Taking An EKG On Yourself
- Posted on: Apr 5 2020
The current COVID-19 pandemic has led to us doing more virtual visits, as we try to stay connected to our patients with predominantly telemedicine.
Having a patient being able to take an electrocardiogram at home can be very helpful and important as part of a cardiologist’s evaluation via telemedicine. The two most common and practical ways for a patient to do an EKG on themselves are via an app called Kardia or with a later series (4 or 5) Apple Watch.
Kardia is a free app developed by a company called AliveCor, that can be downloaded onto a smartphone such as an iPhone or Android device. However, for it to work, it requires a separate small and flat electrode device (KardiaMobile) that does have to be purchased through AliveCor’s website and costs around $90. It works by opening the Kardia app on your phone, then placing one’s fingers on the electrodes of KardiaMobile near their cell phone.
This technology has been around for several years and has arguably revolutionized cardiologists’ ability to diagnose and manage arrhythmias or sometimes exclude arrhythmias as the cause of a patient’s symptoms which can be very reassuring. The accuracy of the recordings is reasonably good the vast majority of the time and usually allows us to help figure out what a patient’s heart rhythm is at a given moment or when they are having symptoms. AliveCor also offers paid subscription models to have virtual diagnoses of one’s recordings but typically it is most useful when the recordings can be reviewed by the patient’s personal cardiologist and correlated with their clinical condition.
EKG’s on an Apple Watch
The Apple Watch of course is more expensive but the EKG functionality is built into the watch itself (for the past 2 iterations, or specifically series 4 and 5 Apple Watches) and is a relatively simple and easy way to record an EKG. Some patients have used their medical excuse of being able to take an EKG on themselves to go ahead and treat themselves to an Apple Watch which also has so many more non-medical functions (that for some are helpful but admittedly for others are annoying or not so helpful). One other function that can be literally lifesaving is its ability to tell if a person has fallen and automatically call for emergency help.
The EKG’s done on the regular KardiaMobile and an Apple Watch are what we cardiologists refer to as a one-lead EKG that can be useful to determine heart rate and heart rhythm. It is generally more accurate (compared to phones, Fitbits or regular “pulse” or “heart rate” monitors on personal electronic wearable devices) as a qualified medical professional can see the actual electrocardiographic tracing from Kardia or an Apple Watch to determine not only if the heart rate measured is accurate but also what the heart rhythm is. It does not fully replace a 12-lead EKG which allows us to get a fuller electronic “view” of the heart, essentially from 12 different perspectives which can also give us other indirect information about the heart such as whether one has had a heart attack or one’s heart is enlarged.
AliveCor actually has recently come out with KardiaMobile 6L which allows a 6-lead EKG to be performed on one’s self (“half” of a full 12-lead EKG, basically it is what we call the “limb leads” but does not record the precordial leads). It requires one to sit in a particular manner and while holding the KardiaMobile6L device with both thumbs to then place the bottom electrode on the bare skin of your left knee or ankle and sit quietly while it records the EKG. While still not as complete as a full 12-lead EKG it can allow for a bit more accurate interpretation of abnormal heart rhythms. Presumably, smart tech and medical folks are working on developing the ability to do a full 12-lead EKG on one’s self.
The accuracy of Kardia and Apple Watch recordings are fairly comparable. The accuracy of the recordings is reasonably good the vast majority of the time and usually allows us to help figure out what a patient’s heart rhythm is at a given moment or when they are having symptoms.
These devices have built-in AI (artificial intelligence) to try to “interpret” the tracings, mostly to tell the heart rate and whether you have atrial fibrillation or not. They are far from perfect and often misclassify the rhythm. AliveCor also tries to get their customers to subscribe to monthly services for ongoing interpretations or to connect with electronic medical records. However, the recordings can also be emailed to our office prior to a virtual visit for the doctor to review as part of the visit. Premier and Concierge EAMP members can also directly email (or text in the case of Conicerge members) our cardiologists for review. (Please do note however, that email is not a secure form of communication and should never be used for true medical emergencies and texted medical information should only be used in an emergency if a patient has verified that the physician is available to immediately review the information).