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

Starting Cardiac Rehab

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It’s started finally!   Tuesday, March 26, 2013 was DH’s first day in Cardiac Rehab, just over 8 weeks post-op.  This was an “intake appointment”, and much longer than the normal ones will be.

We got to choose when the future class would be – either Monday-Wednesday-Friday at 7:00 am or Monday-Wednesday-Thursday at 1:00pm.  Anyone who knows me knows that I chose the afternoon class.  I just didn’t want to get up that early and have to deal with early morning rush hour each of those days.

Diana, the intake nurse was very nice – in fact, everyone we met was.

First things first – money.  We found out that his insurance would pay for most but that there would be a $15 copay each session.  However, we did get a parking voucher saving us $5 on the parking garage.

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Description unavailable (Photo credit: pennstatenews)

We got a packet of information on all kinds of things, including food guides – what to eat, what not to eat.  Hooray!

I noticed a poster showing the image (right) for choosemyplate.gov.  I looked at that site when it first came out – and I’m looking again!

Diana was the one who set up the class times, as well.

Next was Claire, a nurse.  She checked all the meds and vitamins that DH takes.  She said that saw palmetto interfered with one of  his prescriptions and she suggested we take the list to CVS so that they can look for other interactions.

She did an EKG,  checked pulse in several locations, looked at the  scar, checked blood pressure on both arms (sitting and standing), listened to the carotids.

BP was  136/64 right,   112/60 left,   119/70 standing left.

She made an appointment with the dietician for Wednesday April 17 at  2:30, after a rehab class.

Turns out that there are patient meetings on the second Tuesday of each month.  We’re getting very busy with patient meetings, Mended Hearts and rehab plus doctor appointments!

 

They were out of t-shirts his size so we got one that was very large.  Another one will be forthcoming…sometime.

These shirts are special because they have a pocket for the portable EKG machine over the heart in addition to the obligatory logo on the back.  As luck would have it, DH was wearing a t-shirt with a pocket.

DH was hooked up to the EKG.  I gathered that he’ll do that himself in the future.

Next up – Shelly, an exercise physiologist.  She talked a bit, asked DH how often he got new shoes.  She said that it should be every 6 months.  Who knew?

She said to drink water every 15 minutes while exercising.

DH started off slow – Treadmill 5 minutes; Bike 15 minutes; Walked on indoor track for 4 laps

When he was done, we went to the Healthy Heart Cafe for a bit of lunch.

Wednesday, Day 2

We got there in plenty of time.  DH turned out to be the only person in this class, at least for now.

He did his exercises but was told he needed to eat breakfast in the future – his blood pressure was too low.

It’s becoming a habit – when he was done, we went to the Healthy Heart Cafe for another bit of lunch.

I had bought him a Groupon for a local garden shop as a Christmas gift.  Of course, I had no idea then that he wouldn’t be doing much gardening this year.  In any event, it was going to expire on March 30, so we went there after rehab and got a few things 🙂  They may all become house plants – we’ll see!

Absolute exhaustion by the time we got home.

Cardiac Rehabilitation Starts Today!

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DH finally starts his cardiac rehab today, just over 8 weeks after his triple bypass.

Cardiac rehabilitation (rehab) teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health. Cardiac rehab can help you feel better and reduce your risk of future heart problems.

In cardiac rehab, you work with a team of health professionals. Often the team includes a doctor, a nurse specialist, a dietitian, an exercise therapist, and a physical therapist. The team designs a program just for you, based on your health and goals. Then they give you support to help you succeed.

If you have had a heart attack, you may be afraid to exercise. Or if you have never exercised, you may not know how to get started. Your cardiac rehab team will help you start slowly and work up to a level that is good for your heart.

Many hospitals and rehab centers offer cardiac rehab programs. You may be part of a cardiac rehab group, but each person will follow his or her own plan.

Who should take part in cardiac rehab?

Doctors often prescribe cardiac rehab for people who have had a heart attack or bypass surgery. But people with many types of heart or blood vessel disease can benefit from cardiac rehab. Rehab might help you if you have:

  • Heart failure.
  • Peripheral artery disease (PAD).
  • Had or plan to have a heart transplant.
  • Had angioplasty to open a coronary artery.
  • Had another type of heart surgery, such as valve replacement.

Often people are not given the chance to try cardiac rehab. Or they may start a program but drop out. This is especially true of women and older adults. And that’s not good news, because they can get the same benefits as younger people. If your doctor suggests cardiac rehab, stay with it so you can get the best results.

Medicare will pay for cardiac rehab for people with certain heart problems. Many insurance companies also provide coverage. Check with your insurance company or your hospital to see if you will be covered.

What happens in cardiac rehab?

In cardiac rehab, you will learn how to:

  • Manage your heart disease and problems such as high blood pressure and high cholesterol.
  • Exercise safely.
  • Eat a heart-healthy diet.
  • Quit smoking.
  • Reduce stress and depression.
  • Get back to work sooner and safely.

Exercise is a big part of cardiac rehab. So before you get started, you will have a full checkup, which may include tests such as an electrocardiogram (EKG or ECG) and a “stress test” (exercise electrocardiogram). These tests show how well your heart is working. They will help your team design an exercise program that is safe for you.

At first your rehab team will keep a close watch on how exercise affects your heart. As you get stronger, you will learn how to check your own heart rate when you exercise. By the end of rehab, you will be ready to continue an exercise program on your own.

What are the benefits of cardiac rehab?

Starting cardiac rehab after a heart attack can lower your chance of dying from heart disease and can help you stay out of the hospital. It may reduce your need for medicine.

Cardiac rehab may also help you to:

  • Have better overall health.
  • Lose weight or keep weight off.
  • Feel less depressed and more hopeful.
  • Have more energy and feel better about yourself.

Changing old habits is hard. But in cardiac rehab, you get the support of experts who can help you make new healthy habits. And meeting other people who are in cardiac rehab can help you know that you’re not alone.

Adapted from CardioSmart.org