Apple Watch ECG detects heart condition in German woman

AppleInsider

The ECG function of the Apple Watch has been credited with uncovering a heart condition in an 80-year-old woman in Germany, one that was seemingly missed by a hospital's own ECG during a diagnosis.

The Apple Watch has repeatedly appeared in stories where it warned wearers of possible heart problems, and has been praised for being an early warning system for serious cardiovascular issues. In one recently reported case, the Apple wearable actually provided better evidence of a condition than a hospital's own equipment.

In a report published in the European Heart Journal on Wednesday and spotted by 9to5Mac, an 80-year-old woman attended the University Medical Center Mainz of Johannes Gutenberg University, Germany, with what was described as "typical angina symptoms." The patient also advised of two praesyncopy episodes, a situation where a person almost loses consciousness due to reduced flow of oxygenated blood to the brain.

Based on the presented details, and the female engineer's previous diagnosis of arterial hypertension, paroxysmal atrial fibrillation, and having had a pulmonary embolism two years prior, doctors performed an initial 12-channel ECG. The test didn't see any evidence for ischaemia, which is a restriction in blood vessels that can restrict the blood supply.

Despite the hospital's own equipment not showing ischaemia, doctors were then convinced there was a related issue by the patient complaining about earlier ectopic beat episodes, which she recorded by using the ECG function of her Apple Watch. The recordings also included tracings with marked ST-segment depression, evidence that led to the medical team omitting further diagnostic measures in favor of treatment.

[via European Heart Journal]

In effect, the Apple Watch ECG recordings showed evidence of an issue that didn't appear in the hospital's specialized equipment, and successfully convinced doctors to treat the patient.

The woman was transferred to a catheterization laboratory for a "left main stem stenosis and a left anterior descending/diagonal bifurcation lesion," and treatment with coronary artery stenting. The patient left the hospital the next day.

It is suggested by the report that the Apple Watch "may be used not only to detect atrial fibrillation or atrioventricular-conduction disturbances but also to detect myocardial ischaemia."

Current speculation for the Apple Watch Series 6 suggests the next generation of Apple Watch may include a feature for blood oxygen detection, as well as an upgraded ECG capable of working at higher heart rate ranges than the version introduced in the Apple Watch Series 4.

bluefire1

Apple leading the way-again.

svanstrom

Isn’t that like saying that the iPhone gps caught a car speeding while the more advanced police radar couldn’t do that when the car later on was parked…?

hammeroftruth

svanstrom said:

Isn’t that like saying that the iPhone gps caught a car speeding while the more advanced police radar couldn’t do that when the car later on was parked…?

From the looks of things. It doesn’t look like the patient was ever examined over time with a portable heart monitor. Being 80 it might have been a hard sell. I think that’s why more elderly people are buying Apple watches. 

Rayz2016

svanstrom said:

Isn’t that like saying that the iPhone gps caught a car speeding while the more advanced police radar couldn’t do that when the car later on was parked…?

Yes, I think “seemingly missed” might not be how I would’ve phrased it.  Sometimes you have to monitor someone over a period of time before the condition presents itself. The point being made here is that doctors were willing to base a course of action on the info they’re getting from an Apple Watch, when they had no data from their own equipment. That is quite significant. 

digitol

Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy. 

jcbigears

Makes me furious that we still don’t have this feature active in Australia. There’s no reason for it not to be as once a medical device is FDA approved its a “tick the box” form for it to be approved here by our TGA. 

bloodshotrollin'red

jcbigears said:

Makes me furious that we still don’t have this feature active in Australia. There’s no reason for it not to be as once a medical device is FDA approved its a “tick the box” form for it to be approved here by our TGA. 

Please, don't behave like you're an idiot. Cokacola would gain FDA approval as a cure for cancer if submitted. The bar for FDA clearance is so unbelievably low, all any "submission" has to claim is that a vaguely similar prior tech or medication has already been approved for the FDA to approve the new submission. Australian Health Dept. is doing Australians a great service. Oz may be a member of FiveEyes, but only three members have any brains...the USA ain't one of them.

bloodshotrollin'red

Missed Coranavirus though...so, not that fantastic a catch.
Now, A next-gen AppleWatch or even IR detecting AirPod (alone or linked) could sense coughing, sneezing, temperature, moisture, stats and provide a data diagnosis.

ericthehalfbee

digitol said:

Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy. 

Shut up!

lolliver

jcbigears said:

Makes me furious that we still don’t have this feature active in Australia. There’s no reason for it not to be as once a medical device is FDA approved its a “tick the box” form for it to be approved here by our TGA. 

It's not really that simple. I'm glad we don't just blindly approve everything that gets FDA clearance as in most cases our process here is better. However, in this instance I would really like to see the ECG feature of the Apple Watch get approval. At the very least I would like to know if it's even a possibility or not. If approval here in Australia isn't on the horizon then my next Apple Watch will need to be purchased overseas.  

jcbigears

bloodshotrollin'red said:

jcbigears said:

Makes me furious that we still don’t have this feature active in Australia. There’s no reason for it not to be as once a medical device is FDA approved its a “tick the box” form for it to be approved here by our TGA. 

Please, don't behave like you're an idiot. Cokacola would gain FDA approval as a cure for cancer if submitted. The bar for FDA clearance is so unbelievably low, all any "submission" has to claim is that a vaguely similar prior tech or medication has already been approved for the FDA to approve the new submission. Australian Health Dept. is doing Australians a great service. Oz may be a member of FiveEyes, but only three members have any brains...the USA ain't one of them.

I'm in the industry and can testify that, as far as this device is concerned, it's passed a rigorous application process. It also has CE marking which these days is a higher bar. 

zimmie

digitol said:

Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy. 

This is a segment of a pathological ECG recorded using an Apple Watch Series 4:
You can clearly see

• The arhythmic QRS complex.
• The missing P wave.
• The overall character of the QRS complex, and how it's the same beat-to-beat (always a qRs).
• The shape of the T wave. Absolute and relative refractory.
• The QT interval

This is diagnostic-quality, without a doubt. I particularly like how you can tell the patient's heart was expecting to have longer for the T at 13.16 seconds, but it was abruptly shortened for the qRs at 13.32 seconds. The Q to T-peak interval on the subsequent beats is noticeably shorter.

Rayz2016 said:

svanstrom said:

Isn’t that like saying that the iPhone gps caught a car speeding while the more advanced police radar couldn’t do that when the car later on was parked…?

Yes, I think “seemingly missed” might not be how I would’ve phrased it.  Sometimes you have to monitor someone over a period of time before the condition presents itself. The point being made here is that doctors were willing to base a course of action on the info they’re getting from an Apple Watch, when they had no data from their own equipment. That is quite significant. 

Exactly. A lot of heart issues only present relatively briefly. The situation above disappeared after about an hour, which is not generally enough time to get into an emergency room (without also being grievously injured, anyway), let alone to a cardiologist. The options are either monitoring over a really long period of time (certainly longer than anyone would want to be hooked up to a 12-lead), or using a personal ECG. A lot of doctors definitely realize this, and realize any hard data showing an issue is better than no data.

22july2013

Twice this year I’ve visited a hospital. Each time the nursing staff was impressed by what my Apple Watch’s ECG did for me. One of them said, “I’ve got to get myself one of those even though I’m not sick.“

macgui

digitol said:

Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy. 

Digitroll has spoken.


That it wasn't caught in hospital but later on the Watch isn't that surprising since, as somebody just mentioned, the episodes are short. But the Watch did catch it, and if she weren't wearing it, she wouldn't have received treatment when she did.

I don't know that it saved her life, but I'm sure she and any friends and family are happy she was wearing it.

svanstrom

zimmie said:

This is a segment of a pathological ECG recorded using an Apple Watch Series 4:
You can clearly see

• The arhythmic QRS complex.
• The missing P wave.
• The overall character of the QRS complex, and how it's the same beat-to-beat (always a qRs).
• The shape of the T wave. Absolute and relative refractory.
• The QT interval

This is diagnostic-quality, without a doubt. I particularly like how you can tell the patient's heart was expecting to have longer for the T at 13.16 seconds, but it was abruptly shortened for the qRs at 13.32 seconds. The Q to T-peak interval on the subsequent beats is noticeably shorter.

I really wish there was an "ECG for Apple Watch dummies"-book.

Playing around with the watch I've seen all kinds of "irregularities" when I one way or another have felt off; but I haven't got a clue if any of them are signs of a five minutes life expectancy, or not.

And since I'm not about to become that guy that runs to the emergency room every few days I feel like there's a gap here; a gap between the capabilities of my watch to potentially save my life, and me being able to understand the data that I'm given.

beowulfschmidt

Rayz2016 said:

svanstrom said:

Isn’t that like saying that the iPhone gps caught a car speeding while the more advanced police radar couldn’t do that when the car later on was parked…?

Yes, I think “seemingly missed” might not be how I would’ve phrased it.  Sometimes you have to monitor someone over a period of time before the condition presents itself. The point being made here is that doctors were willing to base a course of action on the info they’re getting from an Apple Watch, when they had no data from their own equipment. That is quite significant. 

Exactly true; it's nice that the hospital didn't simply dismiss the Apple Watch recordings because they didn't find anything with their own equipment.

k2kw

bluefire1 said:

Apple leading the way-again.

They need to detect the CoronaVirus or atleast Fever.

bsimpsen

digitol said:

Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy. 

By your logic, clinical measurements and monitoring are often inaccurate because they don't take into consideration what happens outside the clinical setting. This is actually often true, as demonstrated in this story. Do you consider clinical tools to be toys?

I'm retired from a long career designing diagnostic ECG equipment, including ambulatory (worn-at-home) monitors. The Apple Watch is certainly no toy. Both of my parents have had A-Fib for years, and my Apple Watch was able to detect it in both of them. I routinely throw PVCs and I've been able to capture them via the watch.

When it comes to understanding the value of various kinds of medical monitoring, there is real understanding and toy understanding.

zimmie

svanstrom said:

zimmie said:

This is a segment of a pathological ECG recorded using an Apple Watch Series 4:
You can clearly see

• The arhythmic QRS complex.
• The missing P wave.
• The overall character of the QRS complex, and how it's the same beat-to-beat (always a qRs).
• The shape of the T wave. Absolute and relative refractory.
• The QT interval

This is diagnostic-quality, without a doubt. I particularly like how you can tell the patient's heart was expecting to have longer for the T at 13.16 seconds, but it was abruptly shortened for the qRs at 13.32 seconds. The Q to T-peak interval on the subsequent beats is noticeably shorter.

I really wish there was an "ECG for Apple Watch dummies"-book.

Playing around with the watch I've seen all kinds of "irregularities" when I one way or another have felt off; but I haven't got a clue if any of them are signs of a five minutes life expectancy, or not.

And since I'm not about to become that guy that runs to the emergency room every few days I feel like there's a gap here; a gap between the capabilities of my watch to potentially save my life, and me being able to understand the data that I'm given.

Wikipedia has decent articles on the characteristics of an ECG.

The important starting point is the down-UP-down. Each feature of an ECG recording has a letter designation. The quick dip down is the Q, the big spike up is the R, and the small dip down afterwards is the S. Taken together, they make up the QRS complex. When talking about the complex in the abstract, the letters are always uppercase. When talking about the specifics, case can vary. For example, qRs indicates a small Q, big R, small S, which is normal. More Q or S amplitude or less R amplitude can indicate certain problems. Some can be missing entirely. There can even be an extra R (called R prime, written R') in some situations.

Each of these features marks the heart doing something. Together, the QRS is the ventricular beat.

Q is the plane between the ventricles contracting in preparation for a ventricular beat.
R is the ventricles beginning their inward contraction.
S is when the contraction ends.

In a normal ECG, there is a bump up a bit before the QRS called the P wave. This wave is from the atria contracting. It is absent in the recording above, indicating the atria were not contracting. That is almost always caused by atrial fibrillation (kind of a quivering twitch rather than a rhythmic beat).

Then after the ventricular beat, the T wave shows the ventricles relaxing.



ECGs are sensitive to movement. When recording one, you should try to be as still as possible. The R is generally visible, even during movement, but the other features may be overwhelmed entirely.

Everybody with an Apple Watch Series 4 or above should collect a baseline ECG, just to have around in case they need it for comparison later.



To be clear about this next part, I have had medical training, but not in a long time. I haven't practiced any form of medicine in years, and this is NOT MEDICAL ADVICE. It is generic.

It is important to note ECGs can be ambiguous and hard to read, even for professionals. If your ECG looks weird, but you feel fine, maybe schedule a low-priority appointment with your doctor to check it out and learn more. If you feel weird, but your ECG looks fine, it's probably not your heart (most urgent heart problems show up on even single-lead ECGs). If you feel weird, but in a way you have felt before, and your ECG looks weird (missing parts like the one above, different shape from beat-to-beat), call your doctor and see what they recommend.

If you feel weird in a new way and your ECG looks weird, think seriously about going to an ER or urgent care clinic.

Edited to add: Somehow I didn't finish the sentence mentioning R' above. Fixed that.

geekmee

digitol said:

“Caution! Apple watch and it’s measurements/monitoring is often inaccurate. This should not substitute for a Doctor. In fact, it’s almost criminal how horrible these devices are. Many things to account for, that isn’t taken into consideration for health, which may hurt certain individuals with underlying health issues or other circumstances. Apple watch is more of a toy.”

===========

That’s a nice misconstrued opinion, but Apple has never said it’s a replacement for a doctor. As a matter of fact, if you had an Apple Watch you’d be familiar with their alert that essentially says ‘We detected something fishy going on, you might want to get this checked out with more comprehensive testing from a trained professional.”