Electrocardiogram

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Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Procedure 5 More General Terms 6 Additional Terms 7 References

More Specific Terms

• intrinsicoid deflection (ID)
• signal averaged electrocardiogram (SA-ECG)

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

• elevated jugular venous pressure
• dependent edema
• hepatomegaly

• poorly controlled hypertension
• fever of unknown origin in patients with valvular disease
• suspected drug overdose
• blunt chest trauma with precordial injury
• electrolyte abnormalities
• hypothermia
• renal failure
• diabetic ketoacidosis

• abnormal physical findings

• cardiomegaly
• seizures
• congenital deafness
• carotid, cranial or abdominal bruit
• increased intracranial pressure

• pre-operative ( general anesthesia)

• patients over 40 years, or
• known cardiac disease

• routine risk assessment in the elderly ? [4]

Procedure

• voltage calibration: 10 mm = 1 mV
• time calibration: 1 mm = 40 msec, 25 mm/sec
• computer algorithms not always correct [3]

More General Terms

• cardiology
• electrophysiologic measurement

Additional Terms

• cardiac (ECG) monitor
• ECG changes in myocardial ischemia
• ECG J point
• ECG lead
• ECG p wave
• ECG PR interval
• ECG QRS complex
• ECG ST segment
• ECG T wave
• electrical alternans
• electrocardiogram (ECG) axis
• HOLTER
• signal averaged electrocardiogram (SA-ECG)

References

1. Diagnostic History & Physical Examination in Medicine, Chan & Winkle, Current Clinical Strategies, Laguna Hills, CA 1996
2. Practial ECG Interpretation, Basic Electrocardiography & Cardiac Arrhythmias, T. Evans, M.D., UCSF, Ring Montain Press, 1998
3. 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: [1]
4. Auer R et al. Association of major and minor ECG abnormalities with coronary heart disease events. JAMA 2012 Apr 11; 307:1497 PMID: [2]
   - 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: [3]
5. National Guideline Clearinghouse
   - Recommendations for the standardization and interpretation of the electrocardiogram. Part I: the electrocardiogram and its technology. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. ngc-guideline: [4]

electrocardiogram (ECG, EKG)