Are you taking advantage of it? Increasing number of patients receiving “smartwatch outpatient care”… “25% are asymptomatic” Early detection of malignant arrhythmia is also possible. | FRIDAY DIGITAL

Are you taking advantage of it? Increasing number of patients receiving “smartwatch outpatient care”… “25% are asymptomatic” Early detection of malignant arrhythmia is also possible.

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It is very difficult to catch an “arrhythmia” that occurs only once a month or once every six months…

A convenient smartwatch that allows you to check your email, calls, and other notifications at your fingertips. Many business people may find them useful for health management, as they can measure heart rate, activity level, and even sleep status. In this environment, the number of people who seek medical care after receiving a notification from their smartwatches is rapidly increasing. Smartwatch outpatient clinics are beginning to be established at general hospitals and other facilities as a way to accommodate this trend.

The Apple Watch, one of the most popular smartwatches, can measure heart rate and electrocardiograms with high precision. In 2008, Apple’s electrocardiogram application, the Home Electrocardiograph Program, and the Home Heart Rate Monitor Program, which notifies the user of irregular heartbeats, were approved as home medical devices by the Ministry of Health, Labor and Welfare.

Since that time, the number of patients who said they were alerted of an irregular heartbeat has gradually increased. We thought that many of them might not know which department to go to, so we opened the ‘Smart Watch Outpatient Clinic’ in the Department of Cardiology, which treats arrhythmia, in the summer of 2011.

Dr. Yukako Takimura of the Department of Cardiovascular Medicine at General Tokyo Hospital is in charge of the Smart Watch Outpatient Clinic. At the smartwatch outpatient clinic, a specialist in arrhythmias is in charge of diagnosis.

Smartwatches are useful not only for work efficiency but also for daily health management. There is a lot of information available on the Apple Watch, and the accuracy of the electrocardiogram is quite high,” says Dr. Takimura (PHOTO: AFLO).

The Apple Watch alerts us when there is a possibility of atrial fibrillation, which is a malignant arrhythmia, or when the pulse is too fast or too slow. There are several types of arrhythmias, and atrial fibrillation is one of them. To diagnose it, it is necessary to check the ECG at the time the arrhythmia occurs.

If a patient goes to the hospital saying, “I had palpitations yesterday,” but the EKG is normal at the time, the doctor cannot diagnose arrhythmia. On the other hand, even if an arrhythmia is latent, it may be overlooked if there is no problem during the annual physical examination.

Not being diagnosed means that treatment cannot be started early. In this regard, the smartwatch, which is always worn, makes it possible to measure arrhythmia-related symptoms such as palpitations and shortness of breath, not only when they occur, but also when there are no symptoms.

Patients who come to the Smartwatch Outpatient Clinic already have a record of arrhythmia caught ‘red-handed’. This speeds up the process from diagnosis to treatment. It is very difficult to catch an arrhythmia that occurs only once a month or once every six months, but having the ECG on file at the time of the visit helps us as doctors.

25% of patients are asymptomatic… What is “atrial fibrillation,” the arrhythmia that doctors “want to avoid the most”?

Atrial fibrillation, a type of arrhythmia, is “the arrhythmia you should avoid the most,” according to Dr. Takimura. Atrial fibrillation itself rarely causes death, but it can trigger stroke and other blood-clot obstructive diseases, as well as heart failure, in which the heart function deteriorates. It is also reported to double the incidence of dementia.

The heart is divided into four chambers, up, down, left, and right. In a normal heart, the atria, located at the top of the four chambers, are excited by electricity and contract, and then electricity passes to the ventricles, located in the lower chamber, and they contract. The atria then contract, and blood is pumped throughout the body in a constant, regular, and repeated contraction.

In atrial fibrillation, on the other hand, electrical excitation in the atria is abnormally rampant, and the atria appear to be in spasm. As you can read, the atria are in a state of fine motion. The electrical excitation is then transmitted irregularly to the ventricles in the lower chambers, and the waveforms on the electrocardiogram become scattered and spaced apart.

This causes symptoms such as palpitations, shortness of breath, and in severe cases, chest tightness.

A normal heartbeat is said to be 60 to 100 beats per minute. If you have atrial fibrillation, your heart rate tends to increase with even the slightest movement (from Apple’s website).

If you have symptoms, you will seek medical attention, which is still good, but the problem is that 25% of these patients are asymptomatic. The problem is that 25% of them are asymptomatic. Since there are no symptoms, atrial fibrillation often progresses without being diagnosed, and one day, without warning, a stroke or myocardial infarction occurs.

Although the details have not been fully elucidated, it has been reported that men are 1.5 times more likely to develop atrial fibrillation than women. Brain infarction and myocardial infarction occur because atrial fibrillation causes blood clots to form in the heart.

When the heart is in normal motion, blood flow is constant and rapid, but in atrial fibrillation, which is a state of continuous spasm, the heart has difficulty contracting, so blood flows only in “trickles. Only when electrical impulses pass through the lower chambers of the heart is blood drawn in all at once.

This repeated process causes the blood to stagnate and forms a blood clot that looks like strawberry jelly. If this clot flows out and clogs a blood vessel in the heart, it causes myocardial infarction; if it clogs a blood vessel in the brain, it causes cerebral infarction. It can also flow into the blood vessels of the arms or legs, or into the intestines, making it a life-threatening and dreadful disease.

Furthermore, Dr. Takimura says that cardiogenic cerebral infarction, caused by a blood clot in the heart, is more likely to be serious because the clot is large.

About 50% of people with cardiogenic cerebral infarction die, become bedridden, or require a wheelchair or assistance. You should not be reassured by the fact that you are still young. Some stroke patients are working fathers whose children are still in junior high school.

Regardless of the presence or absence of symptoms, early detection of atrial fibrillation is a lucky thing for the rest of their lives. I hope the SmartWatch Outpatient Clinic is a place where such patients can be saved.

Arrhythmias in younger generations are caused by lack of sleep, alcohol consumption, overwork, etc.

Apple Watch also catches arrhythmias other than atrial fibrillation. This is the case when the EKG app displays “Unable to Determine.

The “undetectable” status may indicate a hidden arrhythmia, such as extrasystole, which is like hiccups, or paroxysmal supraventricular tachycardia, which is a sudden increase in pulse rate. From an arrhythmia specialist’s point of view, the Apple Watch’s ECG is quite sophisticated and detects arrhythmias over a wide range.

If the Apple Watch ECG app shows “sinus rhythm,” the pulse is constant and there is no need to worry immediately. However, it is recommended to measure regularly even if there are no subjective symptoms

Smartwatches are packed with information for doctors to get to know their patients, such as checking a regular EKG and daily sleep status. One patient actually visited the outpatient clinic and had an arrhythmia detected and treated at an early stage.

A man in his 50s came to the smartwatch outpatient clinic because he was concerned when he saw the “atrial fibrillation” sign on the watch. He was diagnosed with atrial fibrillation and treated with ‘catheter ablation,’ which burns a part of the heart that is causing the problem. He was asymptomatic, but we were able to diagnose him early, and we have been monitoring him with a smartwatch after the treatment.”

The main cause of atrial fibrillation is the deterioration of the heart that occurs with age, but atrial fibrillation in the younger generation is related to a disordered lifestyle.

It is not serious for a single day, but if this lifestyle continues chronically, it can cause arrhythmias. After the age of 30, it is advisable to focus on taking care of your body, including sleep, diet, and exercise.

For a generation that has begun to realize that “the body is more capital than anything else,” “knowing” one’s body with a smartwatch is the first step toward better health. If more people visit smartwatch outpatient clinics in the future, it will help reduce the risk of diseases that can happen to anyone.

When an ECG recording is completed on the Apple Watch, the ECG app displays the results as shown above. If any other “recording condition is not good” is indicated, it may be due to a loose fit. If there are any results that concern you, consult your doctor as soon as possible.

Yukako Takimura, M.D., Chief of Cardiology, General Tokyo Hospital. She has been in charge of the “Smart Watch Outpatient Clinic,” which opened in August 2011, and is a fan of the Apple Watch. She specializes in general cardiology, arrhythmia, catheter ablation therapy, and cardiac implantable device therapy. He is a board-certified cardiologist by the Japanese Society of Cardiology and a board-certified arrhythmia specialist by the Japanese Society of Arrhythmia and Electrocardiography.

Click here for the website of ” Smart Watch Outpatient Clinic at General Tokyo Hospital

  • Interview and text by Yoko Tsunemochi Interview and text by Yoko Tsunemochi

    Born in Yamagata Prefecture in 1983, Yoko Tsunemochi worked for 10 years in the editorial department of a health information magazine, editing monthly magazines and web media before becoming a freelance writer. Currently, she interviews, plans, and writes about doctors and specialists, focusing on health care and medical fields.

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