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| MESSAGE TO THE HEALTHCARE SPECIALIST
The Specialists are a gifted group of physicians, however, too often scanning centers bind your hands because the technologist, or in some clinics, individuals taught to operate the analyzer are not capable of, or are lacking the education required to assess causative mechanisms, drug efficacy assessment, pacemaker malfunction, complex arrhythmias, as well as vasovagal effects on the cardiac cycle, to mention a few. I taught cardiology technology for over fifteen years, fulltime at a private medical college. I was also the National Program Coordinator. As a former valedictorian of the program, I have spent years studying not only the advanced concepts of electrocardiology, but also the subtle and often overlooked changes that can make the difference in the diagnosis of a condition. For eleven years I have held the board position as Director of Continuing Education for OSCT (Ontario Society of Cardiology Technologists) this is a provincial association of CSCT (Canadian Society of Cardiology Technologists) the CMA recognized governing association for Cardiology Technologists. I received the top mark in Canada when I wrote the National Cardiology Technologist examination. Our focus is to remove as much guess work as possible by correlating findings to patient activity, medication intake, and autonomic variations that affect the rhythm strip. Many of these findings may be normal, but can be perceived as CAD suggestive if only the strip is given, without correlating evidence. This may result in unnecessary additional expensive testing, coupled with the added stress to the patient. At Canadian Cardiology Services, we will not compromise the value of the DIARY. I cannot count how many times I have seen reports without a diary. I spoke with a cardiologist that said, “I don’t use one”. When I asked how do you differentiate ST depression caused by valsalva, post prandial, postural changes, medication effects, smoking, hyperventilation etc, his reply was “ Could you provide me with a diary?” As our name Canadian Cardiology Services suggests, we have committed to this. SERVICES refers to a commitment to provide the specialists with thoughtful and well-correlated anomalies found, so that the value of the holter report, as well as the algorithms would be realized, and ultimately partner with you for the benefit of the patient. Too often scanners are concerned with “ Show them the ectopic beats”. Many of our patients are on medications. I do not over-look the efficacy of the medication. I note when it was taken and then monitor ectopic activity and correlate the ectopic activity in reference to time frame. I will monitor ectopic activity prior to the patients’ next intake of medication. This may assist the specialist in adjusting the frequency of medication, or adding a medication if needed. It may also provide enough information for the Specialist to discontinue the medication. WORKING WITH YOUR SCANNING PROVIDER – At Canadian Cardiology Services, we encourage the specialists to inform us of your concerns for the patients as well as patient history. We are educated, and this information will assist us in deciding the appropriate lead placement for the test. I will indicate the placement site selected, or will comply with your request. Our standard hookup is a MV1 and MV5. These views assist in assessing RBBB, LBBB, LVH, RVH, RVPVC, LVPVC, aberrancy of both branches, both intermittent and rate related. We try and avoid a L11 hookup because all of the above can look the same in L11. We encourage you to advise us of lead preference in the event you are looking for causative mechanisms, eg: accessory pathways, PAT, AVNRT, CMT, and WPW assessment during increased heart rate, placing the patient at risk if rapid arrhythmias develop and delta waves persist, indicating good antegrade conduction. ( RFA consideration ) In closing, I cannot tell you how many times arrhythmias, as well as pseudoarrhythmias were not provided to the physician because the scanner did not know what they were and choose not to present the strips for your assessment. This again binds your hands. At Canadian Cardiology Services, I am not concerned with being able to interpret every event, but I will guarantee you that I will send you the event for your professional assessment, rather than discarding the anomaly, and once again falsely diminishing the efficacy and value of the holter scan. Our commitment to our physicians and patients will be to always analyze every report as though it was a member of our family. I have instilled this attitude in my students for over a decade, and Canadian Cardiology Services will not compromise these principles at any cost. It is our hope that you will access our service and evaluate the quality of the report provided to you and become a long-term partner with us. Canadian Cardiology Services will only employ registered technologists that successfully completed post-secondary education, and passed the CSCT national exam. Sincerely, Don McCoy RCTC Canadian Cardiology Services
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