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Technologists who assist physicians in the diagnosis and treatment of heart disease are known as cardiovascular technologists. (Cardio means heart; vascular refers to the blood vessel/circulatory system.) Increasingly, hospitals are centralizing cardiovascular services under one full cardiovascular "service line" overseen by the same administrator. In addition to cardiovascular technologists, the cardiovascular team at a hospital may include radiology (X-ray) technologists, nuclear medicine technologists, nurses, physician assistants, respiratory technicians, and respiratory therapists. Cardiovascular technologists contribute by performing one or more of a wide range of procedures in cardiovascular medicine, including invasive (enters a body cavity or interrupts normal body functions), noninvasive, peripheral vascular, or echocardiography (ultrasound) procedures. In most facilities, technologists use equipment that is among the most advanced in the medical field; drug therapies also may be used as part of the diagnostic imaging procedures or in addition to them. Technologists' services may be required when the patient's condition is first being explored, before surgery, during surgery (which primarily involves cardiology technologists), or during rehabilitation of the patient. Some of the work is performed on an outpatient basis.
Depending on their specific areas of skill, some cardiovascular technologists are employed in nonhospital health care facilities. For example, they may work for clinics, mobile medical services, or private doctors' offices. Much of their equipment can go just about anywhere.
Exact titles of these technologists often vary from medical facility to medical facility because there is no standardized naming system. Electrocardiograph technologists, or EKG technologists, use an electrocardiograph machine to detect the electronic impulses that come from a patient's heart. The EKG machine records these signals on a paper graph called an electrocardiogram. The electronic impulses recorded by the EKG machine can tell the physician about the action of the heart during and between the individual heartbeats. This in turn reveals important information about the condition of the heart, including irregular heartbeats or the presence of blocked arteries, which the physician can use to diagnose heart disease, monitor progress during treatment, or check the patient's condition after recovery.
To use an EKG machine, the technologist attaches electrodes (small, disk-like devices about the size of a silver dollar) to the patient's chest. Wires attached to the electrodes lead to the EKG machine. Twelve or more leads may be attached. To get a better reading from the electrodes, the technologist may first apply an adhesive gel to the patient's skin that helps to conduct the electrical impulses. The technologist then operates controls on the EKG machine or (more commonly) enters commands for the machine into a computer. The electrodes pick up the electronic signals from the heart and transmit them to the EKG machine. The machine registers and makes a printout of the signals, with a stylus (pen) recording their pattern on a long roll of graph paper.
During the test, the technologist may move the electrodes in order to get readings of electrical activity in different parts of the heart muscle. Since EKG equipment can be sensitive to electrical impulses from other sources, such as other parts of the patient's body or equipment in the room where the EKG test is being done, the technologist must watch for false readings.
After the test, the EKG technologist takes the electrocardiogram off the machine, edits it or makes notes on it, and sends it to the physician (usually a cardiologist, or heart specialist). Physicians may have computer assistance to help them use and interpret the electrocardiogram; special software is available to assist them with their diagnoses.
EKG technologists do not have to repair EKG machines, but they do have to keep an eye on them and know when they are malfunctioning so they can call someone for repairs. They also may keep the machines stocked with paper. Of all the cardiovascular technical positions, EKG technologist positions are the most numerous.
Holter monitoring and stress testing may be performed by Holter monitor technologists or stress test technologists, respectively, or they may be additional duties of some EKG technologists. In Holter monitoring, electrodes are fastened to the patient's chest, and a small, portable monitor is strapped to the patient's body, often at the waist. The small monitor contains a magnetic tape or cassette that records the action of the heart during activity—as the patient moves, sits, stands, sleeps, etc. The patient is required to wear the Holter monitor for 24 to 48 hours while he or she goes about normal daily activities. When the patient returns to the hospital, the technologist removes the magnetic tape or cassette from the monitor and puts it in a scanner to produce audio and visual representations of heart activity. (Hearing how the heart sounds during activity helps physicians diagnose a possible heart condition.) The technologist reviews and analyzes the information revealed in the tape. Finally, the technologist may print out the parts of the tape that show abnormal heart patterns or make a full tape for the physician.
Stress tests record the heart's performance during physical activity. In one type of stress test, the technologist connects the patient to the EKG machine, attaching electrodes to the patient's arms, legs, and chest, and obtains a reading of the patient's resting heart activity and blood pressure. Then, the patient is asked to walk on a treadmill for a designated period of time while the technologist and the physician monitor the heart. The treadmill speed is increased so that the technologist and physician can see what happens when the heart is put under higher levels of exertion.
Cardiology technologists specialize in providing support for cardiac catheterization (tubing) procedures. These procedures are classified as invasive because they require the physician and attending technologists to enter a body cavity or interrupt normal body functions. In one cardiac catheterization procedure—an angiogram—a catheter (tube) is inserted into the heart (usually by way of a blood vessel in the leg) in order to see the condition of the heart blood vessels, and to determine if there is a blockage. In another procedure, known as angioplasty, a catheter with a balloon at the end is inserted into an artery to widen it. Numerous cardiac catheterization procedures are done in the United States each year. Cardiology technologists also perform a variety of other procedures.
Unlike some of the other cardiovascular technologists, cardiology technologists actually assist in surgical procedures. They may help secure the patient to the table, set up a 35mm video camera or other imaging device under the instructions of the physician (to produce images that assist the physician in guiding the catheter through the cardiovascular system), enter information about the surgical procedure (as it is taking place) into a computer, and provide other support. After the procedure, the technologist may process the angiographic film for use by the physician. Cardiology technologists may also assist during open-heart surgery by preparing and monitoring the patient and placing or monitoring pacemakers.
Vascular technologists and echocardiographers are specialists in noninvasive cardiovascular procedures and use ultrasound equipment to obtain and record information about the condition of the heart. Ultrasound equipment is used to send out sound waves to the area of the body being studied; when the sound waves hit the part being studied, they send echoes to the ultrasound machine. The echoes are "read" by the machine, which creates an image on a monitor, permitting the technologist to get an instant "image" of the part of the body and its condition. Vascular technologists are specialists in the use of ultrasound equipment to study blood flow and circulation problems. Echocardiographers are specialists in the use of ultrasound equipment to evaluate the heart and its structures, such as the valves.
Cardiac monitor technicians are similar to and sometimes perform some of the same duties as EKG technologists. Usually working in the intensive care unit or cardio-care unit of the hospital, cardiac monitor technicians keep watch over the patient, monitoring screens to detect any sign that a patient's heart is not beating as it should. Cardiac monitor technicians begin their shift by reviewing the patient's records to familiarize themselves with what the patient's normal heart rhythms should be, what the current pattern is, and what types of problems have been observed. Throughout the shift, cardiac monitor technicians watch for heart rhythm irregularities that need prompt medical attention. Should there be any, they notify a nurse or doctor immediately so that appropriate care can be given.
In addition to these positions, other cardiovascular technologists specialize in a particular aspect of health care. For example, cardiopulmonary technologists specialize in procedures for diagnosing problems with the heart and lungs. They may conduct electrocardiograph, phonocardiograph (sound recordings of the heart's valves and of the blood passing through them), echocardiograph, stress testing, and respiratory test procedures.
Cardiopulmonary technologists also may assist on cardiac catheterization procedures, measuring and recording information about the patient's cardiovascular and pulmonary systems during the procedure and alerting the cardiac catheterization team to any problems.