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    More: Interesting, EKG, mobile apps, Electrical phenomena, TLS, University of Vermont  
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2540 clicks; posted to Geek » on 07 Mar 2013 at 8:09 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»

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2013-03-07 11:38:22 PM
3 votes:

DON.MAC: I wonder if this is a more useful solution than the old "you are not having a heart attack, stop wasting my time because if we check you out again, we will get the same results we had last week"

Lead I can tip you off that you're having a Lateral STEMI, and can show reciprocal inferior changes, but you need a 12-lead to identify. ST-Elevation in a single lead is non-diagnostic, except for specific criteria in the Pre-cordial leads and Augmented Vector leads.

In addition, you can be having a heart attack and not have EKG changes. They're great for identifying the ones that are going to kill you quickly, but not for the ones that are going to kill you over the next week and don't require an immediate trip to the cath lab to fix.
2013-03-07 10:41:21 PM
2 votes:

Shadow Blasko: Now ALL patients on stimulants MUST PAY for quarterly EKGs or NO MEDS for you!

Amphetamine based ADHD meds have a bad history of causing heart disease and valve damage, to be fair. They also up your cardiac risk profile.

I pay out of pocket to get a 12-lead EKG each year at my physical so that the MD has a baseline to go on if I ever start developing weird heart problems.
2013-03-07 08:21:21 PM
2 votes:
It looks like it's just a rhythm strip then a full 12 lead EKG.  This is one of those times where someone that actually knew what they were talking about was writing the article to know how much information it really gives.

Still cool though.
2013-03-08 12:06:22 AM
1 votes:

maxheck: IANAL, but I don't doubt that someone who was could make the case that ANY medical monitoring device could fit that. I have no idea how insulin monitors ever took off.

What  JPINFV said, but things like blood glucose monitors are special cases. The corporations that sell them to the public had to have them approved as OTC Medical Devices by the FDA - namely that any level of medical expertise was not necessary to use them. Even then, there are versions of them that are not sold to the general public, and include advanced monitoring features for healthcare.

A One Touch you buy in Walgreens is not similar to an iSTAT monitoring system used by a critical care team.

There's a reason that all the AEDs that are sold to the general public do not have EKG monitoring capabilities, besides they added cost to the manufacturer.

maxheck: There is another factor though. Damn near every data sheet for an electronic part that I have seen in 30 years of experience has a disclaimer like this towards the end:

Electronics used in mission-critical components, like defibrillators, insulin pumps, IV pumps, and ventilators, have to be tested extensively before they are allowed to be used. It's the reason that these machines have extensive self-check circuits built in to identify failures before they're used on a patient. In addition, the end product has to be FDA approved before it can be used on another human being.

Ironically, the ventilators we use in our hospital have Windows Embedded as the operating system they run.
2013-03-08 12:00:31 AM
1 votes:

maxheck: The data capture is nothing. The interpretation is the rocket science.

Actually, the data capture is a huge issue. One lead is a very very small picture of the heart. Unless it's a rhythm problem (and a lot of heart issues that show up on an EKG aren't rhythm problems), you can't really really diagnose anything. There's a much larger picture that you end up missing.
2013-03-07 10:34:18 PM
1 votes:
I mean, downsides aside, it's still pretty cool. A step on the path to full on medical tricorder.
2013-03-07 09:14:04 PM
1 votes:

thelunatick: Palm had an app for EKG's also (going back to the palm III series).   This is nothing new, someone just finally ported it to Iphone.    The difference was the palm app had full 12 lead cables that hooked up to the palm.

The problem with it is that the computer is a lying bastard. The algorhythms that they use to interpret require precise conditions to be accurate, and that is not always possible. Placement can be off. The patient can have muscle tremor or other artifact. STEMI mimics, like pericarditis, and hyperkalemia can confuse the algorhythm and tempt you to make a trip to the cath lab.

Just to coin an example, the 12SL algorythm, which Phillips and Zoll use, was infamous for calling muscle tremors atrial flutter, and would pick up early repolarization as a STEMI for a while. Physio-Control uses the Glasgow rhythm algorythm, which is still useful, but placement is key. There's now a push to make 15-lead and 18-lead EKGs the standard because of missed inferior-posterior AMIs.

There's a reason we read the EKGs and transmit them to the ERs, and there's a reason a physician has to read them before a decision is made.
2013-03-07 08:56:52 PM
1 votes:

hardinparamedic: Yeah, but it's lead II vector monitoring. Which is only good for monitoring arrythmias. As Bob Paige says in his EKG seminars - Lead II no Clue.

In addition, beyond looking for the kind of arrythmias that you won't be able to look at your phone to see, it's a fun novelty but useless clinically.

If you need an ECG for an acute cardiac or medical condition, you really want someone trained to examine them behind it, and have the capability to monitor more than one lead - and if you have chest pain, syncope, or breathing problems, you probibly want the capability to run serial 12-leads.

/a clean 12-lead doesn't mean you're not having a heart attack. It only means you're not having a heart attack that will kill you in the next 90 minutes.

No leg lead, only hand to hand, so a sketchy Lead I.  If they added a lead for right and left leg, at least they'd have Einthoven's triangle and slightly more useful diagnostic tool.  Since the patient would be holding the phone probably at waist level, the wires could easily be less than 3 feet and attached on the stomach for minimal inconvenience.
2013-03-07 08:49:02 PM
1 votes:
Woohoo... instant lead II.

Oh, wait, the 99% of the rest of the useful information from a 12 lead EKG is still missing?

You can diagnose a heart attack ("STEMI") with it? So... where's your second contiguous lead with reciprocal changes?

Yep... sorry... I honestly don't see that much use for this.
2013-03-07 08:46:30 PM
1 votes:
Seems like a way to bill a patient for something that really isn't worth a shiat.  Without a 12 lead to give you the leads, you could potentially miss a heart attack without having corresponding leads to measure against, since the article seems to indicate it's just taking Lead I of a full 12 lead.  If the doctor is truly looking for an arrhythmia, then I suppose this is a quick way to do it, but they're going to probably do a 12 lead if the app finds it.  Would they double bill for this extremely limited ECG in addition to the 12 lead?  It's a cool toy, sure, just not something I'd want to trust to a single lead for a determination of any potential heart conduction issues.
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