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Critical Care Medicine

Computer-Estimated Heart Rate vs True Heart Rate—Be Aware of the Software

To identify the key insights or developments described in this article

1 Credit CME

JAMA Internal Medicine

Published Online: March 13, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Laszlo Littmann, MD, PhD¹

Author Affiliations

¹Department of Internal Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina

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A patient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock associated with liver cirrhosis, portal hypertension, and ruptured esophageal varices. Emergency treatment included balloon tamponade of the esophagus, blood transfusions, octreotide, and vasopressin. Despite fluid resuscitation and the use of pressors, the blood pressure continued to fall, and the kidney function progressively deteriorated. Computer interpretation of a 12-lead electrocardiogram (ECG) indicated supraventricular tachycardia with right bundle-branch block and right superior QRS axis (Figure, A). The interpretation software also reported frequent premature ventricular complexes. The patient’s baseline ECG recorded a few months earlier was normal.

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A patient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock associated with liver cirrhosis, portal hypertension, and ruptured esophageal varices. Emergency treatment included balloon tamponade of the esophagus, blood transfusions, octreotide, and vasopressin. Despite fluid resuscitation and the use of pressors, the blood pressure continued to fall, and the kidney function progressively deteriorated. Computer interpretation of a 12-lead electrocardiogram (ECG) indicated supraventricular tachycardia with right bundle-branch block and right superior QRS axis (Figure, A). The interpretation software also reported frequent premature ventricular complexes. The patient’s baseline ECG recorded a few months earlier was normal.

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Article Information

Corresponding Author: Laszlo Littmann, MD, PhD, Department of Internal Medicine, Atrium Health Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232 (laszlo.littmann@atriumhealth.org).

Published Online: March 13, 2023. doi:10.1001/jamainternmed.2022.6613

Conflict of Interest Disclosures: None reported.

References

Littmann L , Brearley WD Jr , Taylor L III , Monroe MH . Double counting of heart rate by interpretation software: a new electrocardiographic sign of severe hyperkalemia. Am J Emerg Med. 2007;25(5):584-586. doi:10.1016/j.ajem.2006.11.027 PubMed Google Scholar Crossref

Tomcsányi J , Wágner V , Bózsik B . Littmann sign in hyperkalemia: double counting of heart rate. Am J Emerg Med. 2007;25(9):1077-1078. doi:10.1016/j.ajem.2007.06.009 PubMed Google Scholar Crossref

Mizuno A , Niwa K . The Littmann sign: an indication of hyperkalemia. J Gen Fam Med. 2017;18(4):173-174. doi:10.1002/jgf2.46 PubMed Google Scholar Crossref

Freeman K , Feldman JA , Mitchell P , et al. Effects of presentation and electrocardiogram on time to treatment of hyperkalemia. Acad Emerg Med. 2008;15(3):239-249. doi:10.1111/j.1553-2712.2008.00058.x PubMed Google Scholar Crossref

Mattu A , Brady WJ , Robinson DA . Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000;18(6):721-729. doi:10.1053/ajem.2000.7344 PubMed Google Scholar Crossref

Durfey N , Lehnhof B , Bergeson A , et al. Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events? West J Emerg Med. 2017;18(5):963-971. doi:10.5811/westjem.2017.6.33033 PubMed Google Scholar Crossref

Rafique Z , Aceves J , Espina I , Peacock F , Sheikh-Hamad D , Kuo D . Can physicians detect hyperkalemia based on the electrocardiogram? Am J Emerg Med. 2020;38(1):105-108. doi:10.1016/j.ajem.2019.04.036 PubMed Google Scholar Crossref

Littmann L , Gibbs MA . Electrocardiographic manifestations of severe hyperkalemia. J Electrocardiol. 2018;51(5):814-817. doi:10.1016/j.jelectrocard.2018.06.018 PubMed Google Scholar Crossref

Littmann L , Bustin DJ , Haley MW . A simplified and structured teaching tool for the evaluation and management of pulseless electrical activity. Med Princ Pract. 2014;23(1):1-6. doi:10.1159/000354195 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.