In primer cardiovascular prevention the
ECG monitoring gives a valuable tool detecting ST-segment depression
or elevation (silent ischemia), or rhythm disturbances. After
a cardiological event (stable angina pectoris, after myocardial
infarction) the ECG follow up - between the regular cardiological
checking - should be done.
The internet-ECG would play a special roll in the managed care.
For example, one type of managed care is the health maintenance
organization [HMOs]. These are organizations where users select
a primary care physician from doctors belonging to the HMO group.
Typically, these organizations require patients to consult their
primary care physician before receiving specialized care of any
sort. With each visit, the patient typically makes a minor co-payment.
One of the ways through which HMOs reduce their cost is by eliminating
paperwork and encouraging preventive medicine. The ECG-based
telemedicine cardiology gives a valuable tool for this.
The role of the clinical electrocardiography by the aspect of
general practitioners could be summarized:
The 12-lead ECG:
- Serve as an independent marker of myocardial
- May reflect electrophysiologic, anatomic,
metabolic, and hemodynamic alterations,
- May provide information that is essential
for the proper diagnosis and therapy of a variety of cardiac
- Is without equal as a noninvasive method
for the diagnosis and treatment of arrhythmias.
- Is the procedure of first choice in patients
presenting with chest pain, dizziness, or syncope (symptoms that
may be predictive of sudden death or myocardial infarction).
Electrocardiographic abnormalities also
- The first indicators of life-threatening
side effects of drugs or of severe metabolic or electrolyte disturbances,
- The only sign of myocardial disease such
as, for example, "asymptomatic" myocardial infarction
in the aged.
The long-term electrocardiographic methods
include the Holter- and event-recordings. The indications of
these methods are:
- Suspected rhythm disturbances (syncope,
near syncope, dizziness, palpitation)
- Arrhythmia risk assessment (Post-MI patients,
- Efficacy of antiarrhythmic therapy (supraventricular
and ventricular rhythm disturbances)
- Pacemaker function assessment
- Myocardial ischemia monitoring.
It is important to know the ACC/AHA recommendation:
Before an ECG can have proper diagnostic accuracy and clinical
usefulness, a skilled physician is required to compare it with
previous tracings and, particularly, to integrate clinical data
and provide a differential diagnosis.
In recent years, computers have become an integral part of some
ECG systems. No computer program for ECG interpretation can replace
the interpretation provided by a skilled physician. An incorrect
ECG diagnosis can have significant undesirable medical and legal
In our telemedicine system the stored short- or long-term ECG
recordings are transmitted via the Internet to a remote data
storage device, from which they can be retrieved by a skilled
cardiologist for interpretation and for consultation with the
patient and/or the general practitioner.