Electrocardiografie in de huisartsenpraktijk

Chan cm, willemsen rta, konings kts. Electrocardiography in general practice. Huisarts wet 2014:57(4):196–200. While an electrocardiogram (ecg) is often recorded in general practice, its usefulness and accuracy strongly depend on the indication – an ecg is often only useful if it is recorded at the moment the patient experiences symptoms, and for some indications it is not useful at all.there are five indications for which it is useful to make an ecg in general practice. (1) an ecg should be made in patients with an irregular pulse or other signs of possible atrial fibrillation, in order to confirm the diagnosis. It is useful to monitor the pulse whenever blood pressure is recorded, and to make an ecg if the pulse is irregular. (2) in patients with symptoms that raise suspicion of a heart rhythm disorder, an ecg can confirm or exclude the disorder, but only if the ecg is made when symptoms are present. (3) an ecg is always indicated for bradycardia, if it can be made. (4) a resting ecg can provide prognostic information and serve as basis for exercise testing in patients with stable angina pectoris. (5) suspected heart failure can be excluded as diagnosis if the ecg is normal, and an abnormal ecg can help establish the underlying problem. In a later phase, the ecg can be used to detect progression or identify new problems.suspicion of acute coronary syndrome is not an indication to make an ecg, because normal ecg findings do not necessarily exclude the diagnosis. Ecgs and other investigations for the relatives of a person who died as a result of unexplained cardiac arrest should be performed in secondary care, not in primary care. Screening ecgs in patients with hypertension or in the context of preventing cardiovascular disease is of limited use, contrary to the recommendations of various international guidelines. Likewise, the screening of sportsmen and women in general practice is not advised – there is no evidence that it helps to detect potentially fatal disorders in an early stage, and a false-positive result places both general practitioner and sportsperson for a number of dilemmas.