Guidelines for Optimal ECG Performance

Indications for ECG Performance

The American Heart Association recommends ECG as an integral part of initial evaluation for all patients with known or suspected cardiovascular disease 1
Cardiac abnormalities may be suspected based on symptoms, abnormal physical findings, previous abnormal ECGs, or other abnormal laboratory studies, according to the American College of Cardiology 3
ECGs should be performed in patients receiving treatments known to produce ECG changes that correlate with therapeutic responses or disease progression, as stated by the American Heart Association 4
Serial ECGs are appropriate after initiation of drug therapy, changes in therapy, or addition of drugs that may interact and have cardiac effects, as recommended by the American College of Cardiology 5

Follow-up ECGs should be determined based on changes in symptoms, physical signs, growth or maturation, or laboratory findings, according to the American Academy of Pediatrics 5, 6, 7
Specific symptoms warranting repeat ECG include syncope and near-syncope, unexplained changes in angina pattern, new or worsening dyspnea, extreme fatigue, weakness, or prostration, and palpitations, as stated by the American Heart Association 1, 6, 7

A recent preoperative ECG is recommended for patients with known cardiovascular disease undergoing cardiac or noncardiac surgery, as recommended by the American College of Cardiology 7
Class I indication for preoperative ECG includes all patients with known cardiovascular disease or dysfunction, according to the American Heart Association 7

12-lead ECG is indicated soon after pacemaker insertion or revision, whenever pacemaker malfunction is suspected, after lead threshold maturation, and at periodic intervals throughout the lifetime of the device, as stated by the Heart Rhythm Society 4, 5, 8
Patients undergoing electrical or pharmacologic cardioversion should have ECGs just before the procedure, immediately after the procedure, and before hospital discharge, according to the American Heart Association 2, 5
After cardiac or extensive pulmonary surgery, serial ECGs are recommended until the condition stabilizes and before discharge, as recommended by the American Thoracic Society 6

Performing unnecessary ECGs in patients receiving therapy not known to produce ECG changes is discouraged by the American College of Cardiology 4