From the Guidelines
An electrocardiogram (EKG) can be performed while sitting, as stated in the American Heart Association's recommendations for clinical exercise laboratories 1. The sitting position is acceptable for an EKG when a patient cannot lie flat due to breathing difficulties, mobility issues, or comfort concerns. However, the standard supine (lying down) position is generally preferred because it provides more consistent readings by minimizing muscle activity and movement artifacts that can interfere with the electrical signals. When performed sitting, the technician will still place the same 10 electrodes on the chest, arms, and legs to record the heart's electrical activity. The quality of the EKG may be slightly affected by the sitting position, as body position can influence the heart's orientation in the chest and potentially alter some aspects of the recording. Some key points to consider when performing an EKG on a sitting patient include:
- Recording the EKG in both the supine and standing (or sitting) positions to determine the presence of any ECG and/or hemodynamic abnormalities 1
- Ensuring the patient is at rest for at least 2 minutes or until a stable baseline is achieved before recording the EKG 1
- Informing the healthcare provider if the patient cannot lie down, so they can accommodate their needs while still obtaining useful diagnostic information about the heart's electrical function. It's worth noting that other guidelines, such as those from the American College of Physicians, focus on training and competency evaluation for interpretation of 12-lead electrocardiograms 1, but do not specifically address the position in which the EKG is performed. Therefore, the recommendation to perform an EKG while sitting is based on the most recent and relevant evidence from the American Heart Association 1.
From the Research
EKG Positioning
- EKG can be done in various positions, including sitting, as studies have shown that the position of the patient during the ECG recording does not significantly alter the components of the ECG curve 2.
- A study published in the Journal of Electrocardiology found that comparisons of sums of P waves and QRS complexes of various combinations of ECG leads from recordings in different positions and amplitudes of Q, R, and S waves of all 12 ECG leads revealed stability in the standard and stress ECGs, although few statistically significant but minor changes were noted in some comparisons 2.
- Another study found that Frank-lead electrocardiograms recorded from adult males with suspected coronary artery disease showed significant differences between supine and sitting positions, with QRS spatial amplitudes and R amplitudes in lead z being higher and R amplitudes in lead y being lower for sitting than for supine positions 3.
Clinical Implications
- The findings of these studies suggest that EKG can be performed in a sitting position, which may be more convenient for patients and healthcare providers in certain situations 2, 3.
- However, it is essential to consider the specific clinical context and the patient's condition when deciding on the position for the EKG, as some studies have highlighted the importance of recording the ECG in the same postural position as that maintained during exercise 3, 4.
- The use of EKG stress tests has been updated in recent guidelines, which emphasize the importance of interpreting the results in a multivariate manner and providing a low, intermediate, or strong probability of the existence of coronary lesions 5.