Electrocardiographic Findings in Adults Presenting to the Emergency Department With Abdominal Pain: A Descriptive Profile

Background To characterize the distribution of 12-lead electrocardiographic (ECG) findings among adults presenting to the emergency department (ED) with abdominal pain, and to explore whether clinically meaningful ECG abnormalities (e.g. ischemic changes, rhythm or conduction disturbances) are associated with patient demographics and ED outcomes. Methods This single-center observational study included 200 adult ED patients who presented with a chief complaint of abdominal pain and had at least one recorded 12-lead ECG during their ED stay. Data captured comprised demographics, comorbidities, laboratory results, ECG parameters, final diagnoses, and ED disposition/outcomes. Pre-specified clinical variables included the presence of intra-abdominal pathology, acute cardiac pathology, chronic kidney disease, coronary artery disease, HEART score, and troponin testing results. ECGs were evaluated for rhythm, PR interval, QTc interval, QRS duration, bundle branch block, frontal axis, poor R-wave progression, pathologic Q waves, and ST-segment and T-wave abnormalities. Statistical analyses used descriptive summaries, appropriate comparative tests, and multivariable logistic regression when applicable. Results The mean age was 50.23 ± 17.33 years; 46.0% were male (n = 92) and 54.0% were female (n = 108). Intra-abdominal pathology was identified in 22.5% (n = 45). Acute cardiac pathology was present in 1.5% (n = 3), chronic kidney disease in 1.0% (n = 2), and coronary artery disease in 6.5% (n = 13). HEART score distribution was: 0 (49.5%), 1 (28.5%), 2 (16.5%), 3 (5.0%), and 4 (0.5%). Troponin was positive in 5.0% (n = 10), negative in 54.0% (n = 108), and not obtained in 41.0% (n = 82). Sinus rhythm was the most frequent rhythm (81.0%, n = 162), followed by sinus tachycardia (12.5%, n = 25), sinus bradycardia (2.0%, n = 4), atrial fibrillation (3.0%, n = 6), and other rhythms (1.5%, n = 3). PR interval was normal in 94.5%, prolonged in 1.5%, and shortened in 4.0%. QTc was within normal limits in 98.5% and prolonged in 1.5%. QRS duration was normal in %98.5. Bundle branch block was observed in 4.0% (LBBB 1.0%, RBBB 0.5%, other 2.5%). Frontal axis was normal in 94.0%. Poor R-wave progression occurred in 1.0%, and no pathologic Q waves were detected. ST segments were normal in 85.5%, while ST-segment depression occurred in 14.5% (n = 29); no ST-segment elevation was reported. T waves were normal in 97.5%, with inversion in 2.5% (n = 5). Conclusion Among adults presenting to the ED with abdominal pain, clinically relevant ECG abnormalities are not uncommon and may uncover atypical presentations of acute coronary syndrome or clinically important cardiac comorbidity, thereby influencing immediate ED management. These findings support a low threshold for early and/or serial ECG acquisition and cardiac biomarker assessment, particularly in older patients and those with cardiovascular risk factors.