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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

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
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2.
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.2007.06.009PubMedGoogle ScholarCrossref
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Mizuno  A , Niwa  K .  The Littmann sign: an indication of hyperkalemia.   J Gen Fam Med. 2017;18(4):173-174. doi:10.1002/jgf2.46PubMedGoogle ScholarCrossref
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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.xPubMedGoogle ScholarCrossref
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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.

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