Depending on a number of factors, such as a client’s age, personal and family medical history, and the amount of insurance being applied for, an ECG or “electrocardiogram” is sometimes requested by the underwriter. Here is some more information on this exam procedure.

This post is another excerpt from a book written by Robbie Gardner, RN, VP of Marketing at Quality Underwriting Services Head Office, and shared today by David Runciman, Edmonton General Manager at QUS. www.qus.ca for more information.

E is for ECG/EKG

An electrocardiogram checks how the heart is functioning by measuring the electrical activity of the heart. With every beat of the heart, an electrical impulse (or wave) causes the heart muscle to squeeze and pump blood. By measuring how long the wave takes to pass through your heart, Underwriting can determine if the electrical activity is normal, fast or irregular.

A step back for a second. The term ECG is for electrocardiogram and the term EKG means the same thing. It seems that in different parts of the world, some use the EKG reference versus the ECG reference. I have heard people also use the term electrocardiograph. To distinguish between the two words, an electrocardiograph is the instrument (machine) used to gather the info. The info or end result, is the electrocardiogram.

An ECG may be ordered based on age and amount requirements, also if a past history of heart problems, verifying previous information or test results are other considerations. An ECG is performed at a state of REST and is the most common ECG ordered; however, Underwriting can up the ante any time and could escalate it to a Stress ECG. Same concept as a resting ECG; however, client is put under the stress of exercise. Most commonly in Alberta a treadmill is used.

The resting ECG can be completed at the client’s home, office, Agent’s office or our office (located in Edmonton). The client has to be at a state of rest for the readings to be recorded properly. The test should be arrange in a private room where the client can take off their shirt/blouse/top to allow for proper attachment of the electrodes. The electrodes encircle the heart and there are also leads on the arms and legs.

From experience, the best place is at the client’s home (where they are most comfortable) where there is a bed or couch to lie on. Women usually cover themselves with a blanket. This is one of the few services where the clients are asked to disrobe. Many clients ask us to visit their place of work because it is more convenient for them. As long as we are able to have the client at a state or rest and obtain privacy, the work address can be used.

We do have male and female Health Professionals; however, we typically will send a female HP to a female client with an ECG request.

Some of the difficulties that may arise are bad contact of the leads, resulting in a poor ECG tracing. Dirty or oily skin and hairy chests are typically the main reasons for poor contact. Cleaning the skin with alcohol and making sure the chest hair is separated, will allow the sticky electrode to secure to the skin. Some of the males chests are extremely hairy. For a good result, we do have to have skin contact with the electrodes. We cannot shave the clients due to liability; however, they can certainly shave or trim the areas required for good contact. Body lotion and sprays should be avoided the day of an ECG. Jewelry should also be removed.

We have many types of machines, many that store the recording to be printed later, some that print a full 8 1/2×11 sheet, others that print paper strips to be mounted. Regardless of the format, all of the ECG’s (any paperwork that is) are scanned and uploaded to our system (directly to the client’s order) for the Insurance Company to download.

A Stress ECG must be completed at a set facility, clinic or hospital, because the client needs to be checked by a Doctor first. A Health Professional will monitor the machine, while the client is walking/running on the treadmill. This exam takes 30 – 45 minutes. Since exercise is involved, clients are prepared to bring comfortable clothing and running shoes.

TRUE STORY: I had an ECG to do on a client who worked in a fruit market. He was the owner and insisted there was a place to lie down in his office. His office was tiny and papers everywhere, there was no where to lie down. We did find a spot in the basement (the freezer to be exact) where he could lie down. His brother held the machine and I was able to get the recording. This was not an ideal situation. The client was not willing to have it done elsewhere.

Mobile Nursing does present a lot of unusual circumstances that must be handled professionally.

Photo from Wikipedia entry for Electrocardiography