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OVERVIEW Cardiovascular technologists assist physicians in diagnosing and treating heart and blood vessel ailments. Depending on their specialties, they operate electrocardiograph machines, perform Holter monitor and stress testing, and assist in cardiac catheterization procedures and ultrasound testing. These tasks help the physicians diagnose heart disease and monitor progress during treatment. Cardiovascular technologists hold approximately 39,000 jobs in the United States. HISTORY Electrocardiography can be traced back 300 years to the work of the Dutch anatomist and physiologist Jan Swammerdam, who in 1678 demonstrated that a frog’s leg will contract when stimulated with an electrical cur rent. It was not until 1856, however, that two German anatomists, Albert von Kolliker and Heinrich M. Mueller, showed that when a frog’s heart contracted, it produced a small electrical current. In succeeding years, the electrical behavior of beating hearts was extensively studied, but always with the chest open and the heart exposed. In 1887, Augustus Desire Wailer discovered that the electrical current of the human heart could be measured with the chest closed. He was able to do this by placing one electrode on a person’s chest and another on the person’s back and connecting them to a monitoring device. In 1903 Willem Einthoven, a Dutch professor of physiology, perfected the monitoring device so that even the faintest currents from the heart could be detected and recorded graphically. Throughout the rest of the 20th century, medical researchers made further advancements and refinements on this machine. By the 1 940s, for instance, portable electrocardiographs were in use, allowing electrocardiograms to be made in a physician’s office or at a patient’s bed side. During the 1960s, computerized electrocardiographs were developed to aid physicians in the interpretation of test results. Today, electrocardiographs are widely used in routine physicals, in presurgical physicals, in diagnosing disease, and in monitoring the effects of prescribed therapy. The wide use of these devices ensures a continuing need for trained personnel to operate them. THE JOB Technologists who assist physicians in the diagnosis and treatment of heart disease are known as cardiovascular technologists. (Cardio means heart; vascular refers to the blood vessel/circulatory system.) Increasingly, hospitals are centralizing cardiovascular services under one full cardiovascular “service line” overseen by the same administrator. In addition to cardiovascular technologists, the cardiovascular team at a hospital may include radiology (X-ray) technologists, nuclear medicine technologists, nurses, physician assistants, respiratory technicians, and respiratory therapists. For their part, the cardiovascular technologists contribute by performing one or more of a wide range of procedures in cardiovascular medicine, including invasive (enters a body cavity or interrupts normal body functions), non- invasive, peripheral vascular, or echocardiography (ultrasound) procedures. In most facilities, technologists use equipment that is among the most advanced in the medical field; drug therapies also may be used as part of the diagnostic imaging procedures or in addition to them. Technologists’ services may be required when the patient’s condition is first being explored, before surgery, during surgery (cardiology technologists primarily), or during rehabilitation of the patient. Some of the work is performed on an outpatient basis. Depending on their specific areas of skill, some cardiovascular technologists are employed in nonhospital health care facilities. For example, they may work for clinics, mobile medical services, or private doctors’ offices. Much of their equipment can go just about anywhere. Some of the specific duties of cardiovascular technologists are described in the following paragraphs. Exact titles of these technologists often vary from medical facility to medical facility because there is no standardized naming system. Electrocardiograph technologists, or EKG technologists, use an electrocardiograph machine to detect the electronic impulses that come from a patient’s heart. The EKG machine records these signals on a paper graph called an electrocardiogram. The electronic impulses recorded by the EKG machine can tell the physician about the action of the heart during and between the individual heartbeats. This in turn reveals important information about the condition of the heart, including irregular heartbeats or the presence of blocked arteries, which the physician can use to diagnose heart disease, monitor progress during treatment, or check the patient’s condition after recovery. To use an EKG machine, the technologist attaches electrodes (small, disklike devices about the size of a silver dollar) to the patient’s chest. Wires attached to the electrodes lead to the EKG machine. Twelve or more leads may be attached. To get a better reading from the electrodes, the technologist may first apply an adhesive gel to the patient’s skin that helps to conduct the electrical impulses. The technologist then operates controls on the EKG machine or (more commonly) enters commands for the machine into a computer. The electrodes pick up the electronic signals from the heart and transmit them to the EKG machine. The machine registers and makes a print out of the signals, with a stylus (pen) recording their pattern on a long roll of graph paper. During the test, the technologist may move the electrodes in order to get readings of electrical activity in different parts of the heart muscle. Since EKG equipment can be sensitive to electrical impulses from other sources, such as other parts of the patient’s body or equipment in the room where the EKG test is being done, the technologist must watch for false readings. After the test, the EKG technologist takes the electrocardiogram off the machine, edits it or makes notes on it, and sends it to the physician (usually a cardiologist, or heart specialist). Physicians may have computer assistance to help them use and interpret the electrocardiogram; special software is available to assist them with their diagnoses. EKG technologists do not have to repair EKG machines, but they do have to keep an eye on them and know when they are malfunctioning so they can call someone for repairs. They also may keep the machines stocked with paper. Of all the cardiovascular technical positions, EKG technologist positions are the most numerous. Holter monitoring and stress testing may be performed by Holter monitor technologists or stress test technologists, respectively, or they may be additional duties of some EKG technologists. In Holter monitoring, electrodes are fastened to the patient’s chest, and a small, portable monitor is strapped to the patient’s body, often at the waist. The small monitor contains a magnetic tape or cassette that records the action of the heart during activity—as the patient moves, sits, stands, sleeps, etc. The patient is required to wear the Holter monitor for 24-48 hours while he or she goes about normal daily activities. When the patient returns to the hospital, the technologist removes the magnetic tape or cassette from the monitor and puts it in a scanner to produce audio and visual representations of heart activity. (Hearing how the heart sounds during activity helps physicians diagnose a possible heart condition.) The technologist reviews and analyzes the information revealed in the tape. Finally, the technologist may print out the parts of the tape that show abnormal heart patterns or make a full tape for the physician. Stress tests record the heart’s performance during physical activity. In one type of stress test, the technologist connects the patient to the EKG machine, attaching electrodes to the patient’s arms, legs, and chest, and obtains a reading of the patient’s resting heart activity and blood pressure. Then, the patient is asked to walk on a treadmill for a designated period of time while the technologist and the physician monitor the heart. The treadmill speed is increased so that the technologist and physician can see what happens when the heart is put under higher levels of exertion. Cardiology technologists specialize in providing support for cardiac catheterization (tubing) procedures. These procedures are classified as invasive because they require the physician and attending technologists to enter a body cavity or interrupt normal body functions. In one cardiac catheterization procedure—an angiogram—a catheter (tube) is inserted into the heart (usually by way of a blood vessel in the leg) in order to see the condition of the heart blood vessels, whether there is a blockage. In another procedure, known as angioplasty, a catheter with a balloon at the end is inserted into an artery to widen it. According to the American Heart Association’s 2001 Heart and Stroke Statistical Update, 1,069,000 angioplasties were done in the United States in 1999. Of these, 601,000 were percutaneous transluminal coronary angioplasties. Cardiology technologists also perform a variety of other procedures. Unlike some of the other cardiovascular technologists, cardiology technologists actually assist in surgical procedures. They may help secure the patient to the table, set up a 35mm video camera or other imaging device under the instructions of the physician (to produce images that assist the physician in guiding the catheter through the cardiovascular system), enter into a computer information about the surgical procedure (as it is taking place), and provide other support. After the procedure, the technologist may process the angiographic film for use by the physician. Cardiology technologists may also assist during open-heart surgery by preparing and monitoring the patient and placing or monitoring pacemakers. Vascular technologists and echo-cardiographers are specialists in noninvasive cardiovascular procedures and use ultrasound equipment to obtain and record information about the condition of the heart. Ultrasound equipment is used to send out sound waves to the area of the body being studied; when the sound waves hit the part being studied, they send echoes to the ultrasound machine. The echoes are “read” by the machine, which creates an image on a monitor, permitting the technologist to get an instant “image” of the part of the body and its condition. Vascular technologists are specialists in the use of ultra sound equipment to study blood flow and circulation problems. Echo-cardiographers are specialists in the use of ultrasound equipment to evaluate the heart and its structures, such as the valves.
Cardiac monitor technicians are similar to and sometimes per form some of the same duties as EKG technologists. Usually working in the intensive care unit or cardio-care unit of the hospital, cardiac monitor technicians keep watch over the patient, monitoring screens to detect any sign that a patient’s heart is not beating as it should. Cardiac monitor technicians begin their shift by reviewing the patient’s records to familiarize themselves with what the patient’s nor mal heart rhythms should be, what the current pattern is, and what types of problems have been observed. Throughout the shift, cardiac monitor technicians watch for heart rhythm irregularities that need prompt medical attention. Should there be any, they notify a nurse or doctor immediately so that appropriate care can be given. In addition to these positions, other cardiovascular technologists specialize in a particular aspect of health care. For example, cardiopulmonary technologists specialize in procedures for diagnosing problems with the heart and lungs. They may conduct electrocardiograph, phonocardiograph (sound recordings of the heart’s valves and of the blood passing through them), echocardiograph, stress testing, and respiratory test procedures. Cardiopulmonary technologists also may assist on cardiac catheterization procedures, measuring and recording information about the patient’s cardiovascular and pulmonary systems during the procedure and alerting the cardiac catheterization team to any problems. REQUIREMENTS High School At a minimum, cardiovascular technologists need a high school diploma or equivalent to enter the field. Although no specific high school classes will directly prepare you to be a technologist, good study skills and a firm grounding in basic high school subjects are important to all technologist positions. During high school, you should take English, health, biology, and typing. You also might consider courses in social sciences to help you understand the social and psychological needs of patients. Postsecondary Training In the past, many EKG operators were trained on the job by an EKG supervisor. This still may be true for some EKG technician positions. Increasingly, however, EKG technologists get postsecondary schooling before they are hired. Holter monitoring and stress testing may be part of your EKG schooling, or they may be learned through additional training. Ultrasound and cardiology technologists tend to have the most postsecondary schooling (up to a four-year bachelor’s degree) and have the most extensive academic/experience requirements for credentialing purposes. You can enter these positions without having had previous health care experience. However, some previous exposure to the business side of health care or even training in related areas is helpful. With academic training or professional experience in nursing, radiology science, or respiratory science, for example, you may be able to move into cardiology technology. As a rule of thumb, medical employers value postsecondary schooling that gives you actual hands-on experience with patients in addition to classroom training. At many of the schools that train cardiovascular technologists, you work with patients in a variety of health care settings and train on more than one brand of equipment. Some employers still have a physician or EI<G department manager train EKG technicians on the job. Training generally lasts from one to six months. Trainees learn how to operate the EKG machine, how to produce and edit the electrocardiogram, and other related tasks. Some vocational, technical, and junior colleges have one- or two- year training programs in EKG technology, Holter monitoring, stress testing, or all three; otherwise, EKG technologists may obtain training in Holter and stress procedures after they’ve already started working, either on the job or through an additional six months or more of schooling. Formal academic programs give technologists more preparation in the subject than is available with most on-the-job training and allow them to earn a certificate (one-year programs) or associate’s degree (two-year programs). The American Medical Association (AMA)’s Allied Health Directory has listings of accredited EKG programs. Ultrasound technologists usually need a high school diploma or equivalent plus one, two, or four years of postsecondary schooling in a trade school, technical school, or community college. Vascular technologists also may be trained on the job. Again, a list of accredited programs can be found in the AMA’s Allied Health Directory; also, a directory of training opportunities in sonography is available from the Society of Diagnostic Medical Sonography. Cardiology technologists tend to have the highest academic requirements of all: a four-year bachelor of science degree, a two-year associate’s degree, or a certificate of completion from a hospital, trade, or technical cardiovascular program. A two-year program at a junior or community college might include one year of core classes (e.g., mathematics, biology, chemistry, and anatomy) and one year of specialized classes in cardiology procedures. Cardiac-monitor technicians need in a high school diploma or equivalent, with additional educational requirements similar to those of EKG technicians. Certification or Licensing Right now, certification or licensing for cardiovascular technologists is voluntary, but the move to state licensing is expected in the near future. Many credentialing bodies for cardiovascular and pulmonary positions exist, including American Registry of Diagnostic Medical Sonographers (ARDMS), Cardiovascular Credentialing International (CCI), and others, and there are more than a dozen possible credentials for cardiovascular technologists. For example, sonographers can take an exam from ARDMS to receive credentialing in sonography. Their credentials may be as registered diagnostic medical sonographer, registered diagnostic cardiac sonographer, or registered vascular technologist. Credentialing requirements for cardiology technologists or ultrasound technologists may include a test plus formal academic and on-the-job requirements. Professional experience or academic training in a related field, such as nursing, radiology science, and respiratory science, may be acceptable as part of these formal academic and professional requirements. As with continuing education, certification is a sign of interest and dedication to the field and is generally favorably regarded by potential employers. Cardiology is a cutting-edge area of medicine that undergoes constant advancements, and medical equipment relating to the heart is continually updated. Therefore, keeping up with new developments is vital. In addition, technologists who add to their qualifications through taking part in continuing education tend to earn more money and have more employment opportunities. Major professional societies encourage and provide the opportunities for professionals to continue their education. Other Requirements Technicians must be able to put patients at ease about the procedure they are to undergo. Therefore, you should be pleasant, patient, alert, and able to understand and sympathize with the feelings of others. When explaining a procedure to patients, cardiovascular technicians should be able to do so in a calm, reassuring, and confident manner. EXPLORING Prospective cardiovascular technologists will find it difficult to gain any direct experience on a part-time basis in electrocardiography. The first experience with the work generally comes during on-the-job training sessions. You may, however, be able to gain some exposure to patient-care activities in general by signing up for volunteer work at a local hospital. In addition, you can arrange to visit a hospital, clinic, or physician’s office where electrocardiographs are taken. In this way, you may be able to watch a technician at work or at least talk to a technician about what the work is like. EMPLOYERS There are approximately 39,000 cardiovascular technologists employed in the United States. Most work in hospitals, but employment can be found in physicians’ offices, clinics, rehab centers, or anyplace electro cardiographs are taken. STARTING OUT Because most cardiovascular technologists receive their initial training on their first job, great care should be taken in finding your first employer. Pay close attention not only to the pay and working conditions, but also to the kind of on-the-job training that is provided for each prospective position. High school vocational counselors may be able to tell you which hospitals have good reputations for l ; training programs. Applying directly to hospitals is a common way of entering the field. Information also can be gained by reading the classified ads in the newspaper and from talking with friends and relatives who work in hospitals. For students who graduate from one- to two-year training pro grams, finding a first job should be easier. First, employers are always eager to hire people who are already trained. Second, these graduates can be less concerned about the training programs offered by their employers. Third, they should find that their teachers and guidance counselors can be excellent sources of information about job possibilities in the area. If the training program includes practical experience, graduates may find that the hospital in which they trained or worked before graduation would be willing to hire them after graduation. ADVANCEMENT Opportunities for advancement are best for cardiovascular technologists who learn to do or assist with more complex procedures, such as stress testing, Holter monitoring, echocardiography, and cardiac catheterization. With proper training and experience, these technicians may eventually become cardiovascular technologists, echocardiography technologists, cardiopulmonary technicians, cardiology technologists, or other specialty technicians or technologists. In addition to these kinds of specialty positions, experienced technicians may also be able to advance to various supervisory and training posts. EARNINGS The median salary for cardiovascular technologists was $33,350 in 2000, according to the U.S. Department of Labor. The lowest paid 10 percent earned less than $19,540, and the highest paid 10 percent earned more than $52,930 annually. Earnings can vary by size and type of employer. For example, technologists working in physicians’ offices had the median annual income $33,100, while those in hospitals had the median $32,860. Those with formal training earn more than those who trained on the job, and those who are able to perform more sophisticated tests, such as Holter monitoring and stress testing, are paid more than those who perform only the basic electro cardiograph tests. Technologists working in hospitals receive the same fringe benefits as other hospital workers, including medical insurance, paid vacations, and sick leave. In some cases, benefits also include educational assistance, retirement plans, and uniform allowances. WORK ENVIRONMENT Cardiovascular technologists usually work in clean, quiet, well- lighted surroundings. They generally work five-day, 40-hour weeks, although technicians working in small hospitals may be on 24-hour call for emergencies, and all technicians in hospitals, large or small, can expect to do occasional evening or weekend work. With the growing emphasis on cost containment in health care, more jobs are likely to develop in outpatient settings, so in the future it is likely that cardiovascular technologists will work more often in clinics, health maintenance organizations, and other nonhospital locations. Cardiovascular technologists generally work with patients who are ill or who have reason to fear they might be ill. With this in mind, there are opportunities for the technicians to do these people some good, but there is also a chance of causing some unintentional harm as well: A well-conducted test can reduce anxieties or make a physician’s job easier; a misplaced electrode or an error in recordkeeping could cause an incorrect diagnosis. Technicians need to be able to cope with these responsibilities and consistently conduct their work in the best interests of their patients. Part of the technician’s job includes putting patients at ease about the procedure they are to undergo. Toward that end, technicians should be pleasant, patient, alert, and able to understand and sympathize with the feelings of others. In explaining the nature of the procedure to patients, cardiovascular technicians should be able to do so in a calm, reassuring, and confident manner. Inevitably, some patients will try to get information about their medical situation from the technician. Technicians must remind patients that the interpretation is for the physician to make. Another large part of a technician’s job involves getting along well with other members of the hospital staff. This task is sometimes made more difficult by the fact that in most hospitals there is a formal, often rigid, status structure, and cardiovascular technologists may find themselves in a relatively low position in that structure. In emergency situations or at other moments of frustration, cardiovascular technologists may find themselves dealt with brusquely or angrily. Technicians should not take outbursts or rude treatment personally, but instead should respond with stability and maturity. OUTLOOK The overall employment of cardiovascular technologists and technicians should grow faster than the average through 2010, according to the U.S. Department of Labor. Growth will be primarily due to the increasing numbers of older people who have a higher incidence of heart problems. However, the Department of Labor projects employment for EKG technicians to decline during this same period as hospitals train other health care personnel to perform basic EKG procedures. FOR MORE INFORMATION For information on careers, contact Alliance of Cardiovascular Professionals 4456 Corporation Lane, #164 Virginia Beach, VA 23462 Tel: 757-497-1225 For information on the medical field, including listings of accredited medical programs, contact American Medical Association 515 North State Street Chicago, IL 60610 Tel: 312-464-5000 For information on certification or licensing, contact American Registry of Diagnostic Medical Sonographers 51 Monroe Street Plaza East One Rockville, MD 20850-2400 Tel: 800-541-9754 For information on credentials, contact Cardiovascular Credentialing International 4456 Corporation Lane, Suite 120 Virginia Beach, VA 23462 Tel: 800-326-0268 Next: Dental Laboratory Technicians Prev.: Biomedical Equipment Technicians |
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