Which scenario warrants obtaining a 12-lead ECG according to rhythm assessment guidelines?

• A. Only during acute chest pain episodes
• B. During regular daily activity without any changes
• C. When there is a change from baseline or an acute change
• D. Only if the patient requests it

Answer: (C)

A 12-lead ECG is indicated when there is a change from the patient’s baseline or an acute change in rhythm, symptoms, or clinical status. This helps detect new or evolving problems such as ischemia, arrhythmias, or conduction abnormalities that require timely management. If there are no changes from baseline and the patient is asymptomatic, routine testing isn’t typically indicated. While chest pain or acute symptoms can prompt ECG use, the key driver is a deviation from what is known to be normal for that patient, not just the presence of symptoms alone or a patient request.