Role of the EKG: From Doctor's Office to Apple Watch

There are various tests to diagnose heart disease, with the “EKG” often serving as a springboard to other options.  An EKG, as it is commonly known, refers to an electrocardiogram — also called an ECG by physicians.

An EKG records the electrical activity of your heart through small electrode patches that are attached to the skin of the chest, arms, and legs. At your doctor’s office, it’s initially a “resting” EKG where the patient is lying comfortably. If additional testing is warranted, the doctor may order an exercise EKG, more commonly known as a “stress test” on a treadmill.

The EKG can help your doctor check your heart rhythm for abnormalities (arrhythmias), or determine if you have poor blood flow to your heart muscle (ischemia), or even diagnose a heart attack.

With the announcement this month by Apple that it’s latest Apple Watch will have, essentially, an EKG functionality, a new debate has surfaced about this kind screening.

(Watch now. The Baptist Health News Team hears from Ian Del Conde, M.D., Vascular Medicine Program Director at Miami Cardiac & Vascular Institute, about the new Apple Watch’s EKG funcationality. Video by Alcyene Almeida Rodrigues)

Cardiologists are concerned that with the mass popularity of the Apple device, heart rhythm irregularities will be under-diagnosed or over-diagnosed, and some people might forego a doctor’s visit after getting the wearable heart monitor.

Cardiologists are urging consumers to exercise caution primarily because there have been no clinical studies to determine the Apple Watch’s effectiveness for diagnosing heart irregularities. One such condition, atrial fibrillation, can be a serious condition and a major risk factor for strokes.

“The Apple Watch should not serve as a means of detecting potentially serious or fatal arrhythmias,” says Ian Del Conde, M.D., Vascular Medicine Program Director at Miami Cardiac & Vascular Institute. “People still have to be cognizant that they first have to see their physician, get all of the appropriate tests and then get the appropriate wearable device.”

The U.S. Food and Drug Administration has been taking steps to encourage more development and greater innovation in the digital health space. The FDA said it worked closely with Apple as they developed and tested their heart-monitoring Apple Watch apps.

Apple announced that it received clearance from the FDA for its Apple Watch to be used as a medical device. But it has not undergone studies within the medical community to determine if the watch monitors heart rhythms properly and consistently over a period of time, and no medical peer group or association has yet to endorse the product.

“To get a better understanding of the value of the Apple Watch, in terms of arrhythmia monitoring, studies are needed to demonstrate that it is effective and make sure that it doesn’t overdo or underdo signs of arrhythmias,” says Dr. Del Conde. “You don’t want to be a patient with an arrhythmia that goes undetected by the watch. And you don’t want to be a patient whose watch is telling you that you have arrhythmia and you quickly go to the emergency room to find out that it’s a false alarm.”

The Apple Watch announcement this month comes just three months after a U.S. panel of medical experts urged primary care doctors not to perform electrocardiograms on patients with a low risk of heart disease. In June, the U.S. Preventive Services Task Force (USPSTF), which focuses on preventive measures, screenings and evidence-based medicine, concluded that the EKG test offers little benefits for patients at low risk of heart disease — and it could possibly trigger unnecessary and unsafe follow-up testing and treatment.

However, the USPSTF stresses that an individual should consult with their doctor regarding any questions about the EKG or risk factors for heart disease, which can include high blood pressure, high cholesterol, prediabetes or diabetes, smoking, being overweight or obese, or having a family history of early-onset heart disease.