Silent Cardiac Irregularities: Prevalence and Patterns of ECG Abnormalities in Bangladeshi Hospitalized Individuals

Background: Electrocardiogram (ECG) abnormalities often remain clinically silent yet carry significant prognostic implications, especially among hospitalized patients with comorbidities. In resource-limited settings like Bangladesh, routine ECG screening is underutilized, potentially overlooking cardiac risk in seemingly stable patients. Aim: To determine the prevalence and types of silent ECG abnormalities among adult patients admitted to the medicine wards of Chittagong Medical College Hospital. Methods: A cross-sectional study was conducted from January to December 2024 involving 100 consecutively admitted, clinically stable adult patients (aged ≥18) with no known cardiac history. Standard 12-lead ECGs were performed within 24 hours of admission and interpreted independently by two senior physicians using Minnesota Code criteria. Abnormalities were categorized into conduction defects, arrhythmias, ischemic changes, and repolarization abnormalities. Results: Out of 100 participants, 57% showed one or more ECG abnormalities. The most prevalent were non-specific ST-T changes (21%), followed by left ventricular hypertrophy (13%), atrial fibrillation (10%), and first-degree AV block (7%). A higher frequency of abnormalities was observed in patients over 60 years and those with hypertension or diabetes. Notably, 42% of abnormalities were not linked to any presenting complaint or diagnosis. Conclusion: Silent ECG abnormalities are common in hospitalized patients without known cardiac disease in Bangladesh. Routine ECG screening can play a vital role in early detection of latent cardiovascular conditions. These findings emphasize the importance of incorporating ECG evaluation as a standard part of initial assessment, particularly for elderly and comorbid patients.