Overview

Indications

Symptoms are the foremost indication of the ECG, including palpitation, dizziness, cyanosis, chest pain, syncope, seizure, and poisoning
Symptoms or signs associated with heart disease include tachycardia, bradycardia, and clinical conditions including hypothermia, murmur, shock, hypotension, and hypertension
To detect myocardial injury, ischemia, and the presence of prior infarction
Rheumatic heart disease[9]
ECG changes in cases like drowning and electrocution are very valuable in determining necessary interventions[10]
Detecting pacemaker or defibrillator device malfunction, evaluating their programming and function, verifying the analysis of arrhythmias, and monitoring for delivery of the appropriate electrical pacing in patients with defibrillators and pacemakers[11]
4. It indicates how well mechanical devices that are implanted in the heart, such as pacemakers, are working to control a normal heartbeat.
Evaluation of metabolic disorders
Helpful for the assessment of blunt cardiac trauma[12]
Cardiopulmonary resuscitation
Valuable aid in the study and differential diagnosis of congenital heart diseases[13]
Electrolyte imbalance and rhythm disorders[14]
To monitor the pharmacotherapeutic effects and adverse effects of drug therapy
Perioperative anesthesia monitoring, such as preoperative assessment and intraoperative and postoperative monitoring
Screening tool in a sports physical exam to rule out cardiomyopathy[15]

Contraindications

There are no absolute contraindications for an electrocardiogram. The relative contraindications to its use include:

Patient refusal
Allergy to the adhesive used to affix the leads

1. Diagnose of arrhythmias, conduction defects, chamber enlargement and hypertrophy, ischemia, infarction, pericarditis, valvular heart disease, cardiomyopathy, and hypertensive disease.

2. Reveal findings related to life-threatening metabolic disturbances (e.g., hyperkalemia) or increased susceptibility to sudden cardiac death (e.g., QT prolongation syndromes).

3. Monitor drug treatment (specifically antiarrhythmic therapy). It can indicate how well medicines(like what medicine?)are working and whether they are causing side effects that affect the heart.

+++++++++++++++++++++++++++

Routine EKG for Asymptomatic Patients is not indicated

"The USPSTF concluded with moderate certainty that screening ECG provides no net benefit to asymptomatic, low-risk patients," the guidance stated.

Guidelines from the American College of Cardiology and the American Heart Association suggest that a resting ECG is "reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes."

They also suggest that an exercise ECG "may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), particularly when attention is paid to non-ECG markers such as exercise capacity."

The USPSTF document also addressed the use of ECG to screen asymptomatic adults at intermediate or high risk, with the task force concluding that there is insufficient evidence to recommend for or against the practice.

The authors noted, however, that certain factors should be taken into account when a clinician is considering screening adults in those categories with ECG, including potential harms and preventable burden.

Individuals at intermediate risk, for example, likely have the greatest potential to derive a benefit from screening because getting placed into a higher risk category might lead to more intensive medical management that has been shown to lower the risk for coronary heart disease events.

Those already at high risk based on traditional cardiovascular risk factors, on the other hand, should already be receiving intensive management.

An individual's occupation can also be considered because screening might make sense for people whose sudden incapacitation or death could harm others, including pilots and heavy equipment operators.¹

References

1. http://www.medpagetoday.com/Cardiology/Prevention/33981?utm_

content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=

g546623d0r&userid=546623&email=scabellonjr@gmail.com&mu_id=

USMLE Reviewer

(By Subscription)