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Insufficient Knowledge Interpreting
Twelve Leads Electrocardiogram among
Physicians of a Rural Hospital

Zapata, Mario; Vargas, Regina.

San Carlos Hospital, Province of Nuble, Chile

Introduction: Emergency physicians must be capable of properly diagnose and handling the most common cardiac emergencies, such as cardiac arrhythmia and acute myocardial infarction. The twelve-lead electro-cardiogram (EKG) is essential in the diagnostics of cardiac pathology. It has been presumed that rural hospital physicians have little experience in properly diagnosing them based on this EKG.

Objective: To assess the ability of physicians in San Carlos Hospital of correctly interpreting this type of EKG, excluding internists and cardiologists. This includes evaluating normal EKG as well as those revealing conduction abnormalities (CA), cardiac arrhythmia (ARR) and myocardial infarction (MI)

Method: Fifteen physicians (non-specialist) are surveyed anonymously by assigning them demographic data and auto-perception (AP) of correct diagnostic of pathology's EKG. They are asked to recognize 10 different EKG traces (ET) abnormalities taken from a textbook. The results are expressed as a percentage of correct answers and they are analyzed in terms of the difference of the proportions between AP and ET considering to be significant a p<0,05.

Results: 73% of the physicians are males, mean age of 39, with an average of six years in the hospital emergency room. None of them received training in interpreting an EKG. Of these physicians 56% believe to have made the correct diagnostics of an abnormal EKG, but only 27% is actually correct. By pathology categories, 42% of MI, 71% of ARR and 33% of CD of the cases, are diagnosed correctly. And TE was correctly recognized 18%, 27% and 20% respectively.
In relation with specific cardiac pathological cases, their perception of correctly diagnosing acute transmural myocardial infarction, ventricular tachycardia and complete atrio-ventricular block respectively were 53%, 80% and 33%. While their perception of correct diagnosis were 20%, 33% and 7% respectively.

Conclusions: There are important and meaningful deficiencies in properly recognizing cardiac pathology via ECG analysis in an emergency situation. This fact is easily explained by the lack of proper training of the staff in ECG interpretation.



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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
Dr. Raúl Bretal
Scientific Committee
Dr. Armando Pacher
Technical Committee - CETIFAC

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