Let Me Dial Your Cardiogram

Although millions of Americans have electrocardiograms done every year, the overall procedure is still cumbersome and costly. If the patient is not already in a hospital, he usually has to go there or to a doctor's office. If there is the slightest suspicion of an abnormality in his ECG, the squiggly lines on ruled paper must be interpreted by an expert cardiologist, whose eyes are understandably bleary at day's end. ECGs taken under standard conditions cost $10 to $15.

Now, with the aid of a portable electrocardiograph, some special telephone equipment and a computer, the U.S. Public Health Service is testing a technique that will allow ECGs to be taken routinely in patients' homes and analyzed within seconds by an electronic brain--all for $1 a heart.

Ten-Second Signals. The procedure was tested last week in home calls by nurses from the Alexandria, Va., Health Department carrying a nine-pound portable cardiograph, the size and shape of a small tape recorder. After a routine check on the patient's health, the nurse pulls four wires out of the Honeywell Cardioview box, and tapes the attached electrodes to the patient's arms and legs. Next, she picks up the patient's phone and dials a number. When she hears an answering signal, she gives the department's code number for this patient. Without another word, she shoves the telephone mouthpiece into the receptacle of a Bell Dataphone attached to the cardiograph. Then she throws a switch.

The minute electrical currents in the patient's skin, reflecting the motions of his heart, are picked up by the cardiograph. In the Dataphone they are amplified and converted into high-frequency signals for clear transmission. At the other end of the line, in an engineer ing laboratory at George Washington University, a receiver automatically switches on a tape recorder when the nurse's call comes in. The recorder dutifully notes the squeaky sounds it receives as the nurse transmits a ten-second signal from each of the cardiograph leads.

The receiver at G.W. shuts itself off when the nurse hangs up the phone, but then more significant electrical wizardry takes over. The recorded tape is fed into a desk-size computer developed for the PHS's Heart Disease Control Program. The computer "listens" to as much of the ten-second recording from each lead as it needs to get the pattern, and shows the patient's heart currents on an oscilloscope screen. It also reduces them to electrical impulses on a numbered scale that it stores in its memory.

A physician, using his long, specialized experience in reading ECGs, can interpret the squiggled paper from the nurse's Cardioview if an abnormality is suspected. The computer, with its electronic brain, interprets the impulse scale in a fraction of a second, and it does this superhuman job accurately enough to show instantly whether there is any ECG abnormality.

Possibilities for Prevention. The possibilities that home ECGs will open up for preventive medicine are enormous. But even more important, in the imaginative view of PHS's Dr. Cesar Caceres, are possibilities for automating and computerizing half a dozen other tests which cannot yet be given routinely. The most obvious example is an electroencephalogram, or brain-wave recording. But there is virtually no limit to the capabilities of the Dataphone-computer combination. It can be adapted to measure and record muscle strength, the efficiency of air exchange in the lungs, and even make something scientifically precise of the crude knee-jerk reflex test.

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