Large General Medical Clinic

THE DIAGNOSIS OF ANGINA PECTORIS is frequently complicated by the absence of positive ECG findings. To diagnose these patients it is useful to have an ECG taken during the attack. With the conventional ECG equipment such a recording is almost impossible if the attacks are infrequent and last for short periods of time. In view of the potentially dire consequence of misdiagnosing angina pectoris, many expensive, invasive, and potentially hazardous diagnostic tests have been devised to assist in its diagnosis. The Holter equipment that records the patient's ECG for 24 hours and is similar to the Pocket Electrocardiograph (PECG)' has proved useful.2`4 To make accurate diagnosis of the cases in which there are episodes of palpitation, chest pain, or other varieties of cardiac attacks, the obtaining of an electrocardiogram during the episodes is indispensable. With this in mind, we have developed a pocket electrocardiographic recorder' which can be activated by the patient. The system best suited to this purpose involves the recording of the electrocardiogram with a magnetic tape cassette and its later reproduction for diagnostic examination. In the present study, we postulate that various kinds of cardiac attacks are accurately diagnosed by an ECG record taken during an attack. It should be recognized, however, that because the PECG uses a single modified V, lead, up to 10% of the true ischemic responses which could be detected by additional bipolar leads or a true X, Y, and Z axis system may be missed.5