Role of Electrocardiogram (EKG) in Kawasaki Disease

Primary Cardiac Assessment Strategy

The American College of Cardiology recommends echocardiography, not EKG, as the initial imaging modality for cardiac assessment in children with Kawasaki disease due to its high sensitivity and specificity for detecting abnormalities of the proximal coronary artery segments 2
The American Heart Association suggests that the initial echocardiogram should be performed as soon as Kawasaki disease is suspected, though treatment should not be delayed by the timing of the study 2
For uncomplicated cases, echocardiographic evaluation should be performed at diagnosis, at 2 weeks, and at 6-8 weeks after onset of disease, as recommended by the American College of Cardiology 1, 2

Guidelines from the American College of Cardiology/American Heart Association classify "most ECG abnormalities" as Class I indications for echocardiography in pediatric patients, reinforcing that EKG abnormalities should prompt echocardiographic assessment rather than serve as standalone diagnostic tools 3

The American College of Cardiology recommends obtaining an EKG as part of the initial evaluation for baseline documentation of cardiac electrical activity at diagnosis 3
The EKG may be used for monitoring for arrhythmias in patients with known myocarditis or coronary involvement, as myocarditis is universal in acute Kawasaki disease, according to the American Heart Association 2
Serial assessment with EKG may be performed in patients with documented coronary abnormalities or ventricular dysfunction requiring more frequent monitoring, as suggested by the American College of Cardiology 1, 2