Ask the Doctors March 2019 Issue

Ask The Doctors: March 2019

Q: I heard the Apple Watch can monitor heart rhythms. I have a family history of irregular rhythms. Should I get this watch?


Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

A: The newest Apple Watch Series 4 is able to obtain a single-lead electrocardiogram (ECG) and share the stored waveform with a doctor. Continuous monitoring of this type may help identify intermittent arrhythmias that are difficult to capture on monitors typically used for shorter periods.

The irregular heart rhythm called atrial fibrillation (A-fib) is associated with increased risk of stroke. Since many individuals are unaware they have A-fib, early identification can improve outcomes. The U.S. Food & Drug Administration has designated the ECG app on the Apple Watch Series 4 as a class II medical device. This means it can be used to determine the presence of A-fib, but is not recommended for users with other known arrhythmias. In other words, it is for informational use only.

There are potential downsides to this app. It may incorrectly indicate a rhythm disturbance that is not present (a "false positive" reading), causing anxiety, unnecessary use of the healthcare system and potential exposure to unnecessary tests and treatments. If it fails to detect a true abnormality ("false negative"), it could create a false sense of reassurance. The ECG should always be reviewed by a doctor.

When used appropriately by certain patients and combined with other heart monitoring techniques, the app's advantages may outweigh its disadvantages when used to diagnose or rule out an underlying problem.

The Apple Watch Series 4 is inexpensive. If your primary interest is checking for arrhythmias, there are less-expensive options made by AliveCor. They include a personal ECG monitor that works with smart phones and a watchband for older Apple Watches that adds ECG capability.

Q: I have very high cholesterol and had a heart attack 26 years ago at age 44. Thanks to good medical care, I am doing well. What advice should I give my son and young grandchildren?

A: First, lead by example. Provide your grand- children with a smoke-free environment, and instill in them an appreciation for a healthy diet, exercise and physical activity. Also, make sure your son and his children are checked for a genetic abnormality called familial hypercholesterolemia, which is present in one of every 250 to 500 individuals. With your history of very high cholesterol and heart attack at a young age, there is a strong possibility you carry this gene and passed it to your son.

Pediatric medical associations recommend children of parents or grandparents who had hypercholesterolemia and early cardiovascular disease (CVD) undergo a screening blood test for cholesterol as early as age 2. Guidelines recommend using statins in children who are age 8 and older with LDL levels greater than:
- 190 milligrams per deciliter (mg/dL)
- 160 mg/dL with another risk factor, such as family history of premature CVD, high triglyceride levels, overweight/obesity, hypertension or elevated lipoprotein(a)levels
- 130 mg/dL with diabetes.

Many parents are concerned about starting medications at a young age. However, familial hypercholesterolemia accelerates plaque formation early in life and, if left untreated, can lead to heart attack in the young adult years. Studies have shown no major adverse events or developmental issues in children treated with statins.

Your son and his children may not have high cholesterol levels, but if they do, early identification and treatment can prevent future heart disease. You would be doing them a great service by ensuring they are screened now.

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