Difference in Clinical Recommendations for Various Clinical Contexts

CardioBird considers both ECG signals and submitted clinical information during analysis and interpretation.The following guideline takes single, isolated PACs (Premature Atrial Contraction) as an example, showing how clinical recommendations vary under different clinical contexts. 

 

Scenario 1: General Health Check (Ax)

When the system is marked as a general health check, and the patient has no clinical symptoms and no audible heart murmur, the appearance of a single PAC on ECG is generally interpreted as follows: 

• It may be considered a physiological variation, possibly due to sympathetic activation or stress. However, potential cardiac causes, such as atrial enlargement or rare conditions like atrial cardiomyopathy, should not be excluded.
• It is recommended to supplement with physical examination findings, including auscultation, pulse synchronization, and blood pressure measurement. 
• If there is concern, further diagnostics may be considered, such as thoracic radiographs, echocardiography, comprehensive bloodwork, cardiac biomarkers (cTnI and NT-proBNP), or Holter monitoring. 
• If these evaluations do not identify an underlying cause, and resources are available, atrial mapping may be considered to assess for regional ischemia or fibrosis.  

 

That said, in most asymptomatic cases, observation and follow-up are sufficient. Without Holter results, no treatment plan would typically be initiated.

 

Scenario 2: Pre-Anaesthetic Check (PAC)

If the same PAC (Premature Atrial Contraction) is detected during a pre-anaesthetic ECG, clinical decision may differ significantly: 

• The PAC may be considered a potential anaesthetic risk factor. If the procedure is elective (e.g., dental prophylaxis), it is advisable to postpone surgery and investigate possible underlying causes, such as atrial enlargement, cardiac disease, or systemic conditions. 
• If the hospital lacks access to a cardiologist or the resources (medications, equipment) to manage arrhythmias, referral should be considered. 
• If the surgery is urgent, and anaesthetic risk is inherently high, the presence of PACs further increases intraoperative risk. In such cases, thorough discussion with the pet owner is essential, and surgery should only proceed if the facility has appropriate resources (e.g., anesthesiologist, medications, emergency support). Otherwise, referral is strongly recommended.  

 

In this context, even a single PAC should not be dismissed and may necessitate changes to the surgical plan.

 

Scenario 3: Cardiac Tracking (TRK)

When the case is marked as “tracking,” the significance of a single PAC must be interpreted in the context of the patient’s cardiac history: 

• If this is the first occurrence of PACs in a patient with known cardiac disease (e.g., MMVD), the clinical relevance depends on whether the atria are enlarged. 
• In hospitalized patients being monitored after treatment for malignant arrhythmias, a single PAC may indicate improvement (e.g., transitioning from SVT or VT to APCs).
• For patients already on antiarrhythmic medication, holter monitoring or repeated ECG measures is recommended to assess whether the treatment has improved the rhythm. Comparison with the pre-treatment ECG is essential. 

 

In this context, the PAC serves as a dynamic marker of treatment response or disease progression.

 

Summary of Recommendations 

The clinical interpretation of the same ECG waveform can differ greatly  depending on the selected context at submission:

Evaluation Context	Clinical recommendation	Impact on Clinical decision
General Health Check(Ax)	Observation follow-up  further workup if  clinically indicated	Follow-up recommended
Pre-Anaesthetic Check (PAC)	Postpone elective surgeries for urgent procedures, inform owners of elevated  risk and evaluate facility capabilities. Refer if necessary	May change anaesthetic plan
Cardiac Tracking (TRK)	Assessment of treatment response or disease progression	May alter medical management