By Edward Evans, MD
Right now, there is a trend toward wearable heart monitors. You can get them online or at any big box store. Some are fitness trackers, wristwatch-like devices that help monitor your heart and activity level. Others, like the Apple Watch, are high-tech wristwatches that offer cardiac monitoring among many other functions. These devices mostly track heart rate, that is, how many times your heart beats during a minute. They are very helpful to get the most of out of your exercise program because they tell you how much your heart rate should increase. They can also alert you to a resting heart rhythm that is too fast.
Another new type of heart monitor on the market are small, lightweight devices that can be used to produce an actual ECG waveform tracing like you would see from a hospital or in-clinic electrocardiogram machine. Some of these devices have two thumb pads that you press to get your ECG along with a numerical value of your heart rate. A more elaborate system on the market has both the finger-tip ECG option plus two electrodes that you can attach to your chest for an even more accurate ECG. These monitors can be set up to transmit the ECG from the device to a smartphone app or even emailed to your doctor.
The value of these ECG monitors is that you get not just rate information (how fast your heart is beating), but you also get a picture of the heart’s rhythm (for example, whether the upper and lower chambers are in sync with each other). Clinicians can easily read a simple ECG to tell if you might have atrial fibrillation or other arrhythmia. Rhythm is different than heart rate, although rate and rhythm problems sometimes occur together. A problem with your heart’s rhythm is called an arrhythmia. Some of these devices may even tell you the kind of arrhythmia the device thinks that you have, such as bradycardia (too-slow rhythm), ventricular tachycardia (too-fast rhythm that originates in the lower part of the heart or the ventricles), or atrial fibrillation (too-fast rhythm that originates in the upper part of the heart or the atria).
What to Tell Your Doctor
If you have a device like this and it shows something that you want to discuss with your doctor, here are a few tips for a productive consultation:
- Note the date and time of the event. If you used the recording device and it told you that you were having some specific kind of arrhythmia, save the arrhythmia data if you can and also note when it occurred and what you were doing and how your felt at the time. You may not have felt anything unusual at all—that is not uncommon.
- If you did feel unusual when the event occurred, note any symptoms you may have had at the time of the episode. Typical symptoms might include things like feeling woozy, lightheaded, dizzy, feeling a pounding in your chest, having a sensation of a “racing heart,” palpitations, or fatigue. You might even feel faint. On the other hand, many arrhythmias come and go with no symptoms at all.
- Keep tabs on your heart as you get ready for your appointment. You may want to monitor your rhythm a couple of times a day till you get to the doctor. It is not at all unusual that arrhythmias occur only occasionally, so you may have many normal readings.
What Your Doctor May Tell You
No matter how great your device is and how good you are at taking notes, you are only bringing to the doctor a small amount of “evidence” for solving your cardiac rhythm question. Your doctor will want to get your medical history, know about any symptoms you might be having, and ask about medications you take. (Some medicines can affect your heart rate or rhythm.)
Your physician will likely want you to undergo a medical-style ECG which is a much more elaborate process than your at-home device uses. It typically involves placing multiple electrodes on the body and then collecting several different waveforms arranged one on top of the other. Since each waveform shows a slightly different angle, the physician needs all of these tracings (typically 12 of them) to get a full picture of what is going on. An ECG is a painless procedure and can often be done in the clinic.
Depending on what this shows, your physician may also want to do more tests, such as an echocardiogram (a way to get an image of the heart), a stress test (to see how your heart functions when it has to increase and decrease rate), and possibly other tests.
The physician may want to set you up with a monitor of some sort that can watch your heart round-the-clock. These are external devices that you wear for one or more days. They generate a lot of data that the clinic then assesses to see how your heart functions.
There are also small heart monitors that can be inserted under the skin and can monitor your heart, transmitting the data to a receiver system that can forward it to the clinic. These devices can be set up with alarms that capture data and information when certain things occur (for instance, when the monitor thinks you are having atrial fibrillation or when your heart rate goes over a certain rate, such as more than 200 beats per minute). These little devices can be inserted under local anesthetic in the doctor’s office and will last for years. They provide more long-term information than the external monitors which are usually worn for a few days at most.
Information from an insertable cardiac monitor can be highly accurate and since it gathers data all of the time, month in and month out, it is more likely to “catch” an episode of unusual rate or rhythm than other systems.
In some cases, the physician may want to do a cardiac catheterization or an electrophysiologic test. These are very specific types of diagnostic procedures that your physician can explain to you. Most of the time, these can be done on an outpatient basis although you may need to check in to a hospital. These tests use catheters and imaging technologies to get an inside view of what is going on with your heart.