Despite being more than 100 years old, the ECG remains a critical tool for diagnosis and management across a variety of medical specialties. As highlighted by the top-performing GE Insights articles from 2022, continuing advances in ECG technology have further cemented its role in patient care.

Does Anxiety Cause Abnormal ECG Results?

The top performing article over all, entitled "Does Anxiety Cause Abnormal ECG Results?", continues to attract readers. The short answer to the question is yes, anxiety causes abnormal ECG results. This underscores the need for "increased diligence with ECG readings and assessing patient history for relevant risk factors when possible."

Anxiety has been associated with specific ECG abnormalities, with one study showing that patients with this mental health condition were less likely to have a T-wave inversion. Notably, this finding is the inverse of what has been seen in patients with depression. Some of the medications taken by people with anxiety have been associated with QT prolongation, too.

In this context, a thorough medical history that includes an assessment of mental health issues is a critical complement to the physical exam and ECG when it comes to patient care. If anxiety is present, the ECG interpreter should be cognizant of the potential impact on the readings, particularly if the patient is taking an anti-anxiety medication known to affect the QT interval.

Also, the article notes, clinicians should be aware that just the act of taking an ECG can induce anxiety in patients. This phenomenon takes on even greater importance as the world continues to cope with the effects of the COVID-19 pandemic, which has led to a heightened state of anxiety across the population.

COVID-19 and the Heart

While many are trying to move on from the pandemic as it approaches a fourth year, COVID-19 isn't going away. A variety of articles published in 2022 tackled the major impacts of the virus. One article, entitled "COVID-19 and the Heart: Will Infection Be a Lifelong Risk Factor?", delves into questions about the potential for cardiac damage and increased risk of stroke, heart failure, and myocardial infarction to linger for months or longer after recovering from the initial infection.

There are a lot of unknowns about so-called "long COVID," or post-COVID-19 heart syndrome, but it's likely that ECG will play a key role, along with other diagnostic modalities, in monitoring patients for cardiovascular issues post-infection.

Getting Doctors the Information They Need

Because of the continuing advancements in ECG technology, it's critical that clinicians stay up to date on how best to use the ECG for patient care.

ECG Matters Podcast

2022 saw the launch of the ECG Matters podcast, with the inaugural episode exploring how adoption of an ECG management system integrated into the electronic health record can improve ECG workflow when compared with a traditional paper-based approach. Focusing on one centre that made the switch, the episode details how employing this strategy dramatically shortens the time to complete ECG interpretation, minimizes errors in patient charts, lessens environmental impact by avoiding paper use, eases billing, and ultimately improves patient care.

Clinicians reading GE Insights recognize the crucial role of ECG when it comes to the day-to-day management of patients—and throughout 2022, they tended to gravitate toward "How To" articles about getting the best ECG readings in various clinical scenarios.

Best Practices for ECG Lead Placement on Women

In 2022, the article that garnered the most clicks was "Best Practices for ECG Lead Placement on Women." Incorrect lead placement can result in false negatives or false positives and take clinicians down the wrong diagnostic path in both women and men. That said, anatomical differences—breast tissue, for instance—may make this a more significant concern for women. The article discusses the nuances of placing leads on women and the risks of misplacing them and getting inaccurate readings.

"As sex-based disparities become more apparent in cardiovascular medicine, it will take widespread and consistent efforts in practice and in training to highlight opportunities for improvement, including opportunities that relate to ECG placement," the author notes.

Other popular instructional articles from 2022 dealt with unique considerations in children and teens ("How to Approach and Interpret Pediatric ECG") and best practices for evaluating the QT interval ("How to Measure and Assess a Long QT Interval"). The latter notes one of the advances of ECG technology that has made the test more reliable for clinicians over the years: automated interpretation.

ECG for Everyone

With an eye on the continuing advances in ECG technology and its importance when it comes to patient care, Anthony Kashou, MD, who is known as "The EKG Guy," makes the case for elevating ECG skills across specialties in "ECG for Everyone: Why All Clinicians Should Embrace Electrocardiography." Medical training, he says, is lacking in some ECG-related areas, including electrode placement, detection of abnormalities, and how results can change over time.

"It's difficult to imagine something more central to the practice of medicine than the performance and interpretation of the ECG," Kashou states. "It's a simple, rapid, and noninvasive diagnostic test and remains an important aspect of patient care across a variety of settings and specialties."

Advancements are ongoing in ECG hardware and software, including the development of artificial intelligence algorithms to ease interpretation and introduction of technology—such as consumer wearable devices—that allow for the recording of ECGs outside of clinical settings.

ECG interpretation is a tricky skill to acquire, but it's worth the effort due to the central role it plays in guiding clinical decision-making, Kashou argues.

He has a fitting message about the role of ECG that reflects both its long history and its potential for further advancements in 2023 and beyond. "Learning ECG is a lifelong journey," he says. "But if you do take the time to learn how to become comfortable interpreting ECGs independently, you will be a tremendous asset on any clinical team, and you might even save a patient's life."