A Medical Assistant’s Guide to EKG

Part of the excitement of being a medical assistant is helping doctors dig into the mysteries of the human body. Using the latest equipment, medical assistants perform diagnostic tests that offer important clues about patients’ health.

One such test, electrocardiography, is a mainstay in hospitals and physicians’ offices, and it’s one in which medical assistants play an essential role.

What Is an Electrocardiogram?

Electrocardiography is a test that measures electrical activity within the human heart that produces a report called an electrocardiogram. As a muscle, the heart requires electrical impulses to contract. Voltage flows between the atria and the ventricles (chambers of the heart) in a coordinated pattern that makes the heart beat effectively.

An electrocardiograph, a machine that measures voltage through electrodes placed on a patient’s skin, produces a visual representation of electrical activity in the heart called an electrocardiogram. Abbreviated as EKG or ECG, it uses a total of 10 electrodes to give doctors 12 views of the heart.

Six electrodes are placed on the chest, with two on the arms and two on the legs. Together, they triangulate signals across the body. It’s a simple test, but one that gives doctors actionable information about a patient’s cardiac health.

How Do Doctors Use an EKG?

There are many tests used to learn more about the heart, and electrocardiography is just one of them. An EKG is used to make these assessments.

  • Evaluate heart rhythms
  • Look for abnormalities in the heart muscle
  • Detect electrolyte abnormalities
  • Determine if the heart has adequate blood flow

Common symptoms that might generate an EKG order include these.

  • Chest pain
  • Shortness of breath
  • Dizziness or lightheadedness
  • Fatigue

Electrocardiographs capture each beat in a waveform that is associated with a specific cardiac activity. By examining the peaks and valleys and the spaces between them on a tracing, doctors can diagnose ischemia, dysrhythmias, hypertrophic cardiomyopathy, electrolyte imbalances, and myocardial infarctions.

Ischemia

Ischemia is a condition of reduced blood supply to the heart muscle that can lead to angina or a heart attack.

Dysrhythmias

Dysrhythmias are abnormalities in heart rhythm, including atrial fibrillation.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is thickening of the heart muscle in response to heart failure or high blood pressure.

Electrolyte Imbalance

Electrolyte imbalance describes high or low levels of potassium, calcium, or magnesium which can cause distinct changes in the heart’s rhythm.

Myocardial Infarction

This is the clinical term for a heart attack, the death of part of the heart muscle.

Types of EKGs

There are several types of electrocardiography a medical assistant may be asked to perform or assist with. The most common is the standard 12-lead EKG.

A 12-lead EKG is done with the patient at rest. It may be ordered as a routine screening test or to evaluate cardiac symptoms such as chest pain or shortness of breath.

A 12-lead EKG takes about ten minutes to perform from start to finish, and the process is painless. Extended versions, called signal-averaged EKGs, may be done to diagnose specific types of dysrhythmias.

For patients who have complaints such as palpitations or skipped heartbeats that occur only on occasion or with regular activity, a doctor may request Holter monitoring.

A Holter monitor is a portable electrocardiograph worn on a patient’s body for a few days or even up to a few weeks depending on the symptoms. It can catch abnormalities a 12-lead EKG can miss. Today’s wireless versions can send irregular readings to a doctor in real time.

To evaluate a patient’s heart function during vigorous activity, doctors use a so-called stress test. Patients are asked to walk on a treadmill or pedal a stationary bike while an electrocardiograph measures how their heart responds.

If a patient can’t exercise, he or she is given an injection of medication that simulates the cardiac response to strenuous activity. For safety, this type of test is often performed in a hospital.

More extensive EKGs, as well as limited studies that use only three or five leads, are only occasionally ordered.

Benefits of an EKG

Compared to other types of testing done to evaluate heart function, an EKG has several clear benefits. The EKG is quick and highly diagnostic, it’s noninvasive, painless and convenient, flexible and cost-effective, and it’s easy to perform.

Quick and Highly Diagnostic

An EKG doesn’t tell a doctor everything about the heart, but when compared to other tests used to diagnose a heart attack, it’s speedy.

Blood tests used to measure cardiac enzymes can take hours to complete, and they suggest only that the heart may have sustained muscle damage. An echocardiogram, an ultrasound used to visualize the heart muscle, takes up to an hour. An EKG is done in minutes, and it can diagnose a heart attack on the spot.

Noninvasive

An electrocardiograph measures electrical activity in the heart using only electrodes attached to the skin. No medication or anesthesia is required.

Compared to cardiac catheterization, a technique in which a tube is guided into the coronary arteries from a blood vessel in the arm or groin, an EKG is a virtually risk-free procedure with no threat of significant complication.

Painless and Convenient

Cardiac diagnostics can be stressful for patients. The more complicated the test, the likelier it is to cause anxiety.

An EKG is painless, and with education, it’s a low-stress procedure that patients don’t usually mind. Since the margin of safety is high and the equipment is reasonably priced, most can be performed in a doctor’s office, making them especially convenient.

Flexible and Cost-Effective

A basic 12-lead EKG costs as little as a few hundred dollars. That’s fifty percent or less of the cost of an echocardiogram and thousands less than cardiac catheterization.

Flexible options like Holter monitoring decrease the need for more costly or invasive testing. In an outpatient setting, most insurers require EKGs be done prior to authorizing more extensive testing.

Easy to Perform

Risky diagnostic tests that require medications are performed by a doctor or nurse for safety, adding to their cost. It takes training to perform standard 12-lead EKGs, but the learning curve isn’t steep, and it’s well within the scope of practice for medical assistants.

Performing an EKG—The Medical Assistant’s Role

A 12-lead EKG is always done as part of a more comprehensive exam, so it requires some preparation. A medical assistant is often the go-to team member to educate and prepare patients for testing.

First, the medical assistant sets a safe and comfortable stage for the exam. An electrocardiograph is an electronic device, and other equipment that produces electrical current in the same room could interfere with its use. Optional equipment should be turned off.

The exam room should be properly sanitized, and the equipment readied. This includes a quick check of the electrocardiograph to ensure it’s functioning as expected. Making sure the exam space is comfortable and serene encourages patients to relax and ultimately speeds the process.

Before the test, medical assistants screen patients for changes in health and factors that could affect the EKG results, such as new medications. They’ll also take a set of resting vital signs and spend time discussing the procedure with the patient.

The actual EKG is easy, but getting the best results requires cooperation. Patients are usually asked to lie on their back, something that persons with heart failure may find challenging.

And moving while the electrocardiography is in process creates artifacts, distortions in the waveform that can render the results unreadable. Educating patients about the test in advance allows them the opportunity to ask questions and clarify expectations, resulting in a smoother and more efficient process.

In preparation for the exam, patients should be asked to remove jewelry, watches, and any metal objects or electronic devices from their pockets. They can interfere with the test. Having them change into a loose fitting garment makes electrode placement easier.

After washing their hands, medical assistants can physically prepare a patient for the exam. Before attaching electrodes to the skin, it’s best to have patients lie down first to avoid jostling wires once they’re applied. Lying flat produces the best results. If patients can’t do so comfortably, raising their head and torso by 30 to 45 degrees, known as Semi-Fowler’s position, can help. Ensuring patient privacy during this process is paramount.

The medical assistant then shaves hairy areas and cleanses the skin with alcohol. Electrode pads adhere with a firm, yet gentle adhesive that may not stick on greasy skin or areas with hair. Pads come in two types, one that requires the addition of conducting gel and one that has it already impregnated. Packages containing premoistened pads should be opened at the last minute to prevent drying.

Once the pads are placed, electrode cables can be attached. Leads are colored-coded, so it’s clear where they go. Avoid placement over bones or irritated skin.

A cool exam room minimizes sweating and helps electrodes stay in place. If the EKG being performed is not the patient’s first, the medical assistant should review documentation of prior lead positioning. Consistent application makes it easier for doctors to identify artifacts or notice small changes from study to study.

Before starting the electrocardiograph, patients should be reminded to stay as still as possible until told the test is complete. Asking them to take a deep breath and hold it can be helpful.

Once the EKG has started, it takes as little as 10 seconds to get a quality reading. The medical assistant should review the paper strip or digital readout before letting the patient know the test is done. If artifacts are significant, the test should be redone.

After the exam, the medical assistant removes the electrodes and pads. Individuals with mobility challenges may need additional help.

Before the patient leaves, the results of the EKG are entered in the patient’s medical record. Medical assistants do not interpret EKGs, but with experience, they learn which abnormalities may signal a potential health crisis.

If anything is unusual or unexpected, a physician should be alerted immediately and before the patient leaves. In hospitals and modern practices, an EKG is viewable as soon as it’s entered into the chart. Paper strip EKGs should be mounted securely on a form with the patient’s name on it.

Before patients leave the office, a medical assistant should let them know when to expect results and whom to contact if they develop worrisome symptoms. It helps put their mind at ease, especially if the test was done to evaluate a specific concern.

The medical assistant then disinfects the exam room and ensures all supplies are disposed of according to OSHA (Occupational Safety and Health Administration) regulations and infection control protocols. A busy cardiology practice may do dozens of EKGs daily, so the environment is fast paced.

Although the 12-lead EKG is the most common for medical assistants to do, they may also be asked to participate in stress testing and work with patients using Holter monitors. Understanding why each type of EKG is performed and how to help is a valuable skill.

Final Thoughts

Vocational school training programs cover the ins and outs of electrocardiography and heart health, but it only gets more interesting with practice. Medical assistants may be jacks-of-all-trades, but performing EKGs is a tangible way to be a part of the best that medicine has to offer.

Did learning about what an electrocardiograph or EKG is interest you? Ready for an exciting new career in the medical assisting field?

The Medical Assistant program at Hunter Business School prepares competent, entry-level medical assistants in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains required for professional practice.

The Medical Assistant program provides hands-on experience in a real medical setting where you can foster professional relationships with actual patients. Medical Assistant students spend 160 hours in an externship in an actual medical work environment where they are supervised and taught in order to gain valuable on-the-job training.

Contact us today to find out more about how to become a medical assistant on Long Island.