EVALUATION OF ELECTROCARDIOGRAM IN PATIENTS ATTENDINGMEDICINE OUT PATIENT DEPARTMENT IN A TEACHING HOSPITAL IN WESTERN INDIA

Abstract

INTRODUCTION: The Electrocardiogram (ECG)as an investigation of the cardiovascular system with established diagnostic and prognostic value, is easy to perform, has low cost and great clinical utility. The 12-lead electrocardiogram (ECG) is a widely available and a time-tested modality showing the electrical activity of the heart and contributes significantly to identifying heart related diseases in both symptomatic and asymptomatic individuals. ECG abnormalities are found to be predictors of silent ischemia and other cardiovascular disorders in asymptomatic persons. There is ample evidence to show that ECG abnormalities can occur in asymptomatic individuals. If picked up early, appropriate interventions can be life-saving.

MATERIAL AND METHODS: ECG was performed on the patients attending Out Patient Department (OPD) of our medicine department. A total of 355 patients without any prior history of cardiovascular symptoms and whose clinical evaluation showed no cardiopulmonary involvement or any major co-morbidities were randomly selected and underwent 12 lead ECG recording. Standard criteria were used for the interpretation of ECGs. All possible number of abnormal findings was recorded per ECG.   ECG findings were analysed and divided into broad categories with impact on patient management: like Normal ECG, , abnormalities of rate, abnormalities of rhythm, abnormalities of QRS axis, chamber hypertrophy, bundle branch blocks, IVCD(Intraventricular Conduction Delay),  ST–T-wave changes, either non-specific, or suggestive of ischaemia or infarction, PR interval, QT interval and others. Socio-demographic data like age, sex, socioeconomic status (SES), social background, and occupation and smoking habits was collected.

RESULTS: Of the 355 patients enrolled in the study 23 (6.47%) patients had abnormalities in their ECG findings. No patients were earlier diagnosed for hypertension or diabetes or any other cardiovascular illnesses. The average mean age of the patients was 48±21.42. Of the total 355 enrolled patients 183 (51.54%) were male and 172 (48.45%) were female. Mean age of male patients was 49±22.87 and female patients was 46±19.54. The age range was 18-71 years. There were 243 patients up to age of 40 years and 112 were above the age 40 years.  No female was smoker while 28 out of 183 (15.3%) males gave a positive history of smoking. Out of 183 males 19 (10.38%) were having positive history of CAD(Coronary Artery Disease) in the family while out of 172 females 14 (8.14%) gave positive history of CAD in the family. Out of 23 patients showing abnormal ECGs 15 (65.21%) were males and 8 (34.78%) were females. Thus, overall 15 out 183 males (8.2%) and 8 out of 172 females (4.65%) showed abnormal ECGs. Sinus bradycardia was seen in 19 (5.35%) subjects, out of which 15 were males.  RBBB was seen in 2 (0.56%) and both were males. ST-T changes were seen in 16 (4.5%), out of which 10 were females.  4 out of 16 subjects with ST-T changes were attributable to ischaemia. Also, 13 out of 16 patients with ST-T changes were above the age of 40 years (P value 0.0001).Prolonged QT was seen in 6 (1.69%) out of which 5 were above the age of 40 (P value 0.0005).

 CONCLUSION: Sinus bradycardia and RBBB were common amongst males, while sinus tachycardia and non-specific ST-T changes were common amongst females. Prolonged QT and ST-T changes were common above the age of 40.The interpretation of ECG is important in managing patients. Patients with no symptoms or family history of CAD may show abnormal ECG pattern. Compared with women, men tend to have more abnormalities on the resting ECG.