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Electrocardiogram (ECG)

An <a href="http://www.zoncareglobal.com/ecg-machine/"

target="_self">electrocardiogram (ECG) is a simple test that can be used to

check your heart's rhythm and electrical activity.

Sensors attached to the skin are used to detect the electrical signals

produced by your heart each time it beats.

These signals are recorded by a machine and are looked at by a doctor to see

if they're unusual.

An ECG may be requested by a heart specialist (cardiologist) or any doctor

who thinks you might have a problem with your heart, including your GP.

The test can be carried out by a specially trained healthcare professional at

a hospital, a clinic or at your GP surgery.

Despite having a similar name, an ECG isn't the same as an

echocardiogram, which is a scan of the heart.

When an ECG is used

An ECG is often used alongside other tests to help diagnose and monitor

conditions affecting the heart.

It can be used to investigate symptoms of a possible heart problem, such as

chest pain, palpitations (suddenly noticeable heartbeats), dizziness and shortness

of breath.

An ECG can help detect:

arrhythmias – where the heart beats too slowly, too quickly, or irregularly

coronary heart disease – where the heart's blood supply is blocked or

interrupted by a build-up of fatty substances

heart attacks – where the supply of blood to the heart is suddenly blocked

cardiomyopathy – where the heart walls become thickened or enlarged

A series of ECGs can also be taken over time to monitor a person already

diagnosed with a heart condition or taking medication known to potentially affect

the heart.

How an ECG is carried out

There are several different ways an ECG can be carried out. Generally, the

test involves attaching a number of small, sticky sensors called electrodes to

your arms, legs and chest. These are connected by wires to an ECG recording

machine.

You don't need to do anything special to prepare for the test. You can eat

and drink as normal beforehand.

Before the electrodes are attached, you'll usually need to remove your

upper clothing, and your chest may need to be shaved or cleaned. Once the

electrodes are in place, you may be offered a hospital gown to cover yourself.

The test itself usually only lasts a few minutes, and you should be able to go

home soon afterwards or return to the ward if you're already staying in

hospital.

Ambulatory Blood Pressure Monitoring

The diagnosis, management, and estimated mortality risk in patients with

hypertension have been historically based on clinic or office blood pressure

readings. Current evidence indicates that 24-hour <a

href="http://www.zoncareglobal.com/patient-monitoring/" target="_self">ambulatory

blood pressure monitoring should be an integral part of hypertension care. The

24-hour ambulatory monitors currently available on the market are small devices

connected to the arm cuff with tubing that measure blood pressure every 15 to 30

minutes. After 24 hours, the patient returns, and the data are downloaded,

including any information requested by the physician in a diary. The most useful

information includes the 24-hour average blood pressure, the average daytime blood

pressure, the average nighttime blood pressure, and the calculated percentage drop

in blood pressure at night. The most widely used criteria for 24-hour measurements

are from the American Heart Association 2017 guidelines and the European Society

of Hypertension 2018 guidelines. Two important scenarios described in this

document are white coat hypertension, in which patients have normal blood

pressures at home but high blood pressures during office visits, and masked

hypertension, in which patients are normotensive in the clinic but have high blood

pressures outside of the office. The Centers for Medicare and Medicaid Services

has made changes in its policy to allow reimbursement for a broader use of 24-hour

ambulatory blood pressure monitoring within some specific guidelines. Primary care

physicians should make more use of ambulatory blood pressure monitoring,

especially in patients with difficult to manage hypertension.

What are the features to look for before buying an ECG machine?

<a href="http://www.zoncareglobal.com/ecg-machine/multi-channel-ecg-machine/"

target="_self">Electrocardiography is the process of producing a recording of

the electrical activity of the heart, in the form of a graph, using electrodes

placed on certain specific spots on the body. This graph is called

electrocardiogram.

For the purpose of producing an electrocardiogram, the standard practice now

is to place 10 electrodes in the following 10 different positions on the body: 4

Limbs ( Left Arm, Right Arm, Left Leg and Right Leg) + 6 on the chest on specific

locations near the heart. Potential (Voltage difference) is measured between two

of the electrodes or a common virtual electrode, called as the Wilson’s central

terminal. Wilson’s central terminal is the average potential measurements between

three of the limb electrodes – Right arm, Left arm and Left Leg. These voltage

difference measurements are called “Leads”.

In all 12 ‘leads’ are required to complete the ECG graph. These 12 leads

include, 3 limb leads, 3 augmented limb leads and 6 chest leads (also called

precordial leads). While the three limb leads are measurements of potential /

voltage difference between the limb electrodes, the augmented limb leads and chest

leads (also called precordial leads) are potential difference between the limb and

chest electrodes vs the virtual electrode (Wilson’s central terminal).

Often people use the term ‘lead’ for electrodes also and hence cause

confusion as to whether there are 10 leads or 12 leads in an ECG machine.

When a patient cardiac activity needs to be monitored for a longer period of

time; ECG variants with fewer number of electrodes are used to help aid mobility

– such as with 3-electrodes or 5-electrodes (These may be confusingly called 3-

lead / 5-lead ECGs – but the numbers 3 & 5 here refer not to the number of

leads obtainable but the number of electrodes used). As against the 12-leads ECGs,

the 3 & 5-electrode ECGs capture less information. The 3-elecrode ECGs -

capture only the limb-leads but no anterior view, hence useful for rhythm

monitoring. In a 5-electrode ECG all the 6 limb leads and one chest view is also

captured. If someone says e.g. 5-channel ECG or 5-leads ECG, they essentially

mean 5-electrodes ECG. So, what is a channel?

Channel – The other term commonly used in reference to ECG machine is number

of ‘channels’. ECG machines may come as single channel, 3-channel, 6-channel or

12-channel configurations. Each lead measurement done aPre-owned GE Mac ECG

machines detailed above is then passed through an ‘amplifier’ channel and

recorded. In a single-channel system, each lead is recorded and displayed one at a

time.

In a multi-channel system, the ECG has a microprocessor which manages this

processing of signals based on the number of channels. The signals are amplified,

filtered and sent to a multiplexer. The multiplexer receives all the inputs,

reconstructs signals, de-multiplexes and sends the output to display screen or

chart recorder. If it is a 3-channel ECG, the microprocessor groups the signals

received from the 12-leads, in 4 groups of 3 and processes them. Similarly, in 6-

channel it is in two groups and 12-channel device the same 12-leads are processes

simultaneously. Hence, higher the number of channels, faster the ECG recording

would be. Clearly, ‘channels’ is different from ‘electrodes’ or ‘leads’.

Point-of-Care Ultrasound: A Practical Guide for Primary Care

<a href="http://www.zoncareglobal.com/ultrasound/primary-care-ultrasound/"

target="_self">Ultrasound has head-to-toe applications for primary care, and

the newest machines are portable and affordable enough to fit into almost any

practice.

Family physicians can order a wide range of imaging services for patients. But

barriers such as time, money, and physical distance sometimes prevent patients

from accessing those services, causing gaps in care. Incorporating point-of-care

ultrasound (POCUS) into clinical practice is one way to bridge those gaps.

Technological advancements have allowed more physicians to bring ultrasound

services to the office visit or bedside, and to make POCUS an integral part of

practice. I [Dr. Deutchman] was an early adopter, adding ultrasound to my rural

practice in 1980 after delivering a surprise set of twins in the wee hours of the

morning. I have never since been surprised by twins, nor missed an ectopic

pregnancy. In addition, I [Dr. Shen-Wagner] first used POCUS during residency in

2011, after a patient complained that it felt like her intrauterine device (IUD)

had moved. Everything looked normal on the pelvic exam, but a hand-me-down

ultrasound machine from the clinic's obstetrics department revealed the

unmistakable flutter of a tiny heartbeat. The patient was pregnant, despite having

an IUD for three years.

These are just two examples of the many ways POCUS can benefit doctors and

patients. There is robust evidence that POCUS improves care in critically ill

patients and improves the efficiency and safety of many invasive ambulatory

surgeries that are otherwise performed blindly or by anatomic landmarks. There

is also preliminary but growing evidence that POCUS can improve diagnostic

capabilities, expedite patient care, and inform bedside treatment and management.

Most recently, POCUS has proven to be a valuable tool for confirming COVID-19

diagnoses, as well as monitoring some symptoms of the disease.

The hands-on, “showing while telling” nature of POCUS advances physical

diagnosis skills, fosters doctor-patient communication, and increases patient

satisfaction. This article outlines some common uses for POCUS and explains how

to add it to a practice.

Electrocardiogram (ECG) Solutions

Electrocardiogram (ECG)

systems record the electrical activity of the heart over time by measuring

electric potentials on the surface of living tissue. A biopotential electrode is

used to pick up heart signals from specific locations on the body. The

differential voltage between two electrodes, or the differential voltage between

one electrode and the average voltage of multiple electrodes, can be measured and

displayed as one channel on the ECG printout.<br style="box-sizing: border-box;

color: rgb(99, 99, 99); font-family: Helvetica, Arial, sans-serif; font-size:

14px; white-space: normal; background-color: rgb(255, 255, 255);"/>The primary

function of the AFE is to digitize the heart signals. This process is complicated

by the need to reject interference from strong RF sources, pace signals, lead-off

signals, common-mode frequency, signals from other muscles, and electrical noise.

Typically, the AFE includes instrumentation amplifiers (INAs), filtering, and

ADCs. There are two kinds of ECG architecture design approaches—ac coupling and

dc coupling.

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