How reliable is ECG for predicting heart disease?

Not much, according to Dr. K K Aggarwal, president of the Heart Care Foundation of India and senior national vice-president of the Indian Medical Association, who is also a Padma Shri, Dr. B C Roy National and DST National Science Communication awardee. He believes that doing an ECG is not of much use in predicting future heart problems for people who are examined because of chest pain.

The most common reason for people to seek medical attention for possible heart trouble is chest pain the common test for them is an electro-cardiogram (ECG). Yet, the ECG can be normal in the first six hours even in out-and-out heart attacks. Missing the diagnosis of a heart attack on ECG is one of the commonest mistakes made in medical emergency rooms.

The most important parameters still remain the classical history and physical findings:
⦁ If a chest pain can be pinpointed by a finger, it is not a heart pain.
⦁ If the pain lasts less than 30 seconds, it is not a heart pain.
⦁ If the pain is diffuse in the center of the chest and lasting more than minutes and manifesting as heaviness, burning, discomfort, heaviness or pain often precipitated by physical or mental exertion.
If in doubt, one can do an exercise stress test and, if it is negative, the patient should be reassessed for risk factors.

If the patient is at high risk, then even with a negative treadmill test result, he or she should undergo risk-reduction management for prevention of future heart attacks.

High risk patients are those who smoke, have high blood pressure, are obese, have high cholesterol and suffer from diabetes.

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