artery, 100%left anterior descending coronary artery, 100%left circumflex coronary artery. Internal mammary artery graft open but left anterior descending coronary artery occluded below anastamosis Baseline ECG: Normal sinus rhythm at 66 bpm Left ventricular hypertrophy Previous anterolateral myocardial infarction Inferior ischemia Possible old inferior myocardial infarction Holter Recording: Date: 21/05/1997 Recorder: ICR ST ANNOTATIONS A. Criteria of 30 seconds and 75 microVolts (s20041.sta) Lead 0: Ischemic episodes: 26 Duration: 6:01:18 25.19% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 5 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 30 Duration: 7:24:50 31.01% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 6 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 56 Duration: 13:26:08 28.10% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 11 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 28 Duration: 7:38:26 31.96% Rate-related episodes: 0 Duration: 0:00 0.00% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 28 Duration: 7:38:26 31.96% Unreadable intervals: 0 Duration: 0:00 0.00% B. Criteria of 30 seconds and 100 microVolts (s20041.stb) Lead 0: Ischemic episodes: 17 Duration: 4:07:04 17.22% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 5 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 21 Duration: 5:21:32 22.42% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 6 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 38 Duration: 9:28:36 19.82% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 11 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 20 Duration: 5:37:56 23.56% Rate-related episodes: 0 Duration: 0:00 0.00% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 20 Duration: 5:37:56 23.56% Unreadable intervals: 0 Duration: 0:00 0.00% C. Criteria of 60 seconds and 100 microVolts (s20041.stc) Lead 0: Ischemic episodes: 13 Duration: 3:26:18 14.38% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 5 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 16 Duration: 3:49:54 16.03% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 6 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 29 Duration: 7:16:12 15.20% Rate-related episodes: 0 Duration: 0:00 0.00% Axis shifts: 11 Conduction-change shifts: 0 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 18 Duration: 4:42:58 19.73% Rate-related episodes: 0 Duration: 0:00 0.00% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 18 Duration: 4:42:58 19.73% Unreadable intervals: 0 Duration: 0:00 0.00% QRS ATRUTH ANNOTATIONS (s20041.atr) Total number of beats 109304 Normal beats 102834 Premature ventricular contractions 6427 Fusions of ventricular and normal beat 7 Supraventricular premature or ectopic beats 36