Indications for EKG in Non-Cardiac Conditions

Preoperative Evaluation

The American Heart Association recommends that all patients over 40 years old should have a preoperative EKG, even without suspected cardiac disease 2, 3
Patients being evaluated as donors for heart transplantation or recipients of non-cardiopulmonary transplants should have preoperative EKGs, as recommended by the American College of Cardiology 2, 4
Preoperative EKGs are not indicated for patients under 30 years old with no risk factors for coronary artery disease, according to the American Heart Association 2, 5

EKGs should be performed to assess therapy with medications known to produce cardiovascular effects, such as antineoplastic drugs and psychiatric medications, as recommended by the American College of Cardiology 6, 7
Medications that alter serum electrolyte concentrations, such as diuretics, require EKG monitoring, according to the American Heart Association 6, 7

The American College of Cardiology recommends that patients with symptoms such as syncope or near-syncope, new or worsening dyspnea, extreme and unexplained fatigue, weakness, or prostration, and palpitations should have an EKG 1, 8
Patients who may have received an overdose of illicit drugs known to have cardiac effects should also have an EKG, as recommended by the American Heart Association 7

Periodic follow-up (every 1-5 years) is appropriate for patients at increased risk for developing cardiac disease, according to the American College of Cardiology 1, 8

Baseline EKG is recommended for asymptomatic persons over 40 years of age, as recommended by the American Heart Association 2, 4
Some guidelines recommend a baseline EKG at age 20 years with repeats at ages 40 and 60 years, according to the American College of Cardiology 6, 9

Ordering "routine" EKGs without clinical indication increases healthcare costs without improving outcomes, as noted by the American College of Cardiology 3, 5
Failing to compare with previous EKGs when available may result in misinterpretation of chronic findings as acute, according to the American Heart Association 3