During the global emergency of COVID 19 when we were not able to avail a face-to-face physician consultation, the virtual care saved us. Telemedicine is now an emerging technology in health care meeting the patients’ needs. Cardiovascular medical practice has moved a step ahead with remote processing of cardiac diseases through telecardiology. Real time patient management is possible even during critical conditions like CHF and cardiac arrests.

Tele ECG and its recordings

The main purpose of telehealth cardiology monitoring is to record ECG at any place and the processed signals are send to the cardiologist immediately. A specialized hand held ECG unit records the ECG, encoding signals into a sound  and transmitted through a telephone line to the web based cardiology center. The sound is decoded and finally interpreted by a cardiologist. In advanced technologies, watch like devices enable transmission of single lead ECG’s to help in diagnosis faster.

Elements of telecardiology

The tele ECG can be obtained by direct skin contact of metal electrodes or adhesive electrodes. Recordings till 12 leads are possible. RR interval, PQ interval, QRS width and QT interval are measured. Depending on the manufacturers telecardiology devices may be grouped as

• ECG event recorders or ECG monitoring cards-1 or 12 lead ECG recording is possible. It is a battery powered portable device where the patients can themselves record their ECG when they develop symptoms like palpitation, dizziness, weakness, nausea etc. However, due to the lack of awareness of symptoms patients waited too long for recording the ECG increasing mortality.so a need to educate the people was necessary.
• External loop recorder-Here 1 ,2or 3 lead ECG can be recorded. This device allows automated recording and transmission of events in asymptomatic patients. Even before occurrence of symptoms, ECG can be recorded. The heart rate can be recorded up to 7 days continuously so that any issues of the heart can be noticed.
• Implantable loop recorder-This is a subcutaneous device but the need for surgery to implant the device is a major disadvantage.                

Applications of telecardiology

  1. Pre hospital application

In case of acute myocardial infarction with ST segment elevation, percutaneous coronary intervention (PCI) must be performed within 90 minutes to save the patient. This door to balloon interval is minimized and made feasible through telecardiology application by recording ECG even from a moving ambulance. This saves time as the patients can present themselves directly to the PCI. In addition, this timely process helps in the reduction of the infarct size reducing mortality.

2. In hospital application

This application is useful for referring ECG’s between rural to tertiary hospitals. This technology is widely used in pediatric cardiology care where professional cardiologists are rarely accessible in rural areas .This helps in timely diagnosis and reduces transportation time from shifting the patients to higher centers.. Dobutamine stress tele echo cardiography (DSTE) performed at the Emergency Department for patients with myocardial infarction complaining of sudden chest pain can be immediately interpreted with cardiologists of tertiary hospitals. Advancement has made remote cardiologists to access ECG’s even on their smart phone when an emergency alarm has been requested from a primary care center.

3.Post hospital application

     a) Rehabilitation after a cardiac surgery

              For follow-ups after a cardiac surgery, telecardiology has been useful and avoids readmission of patients.

   b) For patients with implantable cardiac devices

             When patients using pacemaker, implantable cardioverter defibrillator, comes for their regular check up it is more time consuming. However, telecardiology can access their function in remote and manage them. In pediatric cases, a telephonic stethoscope placed on the child can easily diagnose cardiac murmurs.

Uses of tele monitoring in cardiac patients

• Mortality rate is greatly reduced.
• Transportation of  patients to other hospitals are limited and so its cost effective
• Even elderly people can easily access the device and learn its recordings
• Low power consumption
• Old data are already stored by the device so it helps in further follow ups
• Increases bonding between general physicians and cardiologists that boosts the healthcare domain.
• Enables hospitals to provide quick and safe better care
• Reduces the number of visitors to hospitals
• Lessens physician burnout
• Chronic disease management is greatly increased.

Limitations of telecardiology

• Insurance payers only consider the teleconferencing visits .so cardiologists or the patient has to bear the amount.
• Despite its positive results sometimes patient will have to travel for any emergency to visit cardiologist in person.
• Though there are many softwares none are specifically designed for cardiology. So integrating the components is getting difficult as the same call center might receive ECG’s from different devices causing confusion.

Conclusion

Future of cardiovascular healthcare is highly dependent on telecardiology. Medical practice is been made easy by advanced technologies in information technology. This in turn builds a beautiful patient physician bonding .Real time transfer of ECG’s can save lives during emergencies. Though there are operational and financial limitations, telecardiology is moving a step ahead especially after the pandemic.

REFERENCES

Telecardiology and its settings of application: An update-Research gate

(PDF) Telecardiology Tools and Devices (researchgate.net)

Telecardiology through ubiquitous Internet services | Carlos Costa - Academia.edu