Read about the latest news on ECG / EKG Machines

Hoping to greatly reduce the medical intervention during labor and delivery and decrease the high rate of Cesarean deliveries in the United States, Florida researchers have been working on developing a fetal EKG machine (fetal electrocardiogram). Similar to the ultrasound machines currently used during labor, the fetal EKG would monitor the baby’s heart rate during labor with a higher rate of accuracy than the ultrasound can provide. The effectiveness of ultrasound monitoring is limited by the inability to isolate the baby’s heartbeat. Differentiating between the mother’s and the baby’s heart rate can be difficult with a fetal ultrasound and failing to do so often results in the performance of unnecessary Cesarean. Because a normal heart rate for a baby is in a higher range than the mothers, if a slower heart rate is detected on a monitor, it is often assumed that the baby is suffering from a cardiac abnormality. Based on those results, medical intervention then becomes necessary. In addition, a baby with a cardiac abnormality in need of intervention may not receive the necessary treatment if the wrong heart beat is being monitored.

According to the findings of various groups that have been conducting preliminary studies on the effectiveness of fetal EKG monitoring during labor and delivery, the EKG machine has been found to provide a more accurate prediction of the baby’s progress during labor than the ultrasound. The Florida teams of researchers hope that in addition to monitoring fetal heart rate, the fetal EKG will serve to detect abnormal heart rhythms in the fetus as well as help to distinguish between early labor and false labor by monitoring and recording the strength of the mother’s uterine contractions.

Because of the evolving medical and computer technology, researchers hope to be able to offer fetal EKG machines in a clinical setting in the distant future. Currently in the later stages of its development, the fetal EKG may be routinely available during labor and delivery in as early as 2 years.

Most of us associate having an EKG test with a frantic trip the emergency room, or lying flat on our back in our doctor’s or cardiologist’s office having a diagnostic procedure. But you can have an EKG stress test while you are at home or out and about doing your normal activities.

This type of EKG is called an ambulatory EKG, or more commonly a Holter monitor, after its inventor Dr. Norman J. Holter. A Holter monitor is a device which is designed to be worn for an extended period of time, from 24 hours up to a month. Like a standard EKG machine, it uses electrodes to record the electrical activity of the heart, though it may use a smaller number of electrodes for data capture, even as few as three.

Unlike a normal EKG test, however, the Holter monitor is designed to allow doctors to observe and diagnose conditions which may be difficult to observe using a normal EKG. For example, a patient may having occasional arrhythmia’s. The chance of catching the patient during that time, at a facility equipped to perform an EKG, setting up the EKG machine, and catching the arrhythmia while it is happening is so small as to be nonexistent.

In contrast, if a patient is wearing an ambulatory EKG or Holter monitor, the instant recording of data is only the push of a button away. For example, patients wearing this cardiac monitor are instructed to start the device recording any time they feel a symptom of what is expected may be a cardiac event. Many patients are also instructed to keep a journal, recording any medically significant information, including date and time of experiencing symptoms, symptoms experienced, activity at time of symptom onset, duration of symptoms, etc. Not only do you then have subjective information, but you have the objective record of the patient’s heart’s electrical activity while symptomatic.

This can provide clinical data useful in diagnosing—and ruling out—a variety of cardiac conditions, including:

* Atrial fibrillation
* Multifocal atrial tachycardia
* Paroxysmal supraventricular tachycardia
* Ventricular tachycardia
* Bradycardia

Holter monitors are also used to observe the way the heart reacts to normal every day activity and stress, or as a more thorough assessment of heart functioning.

While many people understand the importance of having an annual physical exam, few people think of having an annual heart exam. But heart disease claims a number of lives each year. Often when heart disease is caught early, it can be treated, and the outcomes are good. Here are some guidelines for scheduling your first heart exam.

* Both men and women need to have annual heart exams. If you have a family history of heart disease, or two more more known risk factors (smoking, obesity, high blood pressure, diabetes, lack of exercise, or high cholesterol), you should have your first annual exam around age 35 for men, 40 for women. Otherwise, the first annual exam should occur around 40 for men, and at around the time of menopause for women.

* Heart exams should begin with a complete medical history. A general physical exam should be given, including blood pressure and heart rate. Lab tests should include cholesterol and lipid panels, and tests for diabetes. An EKG test should also be conducted. If the EKG machine results show a problem, further testing, including an ambulatory test, a stress test, or heart catheterization may be appropriate.

* Heart exams should be given annually. The best outcomes occur when heart disease is recognized early and treated appropriately.

* Anyone who experiences symptoms that suggest heart disease should seek earlier evaluation, including emergency care if symptoms of a heart attack are present. Symptoms that suggest heart disease include fainting, dizziness, weakness, shortness of breath, irregular heart beats, rapid heart beats, and discomfort in the chest during activity.

It is important to remember that heart disease does not always give symptoms to warn us that it is present. This is why early and regular testing is important. An EKG machine test is simple, does not take long, and is noninvasive. But the information it provides can save lives, especially when it helps us recognize impending heart disease. While an EKG is an essential tool for providing care for the heart, the information it gives us cannot be evaluated in a vacuum. The EKG machine is just one of the diagnostic tools using in evaluating the condition of the heart and circulatory system.

We are, in many ways, becoming jaded about EKG machines and tests. They are, after all, everywhere–doctor’s offices, hospitals, ambulances, and television shows. How easy is it to dismiss a technology that has become part of a theatrical prop department? But more and more researchers are discovering that this work horse of medical technology has much more to teach us.

We are not referencing a general idea, or even a general screen, but rather a specific mechanism, with real numeric thresholds that can be used here and now, with no delay for FDA approval, such as in the case of a new instrument. This adds to the utility of the EKG machine. Dr. Latha Stead of the University of Rochester reported online in the Journal of Stroke and Cerebrovascular Diseases that there is a link between prolonged Q-T intervals and increased 90 day mortality in stroke patients.

For the uninitiated, the Q-T interval is the length between the peaks of the Q wave and the T wave on an EKG. This is a piece of data that makes up every EKG and has long been a diagnostic criteria seen by physicians. In the largest such study in 30 years, 345 patients’ EKG reports were reviewed alongside 90 day outcomes. Data was corrected for confounding factors, such as drugs known for lengthening the Q-T wave interval.

Once the data was corrected for gender, age and other related factors, it was discovered that 35.7 % of the patients (123) had a prolonged Q-T interval at the initial evaluation, and this was associated with a higher median stroke score. t was reported that 64 patients died within the first ninety days. That means there was a 90-day survival rate of just over 80 percent. Doing the math, that gives a mortality rate of about one-fifth.

The exact threshold we are talking about is a Q-T interval of 438 msec for men and 440 msec for women. Laying exact numbers aside, this means that EKG has given us another diagnostic tool that will give clinicians a simple way to target patients who are at increased risk of mortality and manage those patients more aggressively. More aggressive management means better outcomes. Not a bad use for a century old technology.