Hu Dayi: Wearables are double-edged swords

In recent years, the development of wearable device research and development applications has been very fast, which has brought convenience to the realization of telemedicine, follow-up, health management and patient self-management of health and chronic diseases. However, if there is no perfect health and chronic disease service system, it may sometimes cause patients to pay too much attention to variable figures such as heart rate and blood pressure, which may lead to anxiety and related physical symptoms.

A 70-year-old male patient was recently admitted to Shanghai. For high blood pressure, use for ten years of kangxin (bisoprolol), one tablet (5 mg) daily. Blood pressure control is good and stable. Happy mood, no physical discomfort. But since I put on a watch that has a heart rate and blood pressure check at any time, I found that my heart rate has a lot of leakage every day, I feel nervous, I feel that something big has happened to my heart, so I go to the hospital to see a doctor.

I feel puzzled but think about the conventional misunderstanding of the doctor to see a doctor and understand that the first doctor to see a patient first did not pay attention to the patient's most concerned about the "heart leakage" (the ECG shows that the sinus atrial block, but the heart rate is not slow), but at a glance saw the patient's ECG on the chest lead deep inverted T wave, immediately misjudged as coronary heart disease, myocardial ischemia, to the patient about the serious ischemia of the myocardium, the risk is great, need to be hospitalized immediately for coronary angiography, if necessary, stents. Patients are reluctant to do angiography, let alone stents, and ask the doctor what to do if the heart is leaking? The doctor said that Kang Xin should be discontinued. After the patient was discharged from the hospital, he stopped Kang Xin according to the doctor's instructions and changed the antihypertensive drugs. After stopping Kangxin, the heart leakage is reduced, but the heart rate increases, resting is often 90-100 beats / min, and the slightly active heart rate increases to 120-130 beats / min, feeling palpitations, very uncomfortable.

He also went to the specialist clinic of another university hospital. Experts tell patients that half a tablet of Kangxin can be taken. After returning home, after the patient tried half a tablet of Kangxin, when he looked at his watch, there was a lot of heart leakage. I decided to try 1/4 of Kangxin, and the leakage jump was still not reduced. Don't panic if you don't need it, and miss it when you use it. Patients feel torn between right and left and nowhere to go. Since then, there have gradually been head numbness, chest tightness, back and shoulder discomfort, general weakness, physical and mental exhaustion, from time to time inexplicably upset, depressed, feel heart problems, but also an incurable disease, deep despair. In many university hospitals in Shanghai, the advice of doctors and experts does not solve the problem.

After deciding to go to the Chinese medicine hospital for two months, the watch still showed frequent heart leakage, Chinese medicine and Western medicine were helpless, and the patient's mood became more and more dull.

I asked the patient in detail about the process of pain and analyzed the characteristics of the patient's symptoms.

1. Before wearing a smart watch to observe the heart rate, the patient used Kangxin for 10 years and had no discomfort symptoms. Symptoms appear after the discovery of "heart leakage" with a wearable device watch, and it worsens day by day. Stop Kang Xin, the heart rate is fast, more uncomfortable. Jia Kangxin, even if 1/4 of the tablets, there are frequent leakages on the watch, worried about heart problems, deeply uneasy. Medication does not work, no medication does not work, Western medicine does not work, nor does Chinese medicine work. Worry, uneasiness, entanglement of the heart, and no solution, this is anxiety, anxiety and cause many discomforts in the body.

2. Does the patient have coronary heart disease? I replied: No. The first doctor to see a patient was not seriously studying the basic knowledge of the ELECTROCardiogram, and the second was that he may not have spent time to systematically see the patient's ecG for many years. Patients who have been on multiple ECGs for many years show no changes in the asymmetrical T-wave depth inversion of the chest lead, which should be myocardial hypertrophy, especially the manifestations of apical hypertrophy.

The patient's chest, back, and shoulder symptoms, one is long in duration, calculated in hours; the other is that it has never occurred during exercise, and when exercising, the mood is good, which certainly does not meet the characteristics of angina.

The patient refused the contrast stent, but later had a coronary CT, and the coronary arteries were fine.

3. How to treat? Willow dark flowers bright.

I communicated with the patient for more than 1 hour with Dr. Xiao Xue, a psychiatrist, to help the patient sort out the ins and outs of the disease.

Before wearing the smart watch, when the heart rate is not paid attention, there should be a sinus block, that is, the patient expresses that the heart he sees on the watch is leaking. I have been using one tablet of Kangxin daily for ten years and have no physical discomfort, that is, asymptomatic. Symptoms appear after seeing the heart leak from the watch, and there is no solution during the medical treatment, the uneasiness and anxiety in the heart are becoming more and more obvious, and the discomfort in the front chest and shoulders is getting heavier and heavier.

I communicate with the patient and clearly tell him that one is that the heart leak seen on the watch has no risk, and there is no need for treatment, put the heart down, rather than being the enemy of it, it is better to accompany it and treat it without doing anything!

Symptoms are not caused by leakage, but are somatic symptoms caused by anxiety, which can be resolved with anti-anxiety drugs.

I told the patient that in the past, the treatment was completely entangled in the heart leakage phenomenon displayed on the watch that did not require attention and treatment, and the road became narrower and narrower until there was no way out. Now the direction of treatment should be fundamentally adjusted, and the willow is dark and the flowers are bright and another village. I asked the patient to add me to WeChat, and the patient's WeChat id was exactly the willow dark flower. He asked me, how do you know I'm "willow dark flower"? I replied that it was fate!

A smile already appears on the patient's face as he leaves the office. He sincerely told me that when he approached me at the Renaissance Medical Clinic, he was sure that this was his last stop. If I were talking about the same treatment as in previous hospitals, he would consider himself "incurable" and would have to endure the pain of being unable to be relieved and spend the rest of his life.

In this case, we can see the other side of the wearable. Without a foundation for the management of supporting services, it may cause patients to pay excessive attention to certain meaningless information, especially frequently fluctuating heart rate, heart rhythm and blood pressure, causing uneasiness and anxiety. Therefore, wearing a device is a double-edged sword, not good to use, counterproductive, not only does not cure the disease, but may cause disease!