The Use of Electrocardiography in the Emergency Department

Electrocardiograms can be useful in the emergency department setting when dealing with patients presenting with cardiac symptoms and signs. These include chest pain, syncope, palpitations, cyanosis, heart failure symptoms, and ingestions. Although the electrocardiogram may be helpful in identifying an underlying diagnosis, it may be normal in many cases and should be used as an adjunct diagnostic tool, not to be relied upon solely. Important diagnoses that can be made by electrocardiogram alone include supraventricular and ventricular arrhythmias, conduction system abnormalities such as heart block, and some channelopathies, such as long QT syndrome and Brugada syndrome. Caution must be taken in that, often, these diagnoses cannot be excluded even in the presence of a normal electrocardiogram (differing sensitivity for different diseases) and, often, incidental findings may occur in the absence of heart disease (nonspecific findings). Therefore, it is important to synthesize all data prior to coming to any conclusions.