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Notify me of follow-up comments by email. Notify me of new posts by email. Been Medical Video Lectures Dr. Monday, November 22, Sign in. Powered by Blogger. Post Top Ad. John R. Hello readers..! To ensure user-safety and faster downloads, we have uploaded this. We hope that you people benefit from our blog! The ECG is a basic and valuable tool in the investigation of cardiac problems, and it can be helpful in the case of non-cardiac problems too, but it must always be viewed in the context of the patient from whom the record came.
The ECG must never be a substitute for taking a proper medical history and carrying out a careful physical examination. Because it is simple, harmless and cheap, the ECG is usually the first investigation in a patient with possible cardiac disease and it may be followed by the plain chest X-ray, the echocardiogram, radionuclide studies, CT and MR imaging, and cardiac catheterization and angiography — but none of these are substitutes. The ECG, a recording of the electrical activity of the heart, gives information that can be obtained in no other way.
However, even though it is irreplaceable, it is not infallible. ECGs are recorded from a wide variety of patients, in an attempt to help with a wide variety of possible diagnoses.
It can not be assumed that individuals who present themselves for screening are asymptomatic — the process may be being used as a substitute for a consultation with a doctor.
The ECG itself may cause difficulties of interpretation, for there are a dozen or more normal variants. Minor abnormalities, such as nonspecific ST segment or T wave changes, will have diagnostic and prognostic significance if the individual has symptoms that may be cardiac in origin, but these changes can be of no importance in totally healthy people. It is rare for an ECG to demonstrate anything of importance in a totally healthy individual, although in athletes the detection of abnormalities suggesting asymptomatic hypertrophic cardiomyopathy is important.
In patients with chest pain, the ECG is important but sometimes misleading. It is essential to remember that the ECG can remain normal for some hours after the onset of a myocardial infarction. Under such circumstances the ECG should be repeated several times to see if changes are appearing, and patient management should depend on the plasma troponin level rather than on the ECG.
Nevertheless the ECG is important for deciding treatment in a patient with chest pain, for the management of a patient with myocardial infarction with ST segment elevation is quite different from that of a patient whose ECG shows a non-ST segment elevation infarction.
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