title: Postoperative real-time electrocardiography monitoring detects myocardial ischemia: a case report.
abstract: OBJECTIVE
  This case report outlines the utility and challenges of remote continuous postoperative electrocardiography ECG) monitoring, which is routed through a secure smartphone to provide real-time detection and management of myocardial ischemia.
  
  
  METHODS
  A 42-yr-old male with previous myocardial infarction and angioplasty underwent a radical prostatectomy. At three hours and 45 min postoperatively, remote real-time ECG monitoring was initiated upon the patient's arrival on a regular surgical ward. Monitor alerts were routed to a study clinician's smartphone. About six hours postoperatively, alarms were received and horizontal ST segment depressions were observed. A 12-lead ECG validated the ST segment changes, prompting initiation of a metoprolol iv and a red blood cell transfusion. Approximately seven hours and 30 min postoperatively, the ST segments normalized. The patient was discharged on postoperative day 3 and followed for four years without any sequelae.
  
  
  CONCLUSIONS
  This case report illustrates the use of remote ECG monitoring and clinician response in real time with the use of a smartphone. With each alert, a small ECG strip is transmitted to the smartphone for viewing. In our view, this technology and management system provides a possible means to interrupt myocardial ischemic cascades in real time and prevent postoperative myocardial infarction.
authors.affiliation: Department of Anesthesia, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. hyang@toh.ca.
authors.forename: Homer
authors.identifier: http://orcid.org/0000-0003-1943-8857
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Anesthesia, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fayad
authors.affiliation: Department of Anesthesia, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Chaput
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Oake
authors.affiliation: Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.
authors.forename: Adrian D C
authors.initials: AD
authors.lastname: Chan
authors.affiliation: Department of Anesthesia, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Crossan
mesh_terms: D000328:Adult; D003199:Computer Systems; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D000068997:Smartphone