With a smartwatch for a few hundred euros, wearers can derive a simple ECG (1-lead electrocardiogram). This should serve their «heart health», for example, by detecting atrial fibrillation and timely stroke prevention can be initiated. However, such a smart watch can also harm the health of the wearer, as now confirmed by the medical history of a young man, the Michael Zenzes (Kantonsspital Winterthur) and his colleagues in «Journal of Medical Case Reports».
The patient and his story
The young man was a 27-year-old German-speaking Swiss who, according to the authors, came to the hospital emergency room at night.As a reason, he had stated that after a sporting competition he had felt a movement-dependent, stabbing pain in the left chest. For fear of acute coronary syndrome (ACS), he showed several ECGs with his Apple Watch. The Smartwatch, according to the manufacturer «the ultimate tool for a healthy life» he bought to monitor his «heart health» and check for cardiac arrhythmias. The occasion was media reports about a Danish football player who had suffered a cardiac arrest during a game. The ECG app had always certified him a «normal sinus rhythm». It also regularly pointed out to him that no signs-_ of a heart attack. Nevertheless, the young man became increasingly worried and began to search the Internet for ECG changes in ACS. According to the authors, the result was that he believed his smartwatch ECG contained signs of ACS. In the mistaken belief that he was suffering from acute coronary syndrome, he felt much worse and even had difficulty breathing.
The young man was, as Zenzes and his co-authors further report, fit and healthy; his medical history, including his family history, was inconspicuous; There were no indications of cardiac disease or cardiovascular risk factors, the use of recreational drugs or performance-enhancing agents had been denied.
Findings, diagnosis and therapy
- In the emergency room, the 27-year-old was extremely concerned and complained of increasing anxiety and panic symptoms, including tachycardia, palpitations and sweating.
- 12-lead emergency room ECG: Sinus rhythm with 88 beats per minute, no evidence of ischemia.
In the emergency room, the 27-year-old was extremely concerned and complained of increasing anxiety and panic symptoms, including tachycardia, palpitations and sweating.
12-lead emergency room ECG: Sinus rhythm with 88 beats per minute, no evidence of ischemia.
The authors were convinced that no further diagnostic tests were warranted.Apart from the misinterpretation of the smartwatch ECG in combination with the pain of the musculoskeletal system after physical exertion, there was no other obvious cause for the increased anxiety symptoms. After administration of and lorazepam, the movement-dependent, stabbing pain subsided and the patient felt much better. After clarification of the findings, he had been released from the emergency room. In a telephone follow-up interview, he then reported an inconspicuous cardiological examination and the consultation of an osteopath. He had given up smoking; he feels healthy and continues his sporting activities. He no longer used his smartwatch.
Discussion and conclusion
According to Zenzes and his co-authors, urgent randomized and controlled trials needed to evaluate the clinical utility of such smart watches with ECG function. Thus, there is a risk of unnecessary invasive and potentially harmful diagnostic procedures to *exclude diagnoses made by the smartwatch. In addition, misinterpreted findings or false alarms (false positive findings) could trigger fear or even panic in particularly sensitive people.
The fact that smart watches, with which, among other things, pulse and cardiac rhythm can be controlled, can have unpleasant side effects is also shown by the medical history of a 70-year-old woman, the US cardiologist Lindsey Rosman (University of North Carolina, Chapel Hill) and her colleagues in the journal «Cardiovasc Digit Health Journal».
As previously reported, a year after the diagnosis of paroxysmal atrial fibrillation, the 70-year-old woman was diagnosed by a clinical psychologist with a newly emerging mental disorder, namely hypochondria; this was primarily triggered by extremely frequent ECG examinations with a standard smartwatch, according to Lindsey Rosman and her colleagues.Evidence of a previous mental illness had not been found in the woman’s medical records. High blood pressure and a moderate risk of stroke were documented with a CHA2DS2-VASc score of 3.
The smartwatch data provided by the patient showed that she had performed 916 electrocardiograms within one year. Of these ECG recordings, 701 showed sinus rhythm; 55 indicated possible atrial fibrillation, 30 showed low or high heart rate; 130 ECG examinations did not provide any clear findings or indications. The smartwatch data also showed that ECG recordings became more frequent over the course of the year. Acute escalations in ECG control behavior were often triggered by notifications from the smartwatch that were either harmless (e.g., transient exercise-related increase in frequency), inconclusive, or only indicated possible atrial fibrillation. In particular, reports of irregular rhythm and findings of unclear significance («ambiguous» ECG) caused relatively similar behaviour; this suggests that the patient may have misinterpreted unclear smartwatch data as an actual health threat.
This patient is no exception, Lindsey Rosman said.The 70-year-old is just one example of a phenomenon that is increasingly being observed in cardiology clinics. Rosman: «Patients with cardiac arrhythmias, palpitations or irregular heartbeat come to the clinic with stacks of papers and data from their smartwatches.» These «smart» watches are a great tool in cardiology; they could help educate patients, involve patients more closely in therapy and also provide a wealth of data for research. «Wearables are fantastic,» says Rosman. For some patients, however, they may do more harm than good by triggering and perpetuating fears.»
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Source — https://www.univadis.de/viewarticle/ein-junger-mann-mit-einer-smarten-uhr-2023a100057f