Ventricular depolarisation vectors in exercise induced myocardial ischaemia

Ischaemia reduces membrane excitability and conduction of myocardial depolarisation. This would alter the synergy of electromotive forces that contribute to a resultant force at any instant. Changes in magnitude and direction of resultant forces are reflected in electrocardiographic signals. Here we show a method for obtaining the coordinates of resultant electrical forces during exercise derived from a bipolar orthogonal lead system for calculation of electrical vectors in three planes. In a trial, analysis of changes in vectors indicated that the extent of reduction in magnitude with exercise was significantly greater in groups of patients categorized by impaired effort tolerance and signs of ischaemia. Measurement of changes in the spectrum of depolarisation vectors during exercise has the potential for non-invasive assessment of myocardial ischaemia. This could be the basis of a portable, low-cost tool for investigation of patients with symptoms suggestive of coronary artery disease.