Rest Electrocardiogram - ECG

 

Electrocardiogram: (ECG) A non-invasive test that records the heart’s electrical impulses. An ECG can identify abnormalities in heart rate and rhythm,

and it can help to establish whether the heart muscle is receiving enough oxygen.

 Resting ECG has low sensitivity in screening asymptomatic people for CHD, (Pignone 2003)

 Because of the limited sensitivity of the resting ECG and the low prevalence of disease in asymptomatic adults, a majority of CHD events will occur among persons with an initially normal ECG) (Sox 1989).

 The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. 

(USPSTF 2012)

 

International standards

  1. Offshore; further tests may be performed at the doctor's discretion, e.g. blood tests, ECG and spirometry.

  2. (Norwegian Directorate of Health 2012)

c-     Offshore; Further investigations (e.g. blood tests, ECG, spirometry) may be required to clarify clinical findings but are not a routine.

 (UK Offshore Oil and Gas 2008)

d-    Offshore; Further testing (for example Hemoglobin A1C, stool culture, EKG, CXR), may be required to clarify clinical findings or because of particular job requirements, for example catering personnel, crane operators and fire team members.

(GoM BP 2012)

 

e-     Firefighters, Electrocardiograms (EKG). A resting 12-lead EKG is required.

(NFPA 2012)

  1. Firefighters, ECG abnormality that suggests ischaemic disese considerd as category B(conditions indicates that a more detailed medical assessment is required). (AFAC 2006)

g-     Divers, ECG is required for initial pre-emp, for annual medical, it is required for aged 40 years, then 5 yearly.

(HSE UK, MA1, 2011)

h-    Hazardous Occupations, Workers with poor effort or tolerance, or with history of unstable angina, may have difficulty doing strenuous exercise and carrying the heavy air-supplied respirators. Where indicated, lung function tests and stress ECG can be carried out.

(Hong Kong 2004)

i-       OSHA Standard; Hazardous Waste Operations and Emergency Responses (HAZWOPER): ECG is required for HAZMAT team members and emergency response team (OSHA, 2009).

j-       Commercial driving; ECG is required for initial pre-emp (UK DVLA 2014).

An electrocardiogram (ECG) should be performed if clinically indicated (Austroads 2012).

 

Suggested indications: Baseline test for high effort’s job (fire fighters and offshore...) not recommended for office based employees.

 

References

  1. Pignone M, Fowler-Brown A, Pletcher M, Tice JA. Screening for Asymptomatic Coronary Artery Disease: A Systematic Review for the US Preventive Services Task Force, Systematic Evidence Review No 22. Rockville, MD: Agency for Healthcare Research and Quality; 2003. [15 August 2011]. Accessed at http://www​.ncbi.nlm.nih​.gov/books/NBK42804/

 

  1. Sox HC Jr, Garber AM, Littenberg B. The resting electrocardiogram as a screening test. A clinical analysis. Ann Intern Med. 1989;111:489-502.
  2.  
  3. USPSTF , Final Recommendation Statement, Coronary Heart Disease: Screening with Electrocardiography, July 2012. 
  4. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/coronary-heart-disease-screening-with-electrocardiography
  5. Guidelines - health requirements for persons working on installations offshore. Norwegian Directorate of Health 2012.
  6. Medical Aspects of Fitness for Work Offshore ( 2008 The United Kingdom Offshore Oil and Gas)
  7. GoM Medical Aspects of Fitness for Offshore Work Safety Work Practice (BP 2012)
  8. NFPA 1582, Chapter 6 Medical Evaluations of Candidates - 2012
  9. Australasian Fire Authorities Council (AFAC) Medical Guidelines for Firefighters, 2006
  10.  
  11. HSE UK, The medical examination and assessment of divers (MA1) 2011, http://www.hse.gov.uk/Diving/ma1.pdf
  12. Doctors’ Guide to Medical Examinations for Workers engaged in Hazardous Occupations in Industrial Undertakings - Occupational Safety and Health – 2004, Hong Kong.10- Screening and Surveillance: A Guide to OSHA Standards, 2009 https://www.osha.gov/Publications/osha3162.pdf
  13. At a glance Guide to the current Medical Standards of Fitness to Drive'. Drivers Medical Group, DVLA, UK, May 2014
  14. Austroads (2012) ASSESSING FITNESS TO DRIVE, for commercial and private vehicle drivers, ISBN: 978-1-921991-86-8