Electrocardiography (ECG)

An ECG will be an essential first line investigation in many patients presenting to the ED with dyspnoea, particularly those in whom a cardio-respiratory or specifically cardiac pathology is suspected. This could be on the basis of:

  • An associated history of cardiac ischaemic chest pain in whom an ACS could underlie the presentation
  • Symptoms and signs of cardiac failure (e.g. pulmonary oedema) who may have an underlying acute myocardial infarction or old ischaemic changes – patients with cardiac failure rarely have a normal ECG
  • A presentation consistent with PE in whom ECG findings of right heart strain might support the diagnosis
  • Symptoms and signs suggestive of pericarditis complicated by cardiac tamponade
  • Symptoms and signs of COPD in whom the ECG might show signs consistent with cor pulmonale/pulmonary hypertension
  • Specific interpretation of the ECG is outside the remit of this session; other sessions discuss ECG interpretation generally and specific changes associated with various pathologies.