electrocardiogram (ECG, EKG)
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Introduction
A graphic record of the electrical activity of the heart, obtained with an electrocardiograph.
Indications
- new symptoms or changes in symptoms
- syncope, pre-syncope or cardiac arrest
- chest pain, possibly cardiac in origin
- change in usual pattern of angina pectoris
- acute pulmonary edema
- acute congestive heart failure
- post-thrombolytic chest pain
- new or worsening dyspnea
- unexplained weakness, fatigue or prostration
- unexplained cough or hemoptysis
- palpitations
- new signs or changes in signs
- worsening congestive heart failure
- bradycardia, tachycardia, irregular pulse or new onset of cardiac arrhythmia
- post-thrombolytic hypotension
- unexplained hypotension in an adult
- coma, altered mental status or CVA
- new murmur or friction rub
- new findings suggesting pulmonary hypertension
- poorly controlled hypertension
- valvular heart disease
- suspected drug overdose
- blunt chest trauma with precordial injury
- electrolyte abnormalities
- hypothermia
- renal failure
- diabetic ketoacidosis
- abnormal physical findings
- pre-operative management (general anesthesia)
- patients over 40 years, or
- known cardiac disease
- post event monitoring
- routine risk assessment in the elderly ?[4]
* most arrhythmias are intermittent & not recorded on a resting ECG[6]
Contraindications
- routine screening in the young people[5]
- routine screening in asymptomatic adults at low risk for cardiovascular events[6]*
* routine screening still common in low-risk patients[7]
- these patients underwent significantly more cardiac tests, with no evidence of benefit[7]
Procedure
Notes
- computer algorithms not always correct[3]
- ingestion of a single AA battery led to ECG findings consistent with acute ST-segment-elevation myocardial infarction in a 26-year-old prison inmate[8]
- EKG Interpretations: A Non-Cardiologist Must Know (video)[9]
More general terms
More specific terms
- ECG with modified leads
- microvolt T-wave alternans microvolt testing (MTWA)
- signal averaged electrocardiogram (SA-ECG)
Additional terms
References
- ↑ Diagnostic History & Physical Examination in Medicine, Chan & Winkle, Current Clinical Strategies, Laguna Hills, CA 1996
- ↑ Practial ECG Interpretation, Basic Electrocardiography & Cardiac Arrhythmias, T. Evans, M.D., UCSF, Ring Montain Press, 1998
- ↑ Jump up to: 3.0 3.1 Journal Watch 24(24):183, 2004 Bogun F, Anh D, Kalahasty G, Wissner E, Bou Serhal C, Bazzi R, Weaver WD, Schuger C. Misdiagnosis of atrial fibrillation and its clinical consequences. Am J Med. 2004 Nov 1;117(9):636-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15501200
- ↑ Jump up to: 4.0 4.1 Auer R et al. Association of major and minor ECG abnormalities with coronary heart disease events. JAMA 2012 Apr 11; 307:1497 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22496264
Greenland P. Should the resting electrocardiogram be ordered as a routine risk assessment test in healthy asymptomatic adults? JAMA 2012 Apr 11; 307:1530. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22496268 - ↑ Jump up to: 5.0 5.1 Maron BJ et al Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12-25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology. Circulation. Sept 15, 2014
- ↑ Jump up to: 6.0 6.1 6.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ Jump up to: 7.0 7.1 7.2 Bhatia RS, Bouck Z, Ivers NM et al. Electrocardiograms in low-risk patients undergoing an annual health examination. JAMA Intern Med 2017 Jul 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28692719
- ↑ Jump up to: 8.0 8.1 Giannasi G et al Acute ST-Segment Elevation From an Ingested Battery: A Case Report. Ann Intern Med. 2020. Nov 24, PMID: https://www.ncbi.nlm.nih.gov/pubmed/33226857 https://www.acpjournals.org/doi/10.7326/L20-1123
- ↑ Jump up to: 9.0 9.1 Schurmann P EKG Interpretations: A Non-Cardiologist Must Know Houston Methodist DeBakey Heart and Vascular Center https://www.vumedi.com/video/ekg-interpretations-a-non-cardiologist-must-know/