Pattern of Electrocardiographic Changes in Pre-operative check-up In Patients Undergoing ENT Surgery

Background: The 12-lead ECG is the primary clinical tool for non-invasive assessment of cardiac electrical function. Before any surgery, ECG is commonly used in pre-operative check-up. Therefore pre-operative check-up of large number of people can be a valuable tool for accurate estimates of the prevalence of ECG abnormalities of general population. Objectives: To observe the extent of ECG changes in a group of population undergoing ENT surgery and to describe the prevalence of changes in relation to age and sex. Methods: 704 consecutive adult stable patients were included between age of 20 – 60 years without previously diagnosed case of any other systemic diseases who came to this hospital for elective surgical procedures and were investigated with new ECG for pre-operative check-up in private Hospital between January 201 to December 2010. Results: Total number of ECG recordings were 704; out of them 479 were male & 225 were female. Among 704 ECG recording 486(69.03%) were normal. The number of old myocardial infarction (MI) was in 36 cases (5.11%). Cardiac Ischaemia observed by ST depressions/T inversion was present in 15 cases (2.13%). Conclusion: The observation of the study is concludes that nearly 70% of all asymptomatic people (between 20 – 60 years) possessing normal ECG but Ischaemic changes (like Q wave/ST depression & T inversion/ LBBB) was present in about 8% cases. ECG changes of IHD (Ischaemic Heart Disease) increases with age and male groups at higher risk of developing IHD.


Study population:
Seven hundred and four consecutive patients who attended the Green Life Medical College Hospital for ENT consultation and recommended for elective operation from January 2010 to December 2010.
Every stable adult patients (between age of 20 -60 years) without previously diagnosed case of any other systemic diseases who came to this Hospital for ENT consultation & were selected for elective surgical procedures and was investigated with new ECG for pre-operative check-up (within two weeks before schedule date of surgery 4 ) in Green Life Medical College Hospital from January 2010 to December 2010 were included in this study.Age

Results:
Total number of ECG recordings was 704; out of them 479 were male & 225 were female.The male to female ratio was 2.13 : 1. Ages of the documented people were between 20 years to 60 years.Mean age was 36.63(+10.079 ).

Discussion:
There is not much observation regarding ECG in asymptomatic patients.The resting electrocardiogram has become an accepted part of routine clinical examination of asymptomatic patients.Certain occupational groups, however, are subjected to regular electrocardiographic screening in an attempt to detect cardiovascular problems which might predispose to sudden incapacitation while on duty.However, the sensitivity of resting ECG is not that much high 5,6 .In this study we want to see ECG changes in apparently healthy people undergoing surgery.The prevalence of minor ECG changes was slightly higher in men (10.4% vs 9.5% in women).The occurrence of ischaemia-like finding on the ECG was comparable between men and women (9.0% vs 9.8%) 7 .
Sinus tachycardia rarely leads to any symptoms and usually remits over time 8,9,10 .Sinus tachycardia and sinus bradycardia are not considered pathological until these are associated with cardiac abnormalities.But here in this study Sinus tachycardia and Sinus bradycardia were included without any other major ECG changes.
Zaman et al showed in their study, the prevalence of Ischaemic heart diseases (IHD) in Bangladesh defined by the presence of pathological Q wave on electrocardiogram or current medication for IHD was 3.4%; prevalence in men (4.6%) was almost twice than in women (2.7%) 11 .Here, in this study we found total MI & Ischaemia or presumed ischaemia in 51 cases (7.24%); among them 39 (5.54% of total sample) were male and 15 (2.13% of total) were female, and ratio was 2.6:1.That is slightly higher from previous observation.Considering LBBB for IHD the observation increases 8.5% which is in concordance with study done on elderly patients 12,13 .

Conclusion:
In conclusion electrocardiographic abnormalities are present in considerable number of patients without known concomitant systemic disease who underwent ENT surgery.Ischaemic heart disease or presumed IHD was also present in some of the patients.The prevalence of IHD in our study population found to be more among the male patients in compare to female patients and among the elderly patients in compare to young.Electrocardiogram done routinely in patients prior to ENT surgery seems to be of worth.

Fig.- 1 :
Fig.-1: Simple Bar Diagram showing Different ECG Changes limit was 20 to 60 years.Variables recorded include age & sex.No previous medical record has been considered for patients' selection.All samples were included before schedule date MultipleECG changes (like Bradycardia with inferior MI, Biventricular hypertrophy, RBBB with LVH) in single ECG, arrhythmia (other than RBBB, LBBB, and axis deviation, WPW syndrome etc, ECG that cannot be categorized in any of the previous category, were found in 12 (1.7%)recordings.
PVC (Premature ventricular contraction) was present in 13(1.85%)ECG; male female ratio was 3.33:1 Other ECG changes, like Ischaemia only suggested by the non-specific T wave inversion or ST depression,