Challenges of Clinical ECG & How is the Electrocardiography Test Taken?

The Electrocardiography (ECG) is an apparatus, which is largely used by practicing physicians. It is also used by emergency physicians, general internists, family medical practitioners, and cardiologists. It records the electrical activities of the heart. In this article we will discuss the challenges in clinical ECG.

Electrocardiography or ECG is used to very quickly find conditions of people which require certain time-sensitive therapies. These therapies include emergent reperfusion therapy. It also helps in finding conditions of acute or chronic which are very much likely to be a life-threatening condition. These types of conditions include poisoning, predisposition to certain death, rhythm disorder, and electrolyte disturbances.

In the diagnosis of heart-related diseases, recording of ECG is the most common procedure. Stress test refers to when the electrocardiography test is taken after the person has done exercise or is under very light stress. It is done to see the changes in the heart at various times. Normal results of the ECG test are considered when the heartbeat is 60-100 bpm and the rhythm of the heart is even and consistent.

Sometimes ECG reports are unspecific and uncertain where their accuracy depends on the prevalence of the particular disease. Therefore, proper evaluation of clinical data is important to understand the ECG report accurately. This can avoid unnecessary expensive investigations.

Initially, ECG readers were educated with cardiology and electrocardiography. But with new technologies, improved diagnostic and treatment procedures there is a decline in cardiologists dealing with ECG. In the US, ECG reports are mainly read by non-cardiologists or those who have the least knowledge in clinical electrocardiography. This also led to the inaccurate interpretation of the ECG report, which leads to wrong diagnosis or and expensive investigations. In some hospitals, the minimum fee is paid to the ones who read ECG report, which makes the profession unacceptable. The money received on the readings of thousands of patients every day makes the job difficult to continue.

It is seen that the meal or eating behavior in patients has a significant effect on the ECG report of the person. The eating habits in cardiac patients differ from that of normal patients. It appeared that patients with abnormal behavior towards meal increase with the clinical degree of cardiac movement. The response of the T wave was most frequently deflecting in the patients.

Sometimes the ECG reports of athletes report abnormal heart rate which may not always becomes a reason to worry or it does not indicate any illness. The athletic condition leads to a lot of change in the ECG of an athlete. 40% of the athletes report mild or abnormal ECG report. Indications of enlarged left ventricles and elevated thickness in the wall of the heart are some distinct abnormalities. Athletes with these result participated in sports with fitness requirement like cycling, rowing, and long-distance running. But continuous tests over some period of time showed that these athletes had no structural problem in their hearts.

• The person will be asked to lie down on a bed.
• The nurse or doctor who is taking the test will clean several parts of the body like legs, arms, and chest.
• Some small patches which are known as electrodes will be applied to those parts or areas.
• Shaving of hair would be necessary so that the electrodes stick to the skin perfectly.
• The electrodes are connected to a machine with the help of wires.
• It converts the electrical signals of the heart into wavy lines.
• Usually, the wavy lines are printed on paper.
• Then the doctor reviews the reports of electrocardiography.
• The person would need to be in a still position while the procedure of the test is going on.
• The person may get asked to hold his/her breath for a few seconds while the procedure is being completed.

Electrocardiography or ECG is a simple procedure in which the heart rhythm and the heartbeat is recorded. Electrocardiogram or ECG is produced during the process which records the electrical activity of the heart. Though technology has gifted many improved procedures of measuring and recording heartbeat, still ECG had been always the preferred one for diagnosing the patient with a known or suspected heart disease. It is widely preferred because of its safety as well as it’s a cheap procedure for initial screening. It is a very important measure to evaluate cardiac abnormalities and as well as evaluates the effects of abnormal heart rate and rhythm. When the muscular tissues of the heart are weak, abnormal variation will follow up in the electrical currents due to the heart’s contraction. Electrocardiography shows such obstruction of the coronary artery.

The person needs to be relaxed and in a still position because any kind of movement or stress can affect the results and the reports may not bring false results.

The doctor prescribing the test should know about all the medicine the patient is taking because some medications can interfere with the results of the test.

Before taking a electrocardiography test, the person should not exercise or drink cold water because they can also alter the reports of the electrocardiography test.

The abnormal reports of ECG test may reflect or give signs of various types of heart-related problems or disease. They may include inflammation of the heart, enlargement of the heart, heart attack, abnormal heart rhythm, congenital heart defect, and swelling in the sac which is around the heart.

There are also some heart problems which may lead to changes in the electrocardiography test. These type of heart problems include heart failure, sick sinus syndrome, heart attack, atrial fibrillation, and multifocal atrial tachycardia.

There are also some heart-related problems which ECG test may fail to reflect or give signs but those problems can be there. And there are also some heart problems which do not change the results of electrocardiography test.

P-wave: It is a first short upward notch shown in the reports. It represents that the atria are shrinking to pump the blood out of the heart. The two upper chambers of the heart are known as atria.

QRS Complex: QRS complex is a short downward section which is connected with a tall upward section. This part shows that the ventricles are shrinking to pump the blood out of the heart. Ventricles are the two lower chambers of the heart.

ST Segment: It is a short upward segment. This segment signifies and shows the amount of time which is taken by ventricles to pump the blood out from the end when they shrink to the beginning of the period when the heart was in the rest and before the heart starts to contract or shrink for the next beat.

T-wave: It is the next upward curve and comes after the ST segment. It signifies the period when the ventricles were on the rest.

The size and length of each wave and segments are studied and they form an important part of the reports.

The 12-lead electrocardiograph helps in looking at different parts of the heart. So, if there is an abnormal change in any of the lead may indicate problems related to a particular part of the heart according to the particular lead as each lead represents different parts of the heart.

Arrhythmias: This is a condition when the heart beats are too slow or too fast or inconsistent.

Heart Attack: Heart attacks which the person experienced in the past or recently can be evaluated.

Congenital Heart Disease: It refers to the condition of defects in the heart by birth.

Cardiomyopathy: In this condition, there are areas where the heart muscles are abnormally too thick or too thin.

Coronary Artery Disease: It refers to when the body faces problem in flowing the blood to the muscles of the heart.

Valvular Heart Disease: When there are problems related to structures of heart valves, the condition is known as valvular heart disease.

ECGs are safe, non-invasive, comes with no major types of risks. They are painless tests. The electrodes which connect the sensors to the body to conduct the test, do not pass electric shocks to the body. The person may get normal rashes on the skin or the skin may irritate on the parts of the body where the electrodes were attached.

Sometimes, gel or sticky pastes are used to attach the electrodes, and some people are allergic to those types of gel or pastes. Those people may get an allergic reaction because of it. The skin usually stops irritating ones the patches are taken off the skin and the allergic reaction may recover on its own after some time without requiring any specific treatment.

There are various types of electrocardiogram machines to evaluate different types of conditions related to the heart or lungs. Some types of electrocardiogram machines include:

Holter Monitor: It is a type of monitor which helps in tracing the electrocardiography continuously for 24-hours or more. Electrodes in the form of patches are attached to some parts of the body like chest, arms, etc.

Cardiopulmonary Exercise Test: It is also known as CPET. It is an evaluation of the cardiopulmonary system. It helps to detect and identify any type of lungs or heart disease.

Exercise Electrocardiograph: Exercise electrocardiograph is also known as the stress test. It is used while the person is walking on a treadmill or is pedaling a bicycle. It helps in evaluating the heart activities while the person is exercising. It also monitors blood pressure and breathing rates. It can be used to identify diseases like coronary artery disease or to identify the levels of exercise which is safe for a particular person and if the person was recently a patient of heart surgery or heart attack.

Signal-averaged Electrocardiograph: It is a more detailed electrocardiograph compared to other types. While the procedure is going on, several tracings are taken from the machine within a short period of about 20 minutes with the aim to identify the abnormal heartbeats which may occur only occasionally.

To restore the declining ECG readers, trained and certified cardiovascular practitioners should be considered. Initially, Cardiologists used to give interpretations of arrhythmia to trained nurses but eventually because of the declining number of experts, it is carried out by the non-professionals. No diagnose should be provided without a thorough and proper interpretation of the ECG report by some expert. Sometimes the fluctuation in the electrical rhythm of the heart is due to some stress or mental distress leading to uneven blood pressure, not because of some underlying disease. Thus, ECG reports should be effectively analyzed.

Electrocardiograph was introduced by Einthoven, back in 1902. Electrocardiography is used to very quickly find conditions of people which require certain time-sensitive therapies. It checks and records the electrical activities of the heart and finds any abnormalities.

While the test is going on, the patient needs to lie down still and not move and not take any type of stress because any type of stress or movement can lead to alteration of reports and it may give false results.

The abnormal reports of electrocardiography test may reflect or give signs of various types of heart-related problems or disease. They include inflammation of the heart, enlargement of the heart and heart attack.

The person may get normal rashes on the skin or the skin may irritate on the parts of the body where the electrodes were attached. Some types of gel or sticky pastes are used to attach the electrodes, and some people are allergic to those gel or pastes. Those people may get an allergic reaction because of it but it will recover on its own after some time.

There are many types of electrocardiographs. Exercise cardiograph, holster monitor, and cardiopulmonary exercise test are some of those types.

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Also Read:

• What is an ECG Stress Test?
• How Long Does it Take to Do an ECG?
• What is Right Ventricular Hypertrophy ECG?
• What Does Prolonged QT On ECG Mean?
• What Is Normal QT QTc On ECG?
• Does Myocarditis Show On ECG?