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MEDICAL PROCEDURES

• What is an ECG?
• How is an ECG performed?
• What is measured or can be detected on the ECG?
• When is an ECG performed?
• What conditions may be diagnosed with an ECG?
• What are the limitations of the ECG?

What is an ECG?

The electrocardiogram (ECG or EKG) is a noninvasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart. By positioning leads (electrical sensing devices) on the body in standardized locations, information about many heart conditions can be learned by looking for characteristic patterns on the ECG.

How is an ECG performed?

ECG leads are attached to the body while the patient lies flat on a bed or table. Leads are attached to each extremity (4 total) and to 6 pre-defined positions on the front of the chest. A small amount of gel is applied to the skin, which allows the electrical impulses of the heart to be more easily transmitted to the ECG leads. The leads are attached by small suction cups, Velcro straps, or by small adhesive patches attached loosely to the skin. The test takes about 5 minutes and is painless. In some instances, men may require the shaving of a small amount of chest hair to obtain optimal contact between the leads and the skin.

What is measured or can be detected on the ECG?

1. The underlying rate and rhythm mechanism of the heart.
2. The orientation of the heart (how it is placed) in the chest cavity.
3. Evidence of increased thickness (hypertrophy) of the heart muscle.
4. Evidence of damage to the various parts of the heart muscle.
5. Evidence of acutely impaired blood flow to the heart muscle.
6. Patterns of abnormal electric activity that may predispose the patient to abnormal cardiac rhythm disturbances.

When is an ECG performed?

1. As part of a routine physical examination or screening evaluation.
2. As part of a cardiac exercise stress test.
3. As part of the evaluation of symptoms of chest pain, shortness of breath, dizziness or fainting , or palpitations .

What conditions may be diagnosed with an ECG?

1. Abnormally fast or irregular heart rhythms.
2. Abnormally slow heart rhythms.
3. Abnormal conduction of cardiac impulses, which may suggest underlying cardiac or metabolic disorders.
4. Evidence of the occurrence of a prior heart attack (myocardial infarction).
5. Evidence of an evolving, acute heart attack.
6. Evidence of an acute impairment to blood flow to the heart during an episode of a threatened heart attack (unstable angina ).
7. Adverse effects on the heart from various heart diseases or systemic diseases (such as high blood pressure , thyroid conditions, etc.).
8. Adverse effects on the heart from certain lung conditions (such as emphysema, pulmonary embolus (blood clots to lung), etc.).
9. Certain congenital heart abnormalities.
10. Evidence of abnormal blood electrolytes (potassium, calcium, magnesium).
11. Evidence of inflammation of the heart or its lining ( myocarditis , pericarditis ).

What are the limitations of the ECG?

1. The ECG is a static picture and may not reflect severe underlying heart problems at a time when the patient is not having any symptoms. The most common example of this is in a patient with a history of intermittent chest pain due to severe underlying coronary artery disease. This patient may have an entirely normal ECG at a time when he is not experiencing any symptoms. In such instances, the ECG as recorded during an exercise stress test may reflect an underlying abnormality while the ECG taken at rest may be normal.
   
   
2. Many abnormal patterns on an ECG may be non-specific, meaning that they may be observed with a variety of different conditions. They may even be a normal variant and not reflect any abnormality at all. These conditions can often be sorted out by a physician with a detailed examination, and occasionally other cardiac tests (e.g., echocardiogram, exercise stress test).
   
   
3. In some instances, the ECG may be entirely normal despite the presence of an underlying cardiac condition that normally would be reflected in the ECG. The reasons for this are largely unknown, but it is important to remember that a normal ECG does not necessarily preclude the possibility of underlying heart disease. Furthermore, a patient with heart symptoms can frequently require additional evaluation and testing.

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