CyberECG use
in Primary Care

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 disease,
  • 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 disorders,
  • 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 may be:

  • 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, CHF, cardiolyopathies)
  • 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 consequences.
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.