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Original poster
Apr 12, 2001
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The single-lead ECG function on Apple Watch isn't meant to be as informative or as sensitive as the multi-lead ECGs you might get in a doctor's office or hospital, which use several points of contact. However, a new article in The European Heart Journal tells the story of an 80-year-old woman whose Apple Watch detected evidence of a heart condition that was missed by a hospital ECG (via 9to5Mac).

applewatchseries4ecgfeature.jpg

According to the article, the woman presented at University Medical Center Mainz, Germany, complaining of chest pain, irregular heart rhythm, and lightheadedness. When doctors at the hospital performed a 12-channel ECG, it revealed "no evidence for ischemia," which occurs when blood flow to the heart is reduced, preventing the heart muscle from receiving enough oxygen.

However the woman then showed doctors her Apple Watch ECG results, which included "tracings with marked ST-segment depression." After studying the Apple Watch results, doctors did indeed see evidence of myocardial ischemia, and the woman was transferred to the catheterization lab for a "left main stem stenosis and a left anterior descending/diagonal bifurcation lesion," and treatment with coronary artery stenting.

Essentially, the Apple Watch ECG recordings showed evidence of a heart condition that the hospital's specialized equipment failed to pick up, and that convinced the doctors to treat the patient, who left the hospital the next day.

The report concludes that the Apple watch may be used to reliably detect myocardial ischaemia.
The development of smart technologies paves the way for new diagnostic possibilities. In the case of the Apple Watch, after the mobile application is installed, the records an ECG when a finger is placed on the watch's digital crown. A 30-s tracing is stored in a PDF file that can be retrieved from the application.

Thus, the Apple Watch may be used not only to detect atrial fibrillation or atrioventricular-conduction disturbances but also to detect myocardial ischemia. An apple a day may keep myocardial infarction away.
You can read the full report here. Rumors regarding the Apple Watch Series 6, expected to launch later this year, suggest additional health-related features mental, including blood oxygen detection, sleep tracking, and stress detection.

Article Link: Apple Watch ECG Helps Detect Case of Coronary Ischemia Missed by Hospital ECG
 

NightFox

macrumors 68020
May 10, 2005
2,464
2,187
Shropshire, UK
Rather than the Apple Watch being in some way superior to specialized equipment as the article seems to imply, wasn't it just the case that the symptoms here were only occasional, so needed an extended monitoring period to present themselves? Of course the Apple Watch is a real life-saver for situations such as this where short-duration ECG tests might not otherwise pick up latent problems, but directly comparing the two seems a bit apples and pears.
 
Comment

Veinticinco

macrumors 65816
Feb 25, 2009
1,262
1,015
Europe
No way an Apple Watch flagged up an abnormality a properly maintained 12-lead ECG failed to spot.

More likely, whoever performed that ECG, attached the leads etc. is at fault here, not the equipment itself.

Her clinical history alone would have given cause for caution and a repeat ECG (correctly administered) would have rendered this “publication” irrelevant.
 
Comment

robjulo

macrumors 68000
Jul 16, 2010
1,529
2,745
Exactly. This article seemingly trumpeting a single lead on a watch over a 12 lead is ridiculous.

No way an Apple Watch flagged up an abnormality a properly maintained 12-lead ECG failed to spot.

More likely, whoever performed that ECG, attached the leads etc. is at fault here, not the equipment itself.

Her clinical history alone would have given cause for caution and a repeat ECG (correctly administered) would have rendered this “publication” irrelevant.
 
Comment

[AUT] Thomas

macrumors 6502a
Mar 13, 2016
667
809
Graz [Austria]
IMHO, and that is certainly point for discussion, medical data needs to be put (anonymized) to work using big data based deep learning. The benefits IMHO greatly outweigh the risks. And that comes from someone using Apple devices mostly because of privacy and security.

No cardiologist can have looked at and analyzed as many ECGs in his entire life than a computer can in a couple minutes.

That will NOT put cardiologists out business nor make looking at ECG prints obsolete BUT it will greatly help in not missing something and aid in (not replace!) human diagnosis.

And that goes for many other conditions as well.

[Edit: "replace" was "supplement" previously. Meaning should remaint the same, that the doctor is still doing the diagnosis, with the results from AI as hint or inspiration in finding the cause of the problem.]
No way an Apple Watch flagged up an abnormality a properly maintained 12-lead ECG failed to spot.

More likely, whoever performed that ECG, attached the leads etc. is at fault here, not the equipment itself.

Her clinical history alone would have given cause for caution and a repeat ECG (correctly administered) would have rendered this “publication” irrelevant.
Absolutely true, but it doesn't change the fact, that a small handheld device picked up something that would have been otherwise missed.
 
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chucker23n1

macrumors 603
Dec 7, 2014
5,265
6,641
No way an Apple Watch flagged up an abnormality a properly maintained 12-lead ECG failed to spot.

A smartwatch sensor has far fewer leads, yes, but it also collects a far more comprehensive set of data.

More likely, whoever performed that ECG, attached the leads etc. is at fault here, not the equipment itself.

Er, yes. So what? "Your data doesn't matter because I should've picked up the data myself instead"? Like, maybe fire the doctor responsible for negligence, but even so, the fact of the matter remains that in practice, the smartwatch collected data that the doctors' professional equipment did not. IOW, the smartwatch helped. Should it have been necessary at all? The correct answer is: it doesn't matter, because it was there.
[automerge]1588586313[/automerge]
The Apple Watch is the only product line whose execution and focus is giving me some hope right now. I'm curious what they'll come up with for series 6 after the 5 being more or less 4s.

My biggest hope is the Series 6 will drive down the price of older models. Maybe the 4 or 5 will become the new $199 model. Then I'll upgrade to that from my Series 0.
 
Comment

Biglethal69

macrumors regular
Feb 21, 2019
108
81
Australia


The single-lead ECG function on Apple Watch isn't meant to be as informative or as sensitive as the multi-lead ECGs you might get in a doctor's office or hospital, which use several points of contact. However, a new article in The European Heart Journal tells the story of an 80-year-old woman whose Apple Watch detected evidence of a heart condition that was missed by a hospital ECG (via 9to5Mac).

applewatchseries4ecgfeature.jpg

According to the article, the woman presented at University Medical Center Mainz, Germany, complaining of chest pain, irregular heart rhythm, and lightheadedness. When doctors at the hospital performed a 12-channel ECG, it revealed "no evidence for ischemia," which occurs when blood flow to the heart is reduced, preventing the heart muscle from receiving enough oxygen.

However the woman then showed doctors her Apple Watch ECG results, which included "tracings with marked ST-segment depression." After studying the Apple Watch results, doctors did indeed see evidence of myocardial ischemia, and the woman was transferred to the catheterization lab for a "left main stem stenosis and a left anterior descending/diagonal bifurcation lesion," and treatment with coronary artery stenting.

Essentially, the Apple Watch ECG recordings showed evidence of a heart condition that the hospital's specialized equipment failed to pick up, and that convinced the doctors to treat the patient, who left the hospital the next day.

The report concludes that the Apple watch may be used to reliably detect myocardial ischaemia.
You can read the full report here. Rumors regarding the Apple Watch Series 6, expected to launch later this year, suggest additional health-related features mental, including blood oxygen detection, sleep tracking, and stress detection.

Article Link: Apple Watch ECG Helps Detect Case of Coronary Ischemia Missed by Hospital ECG
Would be really nice if they actually released it in Australia I bought the Apple Watch 4 thinking it would be released With it now the five is out and were almost at the Apple Watch six and still no ECG in Australia come on Apple hurry up And release it here. You haven’t even applied In Australia for approval. Just remember you have customers all over the world not just the US.
 
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Saturnine

macrumors 65816
Oct 23, 2005
1,139
1,309
Manchester, UK
There is no downside to this story. Whether it's marketing hype or not, the fact remains that the Apple Watch picked up something that was not picked up by proper medical equipment. Whether or not it should have been is a different matter entirely. Having a single, unobtrusive device to wear which can detect and inform potentially serious medical issues can only be a positive.

I've suffered with, sometimes quite severe, sleep issues for a long time now. My experience with the medical services hasn't been great. It's not their fault - it's just difficult to get a referral to specialists and then actually have the symptoms present while under monitoring. If the next Apple Watch dues have certain, specific, sleep tracking features then it is potentially a really useful device for me. I just don't understand the cynicism that surrounds good-news stories.
 
Comment

MauiPa

macrumors 68000
Apr 18, 2018
1,670
2,374
Rather than the Apple Watch being in some way superior to specialized equipment as the article seems to imply, wasn't it just the case that the symptoms here were only occasional, so needed an extended monitoring period to present themselves? Of course the Apple Watch is a real life-saver for situations such as this where short-duration ECG tests might not otherwise pick up latent problems, but directly comparing the two seems a bit apples and pears.
Actually, that is what the article said, "showed no evidence of, then showed the watch results". Nowhere did the article imply or infer that single lead ECG was more reliable than a 12-lead hospital grade ECG. Having a heart condition myself which was long-missed at the cardiologists office, I can vouch for having an always nearby device. Just because you are in a cardiologists exam room, doesn't mean your heart will ac up t that moment
 
Comment

Angelus

macrumors 6502
Apr 19, 2002
399
22
New Zealand
Having seen plenty of patients in my time, it’s well recognised that ECG changes in myocardial ischemia due to an unstable lesion can be transient.

The article reads as her Apple Watch reading being taken prior to hospital arrival. The most likely explanation is that her ECG changes were transient and the watch in its single lead detected STdepression.

If her symptoms were abating in the hospital, her formal 12-lead could very well have appeared normal.Considering that conditions other than acute coronary syndrome can also present with ST depression, she must have had significant cardiac risk factors to influence the decision to take her to PCI based on ST depression from a single ECG lead (It doesn’t even meet formal criteria for percutaneous intervention).
Also notable in the article that whilst they mention the presence of lesions they don’t comment on them being flow limiting.

Granted the outcome is good but it’s a leap to say that the watch outperformed a formal 12-lead. To those saying the physicians should be fired, that’s ridiculous.

In essence, herApple Watch ECG is no different to any other pre-hospital ECG taken at the right time I.e with symptoms.
 
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harambe4ever

macrumors newbie
Sep 20, 2017
26
48
Did anybody read the actual journal article instead of this grossly inaccurate sensationalist article? lol...

The formal EKG did not show signs of ischemia because this was unstable angina which can absolutely not be seen on EKG depending on when the EKG is taken. The initial formal EKG did not "catch" the ischemia because there was no signs of it when the EKG was taken! The Apple Watch had previous recordings of the EKG showing ischemia from BEFORE she came to the hospital.

Anybody with 10 minutes of medical training would know this patient with highly concerning symptoms would be admitted overnight, have a bunch of tests (serial troponins, stress echo or another similar test) to be worked up for acute coronary syndrome (ACS). The ischemia would have been seen then, she would have been taken to the cath lab, and been treated appropriately.

More interesting, however, is that I wonder how many people are taken to the cath lab/started on medication/had expensive diagnostic tests based on their Apple EKG findings alone and there is no abnormality. That seems to be conveniently missing from data sets. While I have no doubt Apple's EKG feature is helpful and semi-accurate, it does not replace a formal 12-lead EKG. Again, anybody with 10 minutes of medical training knows this.
 
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Samford

macrumors member
Jan 24, 2011
37
35
No way an Apple Watch flagged up an abnormality a properly maintained 12-lead ECG failed to spot.

Being a atrial fibrillation suffer myself I can say they are often very random attacks. My was missed by lots of 12-lead ECG machines over the 12 years and 5 specalists. This resulted in 12 years of misdiagnosis of my condition. So timing is everything and having a sensor watch present at the time of a attack is a god send.
 
Comment

harambe4ever

macrumors newbie
Sep 20, 2017
26
48
Being a atrial fibrillation suffer myself I can say they are often very random attacks. My was missed by lots of 12-lead ECG machines over the 12 years and 5 specalists. This resulted in 12 years of misdiagnosis of my condition. So timing is everything and having a sensor watch present at the time of a attack is a god send.

Google Holter monitor
 
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Reactions: Si Vis Pacem
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calliex

macrumors 6502
Aug 16, 2018
285
106
Pittsburgh, Pa
Did anybody read the actual journal article instead of this grossly inaccurate sensationalist article? lol...

The formal EKG did not show signs of ischemia because this was unstable angina which can aboslutely not be seen on EKG depending on when the EKG is taken. The initial formal EKG did not "catch" the ischemia because there was no signs of it when the EKG was taken! The Apple Watch had previous recordings of the EKG showing ischemia from BEFORE she came to the hospital.

Anybody with 10 minutes of medical training would know this patient with highly concernign symptoms would be admitted overnight, have a bunch of tests (serial troponins, stress echo or another similar test) to be worked up for acute coronary syndrome (ACS). The ischemia would have been seen then, she would have been taken to the cath lab, and been treated appropriately.

More interesting, however, is that I wonder how many people are taken to the cath lab/started on medication/had expensive diagnostic tests based on their Apple EKG findings alone and there is no abnormality. That seems to be conveniently missing from data sets. While I have no doubt Apple's EKG feature is helpful and semi-accurate, it does not replace a formal 12-lead EKG. Again, anybody with 10 minutes of medical training knows this.

I agree with you. A 12 lead analyzes the heart in a moment in time. If symptoms do not present themselves then it will be missed. Thats why they usually keep you over night like you said and are put through a ringer of tests including a stress test. That being said my wife has a condition called paroxysmal atrial tachycardia (PAT). The heart goes really fast over 200 for unknown reason. It starts and stops out of the blue. We have been able to confirm it with her apple watch.
 
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Angelus

macrumors 6502
Apr 19, 2002
399
22
New Zealand
And how likely is a "pre-hospital ECG taken at the right time I.e with symptoms" vs. casually tapping a button on a smartwatch and waiting a few seconds?

I’m not sure I get what point you’re trying to make? Is an Apple Watch ECG quicker and more accessible than an EMS 12-lead? Sure!

Is it diagnostic for ischemia? Nope. ST elevation and ST depression have multiple causes, of which ischemia is one. A case report gives us an n of 1.

I would suggest that the 30 secs are best served calling an ambulance (with your Apple cellular watch) and taking an aspirin (which has mortality benefit). After that, if you want to take an Apple Watch ECG while you wait for an ambulance go ahead.
 
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