What to Do If You Have Concerns About Your ECG Images
If you have concerns about your ECG, consult a physician qualified to interpret ECGs immediately, as computer-interpreted ECGs alone are insufficient for clinical decision-making and abnormal findings require expert evaluation to exclude potentially life-threatening cardiac disease. 1
Immediate Actions Required
Never rely solely on computer interpretation of your ECG. While automated ECG readings can be helpful, they require physician verification and interpretation to be considered valid medical documentation. 1 Computer algorithms have limitations—they may miss critical abnormalities or generate false-positive results that require expert correction. 2, 3
When to Seek Urgent Medical Attention
Obtain immediate physician evaluation if your ECG was performed in the context of: 1, 4
- Chest pain of any character
- Dizziness or syncope (fainting or near-fainting episodes)
- Palpitations or irregular heartbeat sensations
- Unexplained shortness of breath
- Extreme fatigue or weakness that is new or unexplained
These symptoms may indicate life-threatening conditions such as myocardial infarction, dangerous arrhythmias, or other cardiac emergencies that require immediate intervention. 1, 5
Understanding ECG Interpretation Accuracy
Physician expertise matters significantly. ECG interpretation accuracy varies widely by training level: medical students achieve approximately 42% accuracy, residents 56%, practicing physicians 69%, and cardiologists 75%. 3 This underscores why concerning ECG findings should be reviewed by the most experienced clinician available, preferably a cardiologist.
Computer vs. Physician Interpretation
- Computer-interpreted ECGs show 84% sensitivity but only 76% specificity for detecting abnormalities 2
- Physicians demonstrate 70% sensitivity but 86% specificity, meaning they are better at avoiding false alarms 2
- Critical caveat: Physicians sometimes incorrectly reclassify true abnormalities (identified by computer) as normal, particularly ST-segment deviations, T-wave inversions, and Q-waves 2
What Happens During Professional ECG Evaluation
Initial evaluation of any ECG abnormality should be performed under the direction of a cardiologist. 1 The evaluation process typically includes:
For Abnormal Findings
Depending on the specific ECG abnormality detected, your physician may order: 1
- Echocardiography to assess heart structure and function
- 24-hour ECG monitoring (Holter monitor) to detect intermittent arrhythmias
- Exercise stress testing to evaluate heart function under exertion
- Cardiac MRI (CMR) for detailed structural assessment
- Laboratory testing including electrolytes, cardiac biomarkers, and thyroid function
- Repeat ECG on a separate day to confirm findings
Specific High-Risk ECG Patterns Requiring Immediate Workup
Temporary restriction from athletic activity should be considered for athletes with abnormal ECGs of uncertain clinical significance until secondary investigations are completed. 1 High-risk patterns include:
- T-wave inversions ≥1 mm deep in two or more contiguous leads (excluding aVR, III, V1) 1
- ST-segment elevation meeting criteria for acute myocardial infarction 1, 5
- Prolonged QTc interval ≥500 ms, which may warrant direct referral to a heart rhythm specialist 1
- Brugada Type 1 pattern requiring immediate cardiology or electrophysiology referral 1
- Advanced heart block (2nd or 3rd degree atrioventricular block) 1
- Ventricular arrhythmias including couplets, triplets, or non-sustained ventricular tachycardia 1
Common Pitfalls to Avoid
Do not dismiss computer-identified abnormalities without expert review. General practitioners are effective at correcting false-positive computer interpretations but may miss true abnormalities, particularly subtle ST-segment changes, T-wave abnormalities, and pathological Q-waves. 2
Do not assume "normal" or "otherwise normal" computer interpretation guarantees absence of disease. While one study found 100% negative predictive value for STEMI with these interpretations in an ED triage setting 6, this applies only to immediate STEMI detection and does not exclude other significant cardiac pathology requiring evaluation.
Do not delay seeking care if you have cardiac symptoms, even with a reportedly normal ECG. The ECG has inherent limitations in sensitivity and specificity, and structural cardiac disease can exist despite normal electrical activity. 1
Documentation and Follow-Up
Ensure your ECG becomes part of your permanent medical record with proper physician interpretation documented. 1 If you have risk factors for cardiac disease (hypertension, diabetes, family history, smoking, hyperlipidemia) or take medications affecting cardiac function, baseline and periodic ECG monitoring may be appropriate even without symptoms. 1
For patients on cardioactive medications (antiarrhythmics, antipsychotics, certain antibiotics, antidepressants), systematic ECG monitoring is essential as these drugs can produce significant ECG changes including QT prolongation that may progress to fatal arrhythmias. 7, 8