One of the most innovative new technologies of the 20th century was the electrocardiogram (EKG machine). Designed for the diagnosis of heart disease, the EKG machine was considered a major advancement in modern medicine. Early EKG machines were much bulkier than today’s lightweight and portable machines, but they work on the same principle – the measurement of the electrical impulses of the heart.

In its early days, the patients were required to place their hands and feet in a sodium chloride bath, since water is a conductive method to detect the electric impulses of the heart. A more accurate method was introduced later with the use of electrical wires, which were later replaced by the electrodes we use today. These modern methods of EKG testing make it much easier to perform, while being safer, more comfortable and accurate.

How is EKG testing done?

A typical EKG test requires a patient to lay on their doctor’s examination table, but some doctors use EKG machines to perform stress tests as well. Here, electrodes are attached to a patient and then they are asked to perform moderate exercise, such as walking on a treadmill or riding a stationary bike. The results of a stress test will give the doctor a better understanding of how a patient’s heart patterns change during physical activity.

How are EKG tests used to diagnose heart problems?

An EKG machine works by picking up electrical impulses emitted from various points of the body, wherever an electrode is placed. Typically, doctors use a 10-12 electrode test that measures the heart’s impulses as they are graphically output into readable waves. These continuous waves are then amplified and displayed on a monitor or printed out for later interpretation by a physician.

EKG machines can detect an irregular heartbeat, arrhythmia or angina and diagnose the symptoms of heart disease. It can also detect whether the heart’s chamber walls are too thick, determine whether prescribed heart medicines are effective, and check on any implanted heart devices, such as pacemakers.

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When the time comes to purchase a new EKG machine for your office or medical center, it may help to consult with those who use it the most. Only they will know which features and functions are missing from your current machine, and help you make the right purchasing decision.

Here are some key features to consider for your next EKG machine:

What size paper does the machine use?

Some EKG machines use 60 mm strips and others use EKG paper in half-sized sheets.
Using even smaller paper, such as the 3×4x1 format, may save money in the long run.
It is possible to buy a machine that uses 8.5 x 11” paper. While the paper costs may be higher, it is easier to handle and file these printouts.

Does the machine come equipped with a keyboard for typing in patient information?
When patient demographics appear on their printout, it gives a more professional-looking EKG reading.
However, in some cases it takes too much time for a nurse to personalize the reading for each patient, so this may be a question for your nursing staff.

Does the EKG machine have a screen?
Most medical professionals prefer to have a screen, since it verifies that all leads are working properly prior to testing. It also ensures that the baseline is stable before testing begins.
Making sure that all twelve leads are visible at once, in real time, eliminates the need to switch screens in order to view them.

Does the machine connect to a computer?
If so, make sure the output is based on a system architecture that is compatible with your EMR and EKG management system.
Be careful – Sometimes EKG machines are made to integrate only with the management software made by that manufacturer.

A PC-based EKG machine will allow you to integrate other diagnostic features, to provide a full picture of a patient’s overall health. These user-friendly machines will also allow you to create a searchable database of all EKGs performed, connect to a patient’s electronic medical record, and email results right from your PC.

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The need for mobile EKG machines

Minutes and seconds count when someone is having a heart attack, and medical units in South Carolina are well aware of this fact.  Ever since the invention of mobile EKG machines primarily used in ambulances, emergency medical professionals have been trying to find ways to get them.

This small black machine, with its 12-lead electrocardiograph, can shave twenty minutes or more from the time it would take doctors to diagnose a heart attack.  As a result, all the emergency medical systems in Abbeville, Anderson, Oconee and Pickens counties in South Carolina are applying for a grand that would put one of these mobile EKG machines in every ambulance.

Why is it so important to get these machines in every ambulance?

With these mobile units, paramedics could more accurately determine whether a patient is having a heart attack.  By transmitting the patient’s heart readings directly to the hospital emergency room, via Bluetooth, the appropriate lifesaving measures can be taken immediately upon the patient’s arrival at the hospital.

In addition to monitoring the heart’s electrical impulses, these mobile EKG units can also check a patient’s blood oxygen concentration and blood pressure.  Having these new machines would bring these emergency medical services up to South Carolina’s state requirements, enabling them to send information directly to the ER from the ambulance.

Managing Outcomes

According to AnMed Health’s Director of Clinical Outcomes, the average time it takes to get a patient from arrival at the hospital to the balloon valve is 67 minutes.  With mobile EKG machines, 20 minutes or more could be shaved off that time.

Currently, some ambulances in the area use three-lead EKG machines, which can be used to determine an irregular heartbeat, but they cannot show how the heartbeat became irregular, which leaves an additional step for doctors to perform upon the patient’s arrival.

The goal of these grants would be to put a more advanced EKG machine in every mobile lifesaving unit throughout the region.

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Modern EKG machines are used to diagnose heart problems and check for abnormal heart rhythms.  By translating line tracings on an electrocardiogram, doctors can interpret the spikes and dips (known as waves) to see a complete picture of the heart’s overall health.

The heart muscle is actually made up of four chambers, which act as a pump.  The two upper chambers are known as “atria” and the two lower chambers are ventricles.  But the heart doesn’t pump properly without a certain amount of electrical stimulus, or impulses.  The body’s natural electrical system is what causes the heart to contract and pump blood to the lungs and through the circulatory system.

An EKG test, or electrocardiogram, is done to:

• Assess the heart’s electrical impulses
• Find the cause of chest pain, which is often caused by a heart attack, pericarditis, or angina.
• Diagnose symptoms of heart disease, including shortness of breath, fainting, dizziness or palpitations.
• Find out if the heart chamber walls are too thick
• Check the effectiveness of heart medicines, and determine if they are causing any side effects
• Check on implanted heart devices, such as pacemakers, to be sure they are working properly
• Perform regular heart check-ups, especially when other conditions are present, like hypertension, high cholesterol, diabetes, or a family history of heart disease.

Preparing for an EKG test

Some medicines can change the results of the test, so be sure to tell your doctor about any prescription or non-prescription drugs you are taking.  You may need to change your dosage of these medications prior to the test.

EKG machines are usually used only by health professionals, with the results being interpreted by a doctor.  You may receive an EKG as part of an overall physical exam, or during a series of tests at a hospital.  Because EKG machines are often portable, the test can be done almost anywhere.  If you are staying in the hospital, you may be continuously monitored by an EKG system, which is a process called telemetry.

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EKG machines have been a vital tool in the medical profession, since their discovery in 1903 by Willem Einthoven. Using the science of electrocardiography (ECG or EKG), these machines are used in healthcare environments to interpret the electrical activity of the heart. By placing external electrodes on the skin, EKG machines use a noninvasive recording technique to graph the rhythms of the heart.
Originating in the sinoatrial node, electrical impulses of the heart travel through an internal conducting system into the heart muscle. These impulses then trigger the myocardial muscle fibers to contract. Electrodes, when placed on different sides of the heart, can measure the activity within different parts of the heart, and then the machine can display the voltage in between each pair of electrodes. Doctors can then read this display to see the overall rhythm of the heart, and diagnose weaknesses in different areas, particularly any abnormalities that may have been caused by damage to conductive tissues. Some abnormal rhythms can be caused by higher levels of dissolved salts, or electrolytes. Or, after a myocardial infarction (heart attack), an EKG machine can identify damaged areas of the heart muscle.
While the EKG can diagnose some important areas of damage, it cannot be used to reliably measure the heart’s pumping ability. For this type of testing, an ultrasound device, known as echocardiography) or nuclear medicine tests are more appropriate.
EKG machines have come a long way since their discovery and can now load images faster, using a higher resolution. They are far more computerized, compact and effective in diagnosing abnormalities of the heart. Today’s machines are often used for diagnosing heart disease and can even point out a heart attack while it is happening.

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Medical researchers estimate that up to 35 percent of all Americans suffer at least one episode of Syncope during their lifetime. What is Syncope, you may ask? It is a sudden loss of consciousness, which starts out as light-headedness, weakness and dizziness. While recovery is quick, the signs of onset are unpredictable, which can impair Syncope sufferer’s quality of life.

Since symptoms most often occur when a person’s blood pressure suddenly drops, it is believed that cardiac syncope is the result of a heart abnormality, such as arrhythmia, valve disease, or a blockage.

While Syncope can also be caused by intense anxiety, dehydration, hunger, alcohol and drug use, or other medical conditions, about 20 percent of all cases are heart related. When heart problems are suspected, patients undergo EKG and exercise stress tests and will often wear a 24-hour monitor to record heart rhythms over longer periods of time.

Earlier this year, the FDA approved a tool, known as the Sleuth AT Cardiac Monitoring System, which can help physicians diagnose Syncope. The Sleuth is actually a small EKG recorder, which is smaller than a half-dollar. It is implanted beneath the skin in the upper left chest, and measures the electrical activity of the heart. The recorded information is then stored and retrieved on a Personal Diagnostic Manager, which is a small recorder that can be carried in a handbag or pocket.

Traditional implantable EKG recording devices store information for later retrieval at the doctor’s office, or require manual downloading on a home computer. But the Sleuth makes use of Bluetooth technology to transmit data to a patient’s home base station. From there, the information is transmitted to a monitoring center which is staffed by cardiac technicians, where doctors can access it through a secure web site. Using the Sleuth EKG monitor can assure a patient that their doctor will be alerted immediately of any serious problems.

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Another compactly designed specimen from the GE Marquette series of ECG machines, the GE Marquette Mac 5000 Premium Resting ECG Machine is at top of the line interpretive system that combines additional features with the usual functionalities and features that are incorporated by the highly popular Marquette MAC series of machines. As said by the manufacturers, it delivers high performance using advanced capabilities that can be offered only by the most extensive collection of interpretive algorithms used in the ECG machine industry.

It is a highly evolved non invasive testing solution that combines unparalleled hardware technology with a complete suite of networkable software solutions which optimizes output and productivity which makes it ideal for any facility that aspires for a high performing ECG machine.

Its sophisticated advanced functionalities deliver complete solutions for advanced ECG applications and extend a high degree of performance to the largest possible user base. It allows for advanced 12 lead ECG computer analysis and interpretation with P-wave signal averaging, late potential analysis, ACI-TIPI and gender specific interpretational criteria as part of the revolutionary 12 SL trademarked technology from the GE Marquette series for the identification of arrhythmia.

The MAC 5000 is a premier resting ECG system that delivers the most advanced disease diagnostic management application that most machines fall short of achieving. The late potential analysis offers effective management for ventricular and atrial arrhythmia as well as chest pain. It delivers broad based connectivity solutions using the MUSE CV information system for data storage and retrieval of ECG interpretational data.

The backlit LCD screen display is of high resolution and has waveform enhancement capability. It displays data such as heart rate, patient demographics, filter settings, warning and prompts as well as help messages. The interpreted data can be printed out in high resolution using the thermal dot array printer that is inbuilt and works on Z fold paper of A or A4 sizes on Z fold paper.

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EKG Machines are used to measure and record any abnormal activity within a patient’s heart. It can detect a multitude of heart ailments in quick time and with ease. The readings are usually recorded as a graph that leaps up and down and describes the electrical action of the heart muscles. The average time taken for a test to be conducted is 5 minutes. The readings can be read only by a trained physician is incomprehensible to a layman.

The Nihon Kohden ECG-1350A Cardio Fax M EKG Machine is a 12 channel recording machine that meets major international performance standards that are prescribed for electrocardiographs on pointers such as accuracy and digital filter performance. It comes with a high clarity LCD display screen which lists the results for review. IT has substantial internal memory which allows for storing of up to 40 ECG files and also allows for huge amounts of data to be stored on external SD memory cards which can be transferred onto a PC using a LAN connection or USB cable. It is compatible with windows based computer systems on which the recorded data can be analyzed and managed using optional ECG viewer software.

The performance delivered by this unit is of exceptionally high standards and is relatively economical. It is also portable and light weight which allows for easy transportation and moving around. First hand machines come with a 4 year warranty and an ECAPS 12C interpretive analysis program. The compact design occupies minimal space and is convenient for small clinics and medical facilities. It also comes with an alphanumeric keyboard that enables data entry and patient information storage and retrieval.

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The normal kind of EKG test is done while in a resting position. This is when you lay down on a bed, the EKG technicians attach the electrodes to your arms, legs, and chest area and you lay down for a short while the test is done. This is for about one minute. In the event when this type of EKG does not provide sufficient or significant results, the doctor or cardiologist will request one of the following three types of EKG machine tests:

In many instances serious heart diseases or heart malfunctioning can not be diagnosed when you are in a resting phase. This means, only when there is some strain on your heart like when you perform some kind of activity and your heart needs to work harder, these problems shows up and can be diagnosed effectively and accurately. With a normal stress test you will be walking on a treadmill or pedal on a fitness bicycle.

Now this is all very well if you are able to walk and perform some kind of action, but what happens to patients that cannot walk for instance? With the advancement of medical technology, these patients are injected with a chemical that causes the heart to beat faster and cause your blood to flow faster, resembling the affect normal exercise will have on your heart. In these events, an echocardiography or a nuclear heart scan is done to trace the functioning of the heart.

The process of nuclear heart scanning requires a radioactive tracer to be injected into the bloodstream while a special radiology camera follow the tracer as it travels through your heart and different arteries.

When an echocardiography is used, it makes use of sound waves to indicate the flow of your blood through the heart chambers, functioning of the heart chamber valves and the amount of strength your heart muscle uses to perform these different actions.

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For the layman, an EKG is a series of repeated blips. Interpretation is limited to many beeps = good. No beeps = bad. Fortunately, the clinician can glean a great deal more information from those series of beeps and lines on a chart.

One of the breakthroughs of Einthoven (whom we discussed earlier for his Nobel prize win for EKG machine technology) is that he assigned the letters P, Q, R, S and T to the various deflections of the EKG tracing. It is the T wave, the last part of the cycle, that has great diagnostic value. And according to a new study released in the February 24, 2009 online edition of the Journal of the American College of Cardiology (J Am Coll Cardiol, 2009; 53:774-778,) changes in the T wave may have even greater predictive value in the future. This study is receiving a lot of coverage because with heart disease a major cause of death in the U.S., there is always a need for a better way to diagnose the problem.

First a bit of background: the T wave represents the re-polarization of the ventricles, the part of the heart that sends the blood into the lungs (right ventricle) or out to the body (left ventricle). This re-polarization is vital so that the heart can “reset” and get ready for the wave of stimulation to begin again for the next heartbeat.

What is very important is a T wave phenomenon called the T wave alternans or TWA. This is a periodic variation from beat to beat in the amplitude of the T wave. If too many TWAs are detected, the patient is at greater risk for developing a potentially lethal cardiac arrhythmia and sudden death. Patients with increased TWAs become good candidates for pacemakers.

The study referenced above, led by Dr. Rachel Lampert, MD, FACC, showed that when an anger inducing stimulus was presented to test subjects, they exhibited TWAs. This parallels the induction of TWAs by exercise in other studies. Her team also showed an 11 fold increase in the need to implant pacemakers in patients who showed anger-induced TWAs.

While this could ultimately lead to a new way to predict future arrhythmias in patients, Dr. Lampert had only 62 subjects in this study. She cautions that the study data should be considered preliminary and should only be used to generate hypotheses. Still it will be interesting to see if this adds a new dimension to the diagnostic utility of the ubiquitous EKG machine.

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