It is not uncommon for patients to have cardiovascular or respiratory problems when they consult physicians. As a medical assistant, you may be responsible for performing screening and/or diagnostic testing in the physician's office. To correctly perform testing on the cardiac or respiratory system, you need to review the anatomy and physiology of the heart and the respiratory system. Refer to Chapters 27 and 28 to review the cardiovascular and respiratory systems. This chapter introduces you to the electrocardiograph instrument and how to administer an electrocardiogram. You will also learn how to apply electrocardiograph electrodes and wires, operate the instrument, and troubleshoot problems that can occur while recording the heart's electrical activity. Because many physicians perform more complex cardiac diagnostic testing, you will also learn about Holter monitors and stress testing. Pulmonary function testing is a procedure performed in physician's offices, and this chapter introduces you to the basics of performing respiratory procedures, such as spirometry, peak flow, and pulse oximetry.

Outline

• The Medical Assistant's Role in Electrocardiography and Pulmonary Function Testing
• Anatomy and Physiology of the Heart
• The Conduction System of the Heart
• The Electrocardiograph
• Preparing to Administer an ECG
• Applying the Electrodes and the Connecting Wires
• Operating the Electrocardiograph
• Troubleshooting: Artifacts and Other Problems
• Completing the Procedure
• Interpreting the ECG
• Exercise Electrocardiography (Stress Testing)
• Ambulatory Electrocardiography (Holter Monitoring)
• Anatomy and Physiology of the Respiratory System
• Pulmonary Function Testing
• Spirometry
• Performing Spirometry
• Peak Expiratory Flow Rate (PEFR)
• Pulse Oximetry

Learning Outcomes

After completing Chapter 52, you will be able to:

52.1  Describe the anatomy and physiology of the heart.
52.2  Explain the conduction system of the heart.
52.3  Describe the basic patterns of an electrocardio-gram (ECG).
52.4  Identify the components of an electrocardiograph and what each does.
52.5  Explain how to position the limb and precordial electrodes correctly.
52.6  Describe in detail how to obtain an ECG.
52.7  Identify the various types of artifacts and potential equipment problems and how to correct them.
52.8  Discuss how the ECG is interpreted
52.9  Identify common arrhythmias.
52.10  Define exercise electrocardiography.
52.11  Explain the procedure of Holter monitoring.
52.12  Describe forced vital capacity.
52.13  Describe the procedure of performing spirometry.
52.14  Describe the procedure for obtaining a performing peak expiratory flow rate.
52.15  Describe the procedure for performing pulse oximetry testing.

Summary

Electrocardiography and pulmonary function testing play a vital role in the diagnosis and treatment of cardiac and pulmonary disease. As a medical assistant, you may be required to perform these procedures in the medical office.

To understand electrocardiography, you need to know the basics of the conduction system of the heart and the components of an electrocardiograph. To obtain accurate electrocardiogram readings, you must properly place the electrodes and be able to recognize artifacts and correct them.

Likewise, to provide accurate assessments of pulmonary function, you must use proper technique and recognize the acceptability of a spirometric maneuver, peak expiratory flow, and pulse oximetry. Because patient compliance is crucial for accurate results, effective patient education is vital to the process.