Thursday, June 20, 2013

EKG Machine Donation

I think its a great that CIS Cardiovascular Institute of the South has donated a EKG machine to the Student Health Services Center at the University of Louisiana at Lafayette (ULL).  These machines are very expensive and schools just cant afford to buy or rent them.  They are helping the students get hands on learing at no additional cost to the scool.  Here at Disount Cardiology we offer the lowest price price on your Cardiology suppllies.  We carry all brands of EKG Paper and Electrodes.  Call today and find the best pricing in the country.

Monday, April 22, 2013

ECG and Children

Electrocardiography to test a child’s heart prior to sports participation can help identify some – but not all – causes of sudden cardiac death.
Offering this test is not without debate, however, whether your patient is a young athlete about to start a sports program or a student about to start stimulant medication for attention-deficit/hyperactivity disorder.
Your clinical judgment remains paramount, as ECG screening before sports is not mandated in the United States, but placing your patient in one of the following three categories can help guide diagnosis and management:

 Asymptomatic child, normal physical exam. Most of the patients you see for a sports evaluation will be asymptomatic. Perform the physical examination and take a thorough history, with a specific look for any signs of sudden cardiac death such as family history or previous symptoms. In general, this evaluation will suffice and you will not need to order blood assays or other tests. If you want to augment your evaluation by ordering an ECG, you will be ahead of the curve. Most pediatricians manage these kids whether they order an ECG or not. If you’re uncertain or uncomfortable for any reason at this point, consider referral.
 Symptomatic child. Children in this group may describe palpitations, chest pain, and/or an instance when they felt they were about to pass out (syncope or presyncope). The symptomatic child should be evaluated further if you have any clinical concerns, and ECG is a good starting point. Unless you feel very comfortable, consider specialist consultation and comanagement of these patients. Watch especially for exercise-related syncope. For me, passing out with exercise is a red flag because it’s one of the few specific signs of structural heart disease. At a minimum, evaluations of rhythm (ECG) and structure (echocardiography) are indicated, and sometimes an electrophysiology work-up can be helpful.
 Asymptomatic child, some examination findings. Some asymptomatic children have a potentially relevant clinical finding, such as a murmur. Most innocent murmurs are monitored appropriately in the primary care setting, but referral is more strongly suggested for murmurs of concern, which include holosystolic murmurs, grade 3-6 murmurs, and diastolic murmurs. An ECG is still an excellent starting point, but you have a choice. Some pediatric cardiologists also would recommend an echocardiogram or just a referral to them for further work-up. You don’t always have to rush to echocardiography. (Some would argue there are too many echoes ordered right off the bat, and I think there are too few initial ECGs ordered.)
Much of your management strategy depends on your comfort level. Most pediatricians can read an ECG and immediately know that something is not right if they see a significantly prolonged QT interval or WPW (Wolff-Parkinson-White syndrome) changes. I’ve learned, however, that most of the pediatricians at our institution would be uncomfortable making the call regarding some of the more subtle ECG findings. Many pediatricians’ offices do not have ECG equipment, so the patient will be sent elsewhere anyway.

Screening Before an ADHD Regimen
Consideration of ECG screening also comes up prior to prescription of an ADHD stimulant medication.
Unfortunately, a small number of deaths have been associated with use of these medications. Some of those patients had underlying congenital and structural heart disease that some believe could have been identified with a simple ECG. Most people would agree to some sort of cardiovascular monitoring, such as blood pressure or heart rate measurements. Complicating matters is the increased risk of ADHD in children with congenital heart anomalies.
Proceeding with an ECG screen doesn’t rule out prescribing the ADHD medicine, according to the recommendation, but it might be worthwhile to have a pediatric cardiologist manage any particular clinical concerns.
False-Positive Results
ECGs are safe and very inexpensive if you already have the equipment. The biggest debate about ECGs in the world of sports medicine centers on high false-positive rates. Depending on how the ECG is read and which criteria you use, the false positive rate can be as low as 2% or as high as 15%. Using the right criteria removes some of the unnecessary false positives and can reduce the rate to a more acceptable 2%-5%. In my opinion, that rate is low enough to justify offering low-cost ECGs for those who would like to be screened.
Interestingly, some of the false-positive findings are not as concerning among young athletes. Examples are an incomplete right bundle branch block, early repolarization, isolated QRS voltage criteria for left ventricular hypertrophy, and first-degree atrioventricular block. Some experts argue that if we remove these specific findings, we will be left primarily with the most concerning ones and thus can improve the false-positive rate.
This greater reliability may be reflected by emerging ECG-screening programs across this country. We at Loyola University Health System are in the process of trying to develop one of the first ECG-screening programs at a medical center. Precedents from ECG guidelines for older athletes may be adaptable to protect pediatric patients; about half of large university athletic programs perform ECG screening. In addition, the majority of professional athletes undergo cardiac evaluations.

complements from Cardiology News and NEERU JAYANTHI, M.D.

Friday, April 19, 2013

Innovation in the rich world is based on the approach “Spend money and innovate.” In the U.S., you can see this clearly in health care. We push the frontiers of medical science and technology with very little attention paid to cost. Our health-care system is prohibitively expensive, yet does not guarantee the highest quality; nor does it provide universal coverage.
There is an alternative model of innovation: “Spend less and innovate.” This is the only feasible model in poor countries that are resource-constrained. As some companies have discovered, constraints can be liberating. This notion is at the heart of reverse innovation. General Electric (GE) was able to come up with an ultralow-cost electrocardiogram (ECG) only when it bumped up against many constraints in rural India.
The ECG is the most widely performed cardiac test in the developed world, and GE Healthcare is the market leader. An ECG machine costs about $5,000 and a scan about $20. This complex equipment is heavy and bulky, and requires a skilled technician to operate it, as well as elaborate service support. In other words, GE’s premium ECG machines were nonstarters in rural India, because patients didn’t have the money to pay for the test and small clinics and physicians couldn’t afford the machine or the support costs.
These constraints defined the sandbox for GE Healthcare to develop an $800 ECG machine for rural India that is portable, battery-operated, easy-to-use, and easy-to-repair.
GE found many ways to cut costs. The high-end machine was custom-designed, so GE built a machine using commodity components, realizing huge cost advantages. For a cost-effective printer, GE used the kind of ticket printer found on public buses and in movie theaters. Since these printers are produced in the millions, GE could enjoy significantly lower costs due to economies of scale.
The small printer reduced the weight of the machine—less than a can of Coke—and helped make it portable. By eliminating the monitor, GE reduced the need for huge power consumption. This, in turn, contributed to longer life for the rechargeable battery.
GE also found ways to build a machine that if you know traffic signals, you can operate: A “green” button indicates start and a “red” button means stop. GE did away with the need for extensive service support, designing the machine with a few standard modules that can be easily replaced. If the device failed, users could swap modules.
What this example illustrates is the need to shift our innovation process to frugal thinking based on constraints. GE’s innovation in India has transformed its global business, since the machine is sold in more than 90 countries. Thus, reverse innovation has come full circle.