Body position effects on the ECG: implication for ischemia monitoring. Adams, M. & Drew, B. j-JE, 30(4):285–291, October, 1997.
bibtex   
@Article{RSM:Ada97,
  author =       "M.G. Adams and B.J. Drew",
  title =        "Body position effects on the {ECG}: implication for
                 ischemia monitoring.",
  journal =      j-JE,
  year =         "1997",
  month =        oct,
  volume =       "30",
  number =       "4",
  pages =        "285--291",
  robnote =      "Rotation of the heart in relation to surface
                 electrocardiographic (ECG) electrodes when a patient
                 turns to one side has been reported to cause ST-segment
                 shifts, triggering false alarms with continuous
                 ST-segment monitoring. We prospectively analyzed
                 ST-segment and QRS complex changes in both standard and
                 derived ECGs in 40 subjects (18 with heart disease and
                 22 healthy) in supine, right- and left-lying positions.
                 Of the 40 subjects, 6 (4 cardiac, 2 healthy) developed
                 positional ST deviations of 1 mm or more on the
                 standard ECG. In the derived method, five of the same
                 six subjects showed ST-segment deviation of which most
                 occurred in the left-lying position. Positional ST
                 changes were most frequent for males and for cardiac
                 patients (33\%). Changes in QRS complex morphology were
                 common on the standard (28 of 40, 70\%) and less
                 frequent on the derived ECGs (17 of 40, 43\%),
                 occurring in both healthy and cardiac subjects. QRS
                 axis changes occurred only on the standard ECG. It was
                 concluded that (1) right and left side-lying positions
                 frequently induce clinically significant ECG changes;
                 (2) positional ST-segment deviation is less frequent
                 than previously reported and is most likely to occur in
                 males with cardiac disease; and (3) the derived method
                 is less prone to positional QRS changes than the
                 standard ECG.",
  bibdate =      "Sat Mar 8 12:59:53 2008",
}

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