Heart Attack? Doctors Soon May Have an App for That

There are apps that turn your smartphone into a metal detector, a musical instrument and a GPS system, and now there’s an app that may help doctors save your life if you’re having a heart attack.

The app, which was designed by engineers and critical care physicians, helps doctors rapidly diagnose certain kinds of severe heart attacks, called STEMIs, before patients get to the hospital.

The app currently is in the experimental stage, but it has undergone field testing.

In a STEMI heart attack, which stands for ST segment elevated myocardial infarction, a clot completely blocks blood flow to the heart. About a quarter of a million people have STEMIs each year in the United States.

These kinds of heart attacks create a unique pattern of pulses when doctors hook up patients to an electrocardiogram, or EKG, machine, which measures the heart’s electrical activity.

The problem is that doctors need to see the EKG reading, which is called a tracing, to properly diagnose the attack and quickly assemble the team of specialists that is needed to clear the clot.

There are proprietary systems that use EKG machines hooked up to modems to send images back to hospital computers, but those systems are expensive and not all hospitals and EMS systems can afford them.

As an alternative, paramedics can use their smartphones in the field to snap a picture of the tracing and send it to a doctor at the hospital via email.

But as anyone who has ever tried to email a picture from their phone knows, it’s far from foolproof. Large, high-quality images — the kind doctors need to see — can take several minutes to send and receive.

To address the issue, Dr. David Burt, an associate professor of emergency medicine at the University of Virginia, challenged a class of systems engineering students to develop an app that could shrink images to make them faster to send, but still maintain the clarity needed for diagnoses.

“It’s very easy to use,” Burt said. “You hold it over the EKG tracing, you snap a picture.” Hitting a button sends the image. When it’s finished, the app shakes and makes noise to alert senders to the successful transmission.

“It’s very simple but we want it to be very rugged, so that it’s kind of like a hammer — it always works,” he said. He also wants to offer the app at no cost to doctors and hospitals.

So far, Burt said, they have tested the app more than 1,500 times using different wireless carriers in a city.

They also have pitted the app against the alternative method of using an iPhone to email a picture. In that study, the app consistently sent images within four to six seconds. Emailed images could take nearly two minutes to go through. The app failed less than 1 percent of the time, while the emailed images flopped between 3 percent and 71 percent of the time, according to the study.

The study is scheduled for presentation Friday at an American Heart Association meeting in Baltimore. Studies presented at medical conferences are considered preliminary because they haven’t yet undergone the scrutiny required for publication in a peer-reviewed journal.

Dr. Iltifat Husain, founder of the iMedicalApps website, which keeps up with news about technology in medicine, said he was impressed by the app, but also by how thoroughly the team has been testing it. Husain estimates that less than 1 percent of apps that are developed for doctors are field tested to see if they actually work.

“Something like this would have to be tested before it was put to use because of how critical the information is that you’re relaying,” said Husain, who was not involved in the research.

Husain, who also is an emergency medicine resident at Wake Forest University in Winston-Salem, N.C., said the time the app shaves off image transmission could be critical.

“The longer you wait, the more heart muscle dies, so every minute counts,” he said. “Actually, every second counts.”

Surviving a STEMI depends on how quickly doctors can restore blood flow, which often is done by snaking a catheter up to the heart and using a small balloon to clear the clot.

“We’ll get an EKG reading and the ER physician will activate the cath lab. Once you activate it, a huge team has to be assembled,” Husain said. “If it’s overnight, people are sometimes coming in from home. If you can get someone coming in from home five minutes faster, I think it’s a big deal.”

More information

For more about heart attacks, head to the U.S. National Heart, Lung, and Blood Institute.

SOURCES: David Burt, M.D., associate professor of emergency medicine, University of Virginia, Charlottesville; Iltifat Husain, M.D., second-year emergency medicine resident, Wake Forest Baptist Health System, Winston-Salem, N.C., and founder, iMedicalApps website; May 17, 2013, presentation, American Heart Association meeting, Baltimore

Read more at http://www.philly.com

It’s Pretty But…

snowstorm

 

 

No shoveling here!  We’ll tough it out somehow.

From Shoveling snow can be hard on the heart

Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases when enough of the white stuff has fallen to force folks out of their homes armed with shovels or snow blowers.

What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snow blower can do the same thing. Cold weather is another contributor because it can boost blood pressure, interrupt blood flow to part of the heart, and make blood more likely to form clots.

More on CABG (Coronary Artery Bypass Grafting)

From the NIHWhat To Expect After Coronary Artery Bypass Grafting

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What DH had

Recovery in the Hospital

CheckmarkAfter surgery, you’ll typically spend 1 or 2 days in an intensive care unit (ICU). Your health care team will check your heart rate, blood pressure, and oxygen levels regularly during this time.

CheckmarkAn intravenous (IV) line will likely be inserted into a vein in your arm. Through the IV line, you may get medicines to control blood flow and blood pressure. You also will likely have a tube in your bladder to drain urine and a tube in your chest to drain fluid.

CheckmarkYou may receive oxygen therapy (oxygen given through nasal prongs or a mask) and a temporary pacemaker while in the ICU. A pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms.

CheckmarkYour doctor also might recommend that you wear compression stockings on your legs. These stockings are tight at the ankle and become looser as they go up the legs. This creates gentle pressure that keeps blood from pooling and clotting.

CheckmarkWhile in the ICU, you’ll also have bandages on your chest incision (cut) and on the areas where arteries or veins were removed for grafting.

After you leave the ICU, you’ll be moved to a less intensive care area of the hospital for 3–5 days before going home. (only 2!)

Recovery at Home

Your doctor will give you instructions for recovering at home (yes to all), such as:

  • How to care for your healing incisions
  • How to recognize signs of infection or other complications
  • When to call the doctor right away
  • When to make followup appointments

You’ll also learn how to deal with common side effects from surgery. Side effects often go away within 4–6 weeks after surgery, but may include:

  • Discomfort or itching from healing incisions
  • Swelling of the area where arteries or veins were removed for grafting
  • Muscle pain or tightness in the shoulders and upper back
  • Fatigue (tiredness), mood swings, or depression
  • Problems sleeping or loss of appetite
  • Constipation
  • Chest pain at the site of the chest bone incision (more frequent with traditional CABG)

Full recovery from traditional CABG may take 6–12 weeks or more. Nontraditional CABG doesn’t require as much recovery time.

Your doctor will tell you when you can become active again. It varies from person to person, but there are some typical timeframes.

Often, people can resume sexual activity and return to work after about 6 weeks. Some people may need to find less physically demanding types of work or work a reduced schedule at first.

Talk with your doctor about when you can resume activity, including sexual activity, working, and driving.

Ongoing Care

Care after surgery may include periodic checkups with doctors. During these visits, you may have tests to see how your heart is working. Tests may include an EKG (electrocardiogram), stress testingechocardiography, and a cardiac CT scan.

CABG is not a cure for coronary heart disease (CHD). After the surgery, your doctor may recommend a treatment plan that includes lifestyle changes. Following the plan can help you stay healthy and lower the risk of CHD getting worse.

Lifestyle changes might include changing your diet, quitting smoking, being physically activelosing weight or maintaining a healthy weight, and reducing stress.

For more information about lifestyle changes, go to the National Heart, Lung, and Blood Institute’s “Your Guide to Living Well With Heart Disease.”

Your doctor also may refer you to cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home.

Taking medicines as prescribed also is important after CABG. Your doctor may prescribe medicines to manage pain during recovery, lower your cholesterol and blood pressure, reduce the risk of blood clots forming, manage diabetes, or treat depression.