ActiveECG review, page 3: In a Doctor's Office

By: Alec Cooper MD

A few weeks ago, a 79 year old gentleman with a history of Chronic Obstructive Pulmonary Disease and Biventricular Heart Failure came to my office on a routine visit. He has over the last year developed a tendency to pop in and out of pulmonary edema with the slightest cold or runny nose. I see him weekly in order to check and adjust his Lasix and anti-hypertensives.


On this visit I perceived an irregularly irregular heartbeat while taking his blood pressure and I feared that he may have newly developed atrial fibrillation, perhaps due to cardiac dilatation secondary to inadequate diuresis over the previous week.

In my family medicine clinic, I would have ordinarily sent this patient to the hospital emergency room next door for an ECG, but this time I had another trick up my sleeve (almost literally!). I reached into my medical bag and pulled out "ActiveECG", a Palm handheld-sized device and a portable hot-sync cable. Slipping my Palm IIIc out of my pocket, I then connected it to the device, unravelled three wires from a moulded plastic "raceway" on the device's flat surface, connected them to the patient with three sticker-electrodes and presto, within 30 seconds I was watching this patient's cardiac rhythm on my Palm IIIc screen. The rhythm plainly showed occasional premature ventriclar singlets with no fibrillation, and I was able to confidently reassure myself and my patient that no visit to the Emergency Room was necessary this time around.

This case differed from another one I had seen the previous week where another cardiac patient came to my weekly walk-in clinic with his home-care nurse. He was complaining of shortness of breath. On exam, he was pale and his pulse was rapid. Within a minute, I had a rhythm strip of rapid atrial fibrillation recorded in my Palm IIIc memory. I called my secretary Manon, giving her my handheld for hot-syncing on the cradle I have permanently connected at her Windows work station. While I telephoned the duty emergency physician, Manon printed out the strip on a neatly formatted page containing all the data I had entered on the Palm IIIc; (name, age of patient, date, time of strip), and of course, the strip, with standard ECG gridding: all this onto a blank sheet of standard office paper, thanks to the ActiveECG software that is supplied with this remarkable Palm OS accessory.

I sent this sheet off with the patient to Emergency, printing out an identical second sheet for my office chart. A few eyebrows were doubtless raised amongst the triage nursing and medical staff and the hospital next door, all the while saving precious pre-hospital diagnostic time.

The hardware is robust and as easy to hook up to a Palm OS handheld as any portable hot sync cable or accessory. The screen display is entered in the usual manner by tapping an icon that runs the Palm OS-side of the software. It is easy to read, with centimeter-wide buttons that can be customized to enter specific data such as custom office chart numbers. I found the real-time moniter easy to read, with excellent black/white contrast on a Palm IIIc. The number of patient ECGs you can enter and save on your Palm OS Handheld is only limited by the available memory (ie what other programs and data you have on your device at the time).

I found Active ECG was indeed a welcome addition to my retinue of Palm IIIc accessories that includes the Kodak PalmPix for photographing wounds and skin infections, the Palm Keyboard for note taking, the portable recharger, and extra cradles for the office.

Is it a "must have"? Well, I could see this device being especially useful in the pre-hospital emergency "first-response" setting such as is more frequently seen in paramedic and ambulance work. In the two months I have carried this device around in my medical bag, I have taken it out about a dozen times. That includes a couple of "gadget demonstrations" for physician friends and family, a few routine rhythm strips that I added to patient charts, and the two cases described above. I have used the Active ECG on several housecall visits as well. Finally, I used ActiveECG this morning to record a strip on an asymptomatic patient. He graciously allowed a nurse to photograph the procedure (with my wife's Palm + my PalmPix attachment) for this article. In return for his kind cooperation, I was able to assure him and his wife that their hearts were just fine.

ActiveECG is an extremely convenient if somewhat luxurious accessory to have in a medical bag. As far as my part-time emergency room work is concerned, the ActiveECG is not really useful except perhaps as a far-fetched back-up system in the event of multiple-level power failures affecting the usual cardiac monitering and ECG equipment!

All the same...the next time I'm at a public event or flying the friendly skies, and that dreaded announcement "Is there a doctor in the house ?" comes over the public address system... along with a stethoscope and maybe a nitrospray puffer, I think I would feel quite content knowing I had ActiveECG-enabled Palm handheld along for the ride!

Alec Cooper, MD



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