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How to Administer an EKG: A Medical Assistant’s Guide

Did you know that employment for medical assistants is projected to grow 19 percent from 2019 to 2029, according to the U.S. Bureau of Labor Statistics? One of the special skills a medical assistant learns in a medical assisting program is administering an EKG exam.

Testing for cardiovascular disorders with electrocardiography (EKG or ECG) is noninvasive. A cardiovascular exam is administered to assess the heart and blood vessels. As a medical assistant, you are responsible for administering a good quality EKG exam without avoidable artifacts. An artifact is an abnormal signal that does not reflect electrical activity of the heart during the cardiac cycle.

The medical assistant must make sure that the patient doesn’t move while administering the EKG exam, there are no mechanical problems with the EKG machine, and the proper technique is used while administering the EKG exam.

What Should the Medical Assistant Know Before Administering an EKG Exam?

Before administering a cardiovascular exam or EKG, it is important for the medical assistant to interview the patient to learn of medications the patient may be taking. The physical exam, performed by the doctor, will provide vital signs from the patient that include weight, blood pressure, heart rate, respiratory rate, and body temperature.

Prior to administering the patient exam, the medical assistant will also want to obtain current symptoms and a family history of cardiovascular disorders, including heart disease and hypercholesterolemia (excess cholesterol in the bloodstream). The medical assistant will want to know also if the patient consumes alcohol, smokes tobacco, has a healthy diet, and/or participates in any exercise regimens.

What Is an EKG?

An EKG is a diagnostic tool used to evaluate the electrical pathways through the heart. An EKG is a graphic record of the electrical current as it progresses through the heart. The EKG exam is administered to detect the electrical impulses through the skin, and those impulses are measured, amplified, and recorded.

Why Is an EKG Exam Administered?

The EKG exam assists in the diagnosis of ischemia, delays in impulse conduction, hypertrophy of the cardiac chambers, and arrhythmias. Some types of arrhythmias include ventricular fibrillation, premature ventricular contractions, and atrial fibrillation.

  • Ischemia – an inadequate blood supply to the heart muscle that can lead to a heart attack or stroke
  • Hypertrophy of the Cardiac Chambers – enlargement and thickening of the walls of the heart’s main pumping chamber that can be caused by uncontrolled high blood pressure
  • Arrhythmia – improper beating of the heart that occurs when electrical impulses in the heart don’t work properly
  • Ventricular Fibrillation (VFib) – life-threatening heart condition where the ventricles of the heart appear to quiver and there is no cardiac output
  • Defibrillation – used to stop an arrhythmia
  • Premature Ventricular Contractions – premature heartbeats that originate from the heart’s ventricles
  • Atrial Fibrillation – multiple electrical signals that fire rapidly from different areas in the atria, causing a rapid, irregular heartbeat

How Does the Medical Assistant Prepare a Patient for an EKG Exam?

The medical assistant will want to make sure that no other machines in the room are emitting any electrical currents, while administering an EKG exam. The air conditioning, refrigerator, fans, and laboratory equipment should be turned off. The room should be private and free from interruptions.

The medical assistant will then turn on the electrocardiograph and explain the procedure to the patient, answering any questions the patient may have before administering the EKG. The medical assistant will want to wash his/her hands before administering the EKG exam. The patient will be asked to remove all jewelry, socks, and shoes and to lie down on a table in the supine position (face upward).

The medical assistant will properly drape the patient and ask her/him to breath normally, lying still. The patient’s skin will then be cleaned by the medical assistant by rubbing alcohol where the electrodes will be placed. Next, the medical assistant will apply the electrodes in their proper positions. The wires and cables will then be attached to the electrodes.

Patient data is entered into the electrocardiograph. The EKG exam is administered, and all artifacts are identified and if possible, eliminated. The medical assistant will remove the electrodes, wash the affected areas, allow the patient privacy to get redressed, and record the procedure in the patient’s chart.

Finally, the used materials and electrodes are disposed of properly, and the room is disinfected in compliance with OSHA (Occupational Safety and Health Administration) guidelines.

How Are EKG Leads (Cables) Applied to the Patient?

An EKG exam is administered with 12 leads that produce a three-dimensional record of impulse waves. Each lead records the electrical impulses that flow through the heart from different angles, giving the physician a complete view of the heart.

How Is an EKG Interpreted by the Physician?

Whether weak or strong, fast or slow, each heartbeat produces an electrical current that can be measured with an electrocardiograph. The physician examines the waveforms associated with the cardiac cycle and measures the PR interval, PR segment, ST segment, and ventricular activation time.

To measure these variables, the physician observes the waves labeled with letters P, Q, R, S, T, and U. The elements that are considered from these measurements include rate, rhythm, axis, hypertrophy, ischemia, and infarction.

  • Rate – how fast the heart is beating
  • Rhythm – regularity of cardiac cycles and intervals
  • Axis – position of the heart and direction of electrical movement through the heart
  • Hypertrophy – abnormal enlargement of the heart
  • Ischemia – decrease in blood supply to an area of the heart
  • Infarction – death of heart muscle resulting in loss of function

What If a Resting EKG Does Not Give Enough Information?

There are additional tests a physician can administer if a resting EKG exam (the kind that most people are familiar with) does not provide enough information to diagnose a heart problem. Exercise electrocardiography can be used to identify additional heart problems.

  • Exercise Electrocardiography – assesses the heart’s conduction system during exercise, when the body demands an increase in oxygen
  • Echocardiogram – produces an ultrasound video image of the working heart valves and chambers and how the blood moves through the heart
    • Transthoracic – an ultrasound transducer (handheld device used when doing an EKG) is moved around the chest and abdomen to produce heart images
    • Transesophageal – the ultrasound transducer is passed over the esophagus instead of penetrating the ribs
    • Doppler – a special ultrasound looks at blood flow through the heart to assist in assessing coronary artery blockage and heart valve damage
    • Stress Echo – done before and after exercise to assess how well the heart responds to the increased demand

Some patients may have anxiety about getting an EKG exam, so the medical assistant should create a comfortable atmosphere for the patient to stay calm, since movement by the patient can cause artifacts to disrupt the EKG exam.

Want to learn more about how to administer an EKG exam? 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 patients. Medical Assistant students spend 160 hours in 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.