Capital Cardiology Associates
Holiday Heart Gift:
The Apple Watch Series 4
Why the Apple Series 4 Watch is the hot, holiday gift idea for heart patients this year
When was the last time you bought your parent or grandparent a watch? Spoiler alert: the hottest gift this Holiday Shopping Season will most likely be the latest wearable gadget, the Apple Watch Series 4.
As with most Apple product releases, the Apple Watch Series 4 announcement came with much excitement and wonder just before the Holiday Shopping season. Surprisingly, the flatter design, faster processing speeds, and new look were not what drove the anticipation. The new Apple Watch is the first smart-watch that can monitor your heart, and if it detects an irregular heart rhythm, notify you and record the episode. There’s more. That feature, when combined with the fall detection tech in the watch, enables the watch to call emergency services if you fall and are unresponsive for 60-seconds. The Apple Watch will also send your location with a message to your emergency contacts.
If you have a family member or loved one who is at risk of heart events, you can see why this watch is on the top of most shopping wish lists
Typically, as a Wristly report from 2016 shows, men who work outside of the tech industry (45%), are over the age of 55 (29%), followed by 45-54 year olds (25%) — own an Apple Watch. Most (27%) of those surveyed say they purchased the watch, “as a new type of computer on my wrist” to receive “notifications.” However, just two years ago, the most an Apple Watch could do at that time was serve as a glorified pedometer for tracking runs, workouts, and activity. In the Apple Watch Series 2 in 2016, Apple began to reveal it’s intentions to take their technology beyond tracking activity and workouts. Their core customer is a middle-aged, professional man with an interest in health and fitness. As Apple stated in their 2016 press release, “Apple Watch Series 2 is packed with features to help our customers live a healthy life.”
Technology that tracks your heartbeat
Fast forward two years. Apple is now working to get the ECG app and irregular rhythm notification out by the end of 2018. When the ECG app is live, the Apple Watch Series 4 will be capable of “generating an ECG similar to a single-lead electrocardiogram,” states the Apple website. This new feature is intended to, “indicate whether your heart rhythm shows signs of atrial fibrillation (AFib).” Dr. Lance Sullenberger, board-certified cardiologist at Capital Cardiology Associates, stated that “Atrial fibrillation is the most common abnormality that we experience in cardiology.”
The most common symptom of AFib is an irregular heartbeat or palpitations. Dr. Sullenberger describes a thumping or racing heart, some patients experience fluttering or feeling like their heart is skipping a beat. Other common symptoms are shortness of breath, dizziness or light-headedness, and fatigue. If you experience these symptoms, contact your doctor immediately. “Everyday I see patients who have heart palpitations,” notes Sullenberger. “What we are really trying to determine when we see a patient with palpitation is: do they have atrial fibrillation?”
The new Series 4 watch will be able to read your heart’s electrical signals, if it detects an irregularities, record the ECG waveform, and store the results in Health app on your iPhone. The Apple Heart Study, conducted by Apple and Stanford University, provided to the Food and Drug Administration, showed the app was able to “identify over 98% of the patients who had AFib, and over 99% of patients that had healthy heart rates. Cardiologists were able to read 90% of the total readings, although about 10% of them were unreadable.” This would put critical data on your arm, or in your phone, for doctors to review. For the starting price of $399, you can purchase a wearable heart-tracker that also tells time, keeps you connected with texts/email, and has a slew of other health and fitness apps.
Concerns from the medical community
Rich Mogull, a Boulder, Colorado EMT and blogger stated, “thanks to its health monitoring features, the new Apple Watch Series 4 will save lives, probably within weeks of launch.” In his article, he addressed the very technical education needed to understand an ECG. This is where lies the concern. How many of us can identify the P-Wave, the QRS complex, and T-Wave on an electrocardiogram graph?
Electrocardiography (ECG, EKG) is a test of your heart. It lets your doctor see how well your heart is working. A doctor can use this test to find out if you have a heart problem, or to monitor a heart problem your doctor already knows you have. During a standard test, you lie still as the electrodes monitor your heart. The electrodes detect the electrical waves your heart makes. This is recorded on a chart. They can see if it has a steady rhythm. And, they can detect the strength of the electrical signals that trigger your heartbeat. It usually takes about five to ten minutes to complete the test.
The science of detecting and measuring electrical currents in your body dates back to 1790, when Luigi Galvani, an Italian physician, physicist, biologist and philosopher, discovered electricity in the body. He found that the muscles of dead frogs’ legs twitched when struck by an electrical spark, using a copper base, zinc connector, and a metal rod applied to the frog legs. It wasn’t until the mid 1880’s when the first practical ECG machine which was invented by Augustus Desiré Waller. This was the first time that physicians could record the heart’s electrical activity from skin surfaces. In 1901, a Dutch doctor and physiologist, Willem Einthoven, used wires, a large magnet, a light bulb, and a silvered wire to build the first EKG machine. He was able to read the heart’s waves on a scroll of photographic paper.
Over 100 years later, we live in a time when the heart’s abnormal electrical activity can be detected and recorded from a device strapped to our wrist.
The concern from medical professionals is not over the quality of the EGC from an Apple Watch. The question is whether patients will be able to understand what the readings mean and know when it’s time to seek medical attention. “How to read an ECG” is something you can search online. What you find is math, being able to identify irregular rhythms, measuring the cardiac axis by using leads (I, II, III), looking at the P-Waves to identify atrial activity, evaluating the P-R interval, assessing the QRS complex, and evaluating the ST, T, and U waves. The complexity of reading an ECG is overwhelming; processing and diagnosing the cardiac physiology is much more in depth.
“This complexity means that patients should not rely on the internet or step-by-step guides to diagnose their own symptoms,” stated Maryellen King, an Advance Practice Nurse. In addition to working with heart failure patients in the hospital as well as in outpatient settings, Maryellen is also Manager of Remote Monitoring at Capital Cardiology Associates. She specializes in cardiac device management and electrophysiology. “Most of these devices will allow patients to send PDF’s to a physician for evaluation. Mechanisms for doing this will vary by physician practice. At Capital Cardiology we have the ability to receive and evaluate patient reports.”
“The watch is good at recognizing irregular heart beats and giving you an alert,” said King. She explained how the Apple Watch is not the first type of wearable tech that has the ability to scan or monitor heart activity from home. The Holter monitor has been available for heart patients since the early 1960’s. There’s also a major difference in the report that comes from a wearable device versus a full ECG/EKG that would be performed at your doctor’s office or hospital. The Watch produces a PDF that is considered a strip, not the full EKG. “A rhythm strip is a one-lead transmission (Lead I) that can detect rate, irregularity, and presence or absence of P-waves, which is a good first step, something we use in cardiology.”
“Let’s say you’re looking at an object in your house and there are 12 different windows that you can look through. Apple’s watch looks at one. So you see one view of the flower vase or whatever you are looking at. It tells us and we can identify heart irregularities with that one view. A 12-lead looks through 12 different windows or views. That’s how we diagnose myocardial infarction (the irreversible death of heart muscle secondary to prolonged lack of oxygen supply), left ventricular hypertrophy (enlargement and thickening of the walls of the heart’s main pumping chamber), or different electrical conduction problems. You can diagnose AFib from one view but you need more data to see the additional causes of the cardiac disturbance,” King explained.
The Apple Watch Series 4 is the next step in emerging medical technology, a history that began over 200 years ago. This Watch offers features that were imaginable only in movies or in science fiction, and yes, we’re getting closer to “The Jetsons” lifestyle we grew up watching Sunday nights and Saturday mornings. At best, the Watch is a diagnostic tool for heart rhythm disturbances. That’s what it’s presently limited too. As far as a gift idea for heart patients, “it’s not an age thing for seniors when it comes to technology today,” said King. “Using cell phones is not always age specific. I think that demographical change will be when people see that they are able to use the Watch for more than recording exercise or activity. People have to wear it, they have to be comfortable with it.”
Thankfully, Apple has perfected creating technology that is easy for all ages to understand. As well as creating many ways to personalize devices to make it feel like, “your own.”
Written by: Michael Arce, Media Specialist
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.