Guidelines for training in adult cardiovascular medicine. Core Cardiology Training Symposium (COCATS). Task Force 2: training in electrocardiography, ambulatory electrocardiography and exercise testing

The electrocardiogram in the primary care office

A 12-lead electrocardiogram (ECG) graphically displays the heart's electrical activity. It is the most common clinical tool for detection and diagnosis of heart disease, and is especially useful for detecting conditions related to abnormalities of cardiac rhythm. ECG should be considered in patients who have known cardiovascular disease or an increased risk for it. The responsibility for correctly interpreting an ECG lies with the physician, who should be able to recognize patient-dependent errors, operator-dependent errors, and artifact. Current ECG tracings should always be compared with previous tracings. Following a specific routine and methodical analysis of the data will ensure an accurate interpretation result. In the worst-case scenario, they can always be faxed or transmitted for inter-consultation with a more experienced reader.

[Spanish Society of Cardiology practice guidelines on ambulatory monitoring of electrocardiogram and blood pressure]

In the present paper, a historical review and a clinical up-date are done on two procedures of great medical interest: Holter electrocardiography and ambulatory blood pressure monitoring. Technical and methodological characteristics of each procedure are carefully exposed, emphasizing each the lack of an international agreement in order to establish regulations that make all the equipment homogeneous and reliable in order to increase both accuracy and reliability in diagnosis. Based on published international scientific documents and the personal experience of the authors, guidelines for clinical applications, indications and limitations of each technique are analyzed in relation to capacities of the Spanish political and social public health system profile. New concepts and dynamics of developments such as; dynamic QT, RR variability or pulse wave velocity are exposed, in the frame of the present time and future for improving efficiency and clinical application.