ECG doesn’t warn against heart attack

Two out of three heart attacks not detected by ECG at all or not soon enough.

Author: Christoph Fasel

Accuracy of the new cardiogoniometry method comparable to magnetic resonance imaging. Rolf K., head of a medium-sized corporation in Hagen, Germany, was scared. A doctor friend of his warned him about the possibility of heart problems. That was why he went and had an ECG screening exam (electrocardiography) performed. Afterwards, he called up his friend and reported that there was no longer any cause for alarm – the results came out “completely normal”. Two days later Rolf K. suffered a fatal heart attack.

Mohammad M. from the German city of Reinberg in Holstein had never before experienced cardiac complaints. The 47-year-old architect could hardly sleep because of strong pain in the chest. He went to visit his general practitioner. Tightness, discomfort in the chest, shortness of breath and chest pain are all warning signs of a possible heart attack. His GP took an ECG and, to be on the safe side, ran an additional lung function test. Both findings turned out normal, upon which the doctor sent the architect home with some painkillers. But, the symptoms didn’t improve. So, the architect took the initiative and drove to a specialized heart center.
People with unspecified chest pain usually first consult their general practitioner. That is why the GP’s diagnosis plays a crucial role. But, new studies have revealed alarming findings: Only 30 percent of infarctions are detected by means of classic ECG – that means that previous infarction diagnostics are fraught wit a dangerously high error rate. Because, even if the ECG proves unremarkable, an infarction may still be present or imminent.
As with Mohammad M., the “classic” ECG conducted in the Cardiology Department did not produce any evidence of an impending heart attack. Fortune in misfortune: As it turned out, the cardiologists at the Bad Segeberg Cardiovascular Center – the biggest Cardiac Hospital in the Northern German Federal State of Schleswig-Holstein which treats thousands of patients a years – were currently putting a new diagnostic method through scientific testing. So, to be on the safe side, they also examined him by the method called cardiogoniometry (CGM). This new examination technique showed instantly that a heart attack was threatening. In fact, that is exactly what happened a few minutes later. Because the patient was already at the Cardiovascular Center, the doctors were able to open up the occluded vessel without losing any time. Our architect survived his heart attack without any complications or late sequelae.
Thanks to new therapeutic options, heart attacks can actually be managed very well these days. Nevertheless, each year, over 60,000 out of the around 210,000 new heart attack sufferers in Germany do not survive. According to leading heart specialists, the ECG, a method that has been in use for over 100 years, is one of the reasons for this.
In fact: the ECG has proven to be much less accurate in diagnosing heart attacks than patients and doctors would like to believe. The wake-up call for patients: ECG does not detect two out of every three heart attacks at all or not in time.
Since the time factor plays a particularly huge role in acute heart attacks, a clean bill of health given by the doctor after an unremarkable ECG finding might have fatal consequences – ranging from irreparable damage to the heart muscle to death of those affected. Around 50 percent of myocardial infarctions can be identified by blood tests, but often not until hours after the infarctions took place. The new method of CGM detects over 70 percent of all silent heart attacks and their precursors and is thus more than twice as accurate as conventional ECG. Like with ECG, electrodes are attached to the patient‘s skin for the CGM method – a total of five on the chest and back. The computer takes the myocardial signals measured and converts them into a three-dimensional graphic image that shows if any lesions are detectable on the  yocardial (heart muscle) tissue. That way, it can predict an impending heart attack, angina pectoris and even ischemia (deficient blood flow to the heart).
CGM is simple and can be used anywhere and also features safe handling for patients with disabilities and physical limitations. CGM produces its findings within twelve seconds. As the first multicenter study was presented at the 2010 European Cardiology Society’s Conference in Stockholm, the results caused a furor.
But more: “To our great surprise, observations have shown a very high correspondence between the fast yet affordable CGM, on the one hand, and the highly sophisticated magnetic resonance imaging on the other,” reported one of the lead clinical investigators. “This holds great promise for the future of cardiogoniometry.“ With that, every general practitioner would be put in a position to identify with high accuracy the hallmarks of impending heart disease – and, by doing so, give their patients life-saving treatment fast. But, they would also be able to rule out with certainty whenever their patients‘ complaints were not attributable to diseases of the heart.
The doctors at the participating heart centers believe that the main areas of application for CGM will especially lie in outpatient and rural settings, i.e., with general practitioners in particular. Doctors are expecting that CGM will offer an important decision-making tool for private practices. It is at this very early stage that the strategy is laid out as to whether a patient has to be referred to a hospital or will continue to be treated on an outpatient basis.
Rolf K. might still be alive today if his general practitioner had had a better diagnostic technique at hand than an ECG. Indeed, Architect M. was lucky. CGM saved his life.
Now, a new comparative study has shown that the accuracy of CGM is two-and-a-half times more accurate than the previously used ECG.

Original Source:
Die Welt