Heart ECG Handbook app for Android shows dangers of blindly trusting mobile medical content

by: Michael Wong, MD

Heart ECG Handbook from developer “NP” is a relatively successful ECG reference app that is meant to help users, including “medical doctors,” to learn about the basics of ECG interpretation.

The app includes the (supposedly) most commonly encountered 25 ECG rhythms with short descriptions and sample ECG strips all packaged into a lightweight app.

Heart ECG Handbook comes in a Lite version, with only a limited number of the 25 ECGs available for the user to browse, and a Full version for a price of $2.19. Interpreting ECGs is definitely a daunting task for medical students, residents, and physicians who aren’t used to ordering EKGs frequently.

Let’s see how NP’s Heart ECG Handbook compares to the likes of Dubin’s “Rapid Interpretation of EKGs.”

Developer NP has been very active in the app arena, with numerous health related apps not only on Google Play, but also on BlackBerry as well.

However, I have noticed that there was no source reference made in his app, which is always a red flag with medical apps in my opinion. The app’s credibility really suffered when I found out all NP is is a “Full time student, with a hobby for android programming (sic)” when I was looking around his blog. From my interpretation, this suggests NP is either a medical student very early on in his schooling, or he is attempting to teach ECG as a non-health care associated novice.

This finding actually explains a lot regarding the odd presentation of information in this app.

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The app loads into the menu screen which gives you basically two options: either browse through the the ECGs or start a Quiz. The “License” talks about what to expect from the app and the “About” section basically shows the info on the app. Both these two sections overlap in content, and is rather confusing for me as to why they are divided into two different selections in the first place.

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The 25 ECGs listed include PACs, PVCs, sinus bradycardia/tachycardia, atrial fibrillation/flutter, and AV blocks, which are appropriate. However, the developer included normal sinus rhythm and agonal rhythm in the discussion, which I found odd and perhaps unnecessary.

Also, the whole category of supraventricular tachycardias is presented as its own ECG rhythm despite discussing atrial fibrillation and flutter separately already. To top things off, the developer completely leaves out ST elevations/depressions, bundle branch blocks, or fascicular blocks!

Overall, I am very confused on the developer’s decision to include and exclude certain ECG rhythms.

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After picking a rhythm of interest, you are presented with the “Full Name (why can’t this just be the title of the ECG on the menu?),” a very definite “Heart Rate,” a short paragraph describing the rhythm, and one hand-drawn single strip ECG (with no clarification on lead). The ECG strip is pretty cool in that you can scroll left and right to look further up or down the strip, with a toggle to turn the grid lines on or off.

However, everything else is just off. First, as many of you may know already, interpretation of single leads is often unreliable. 12-lead ECGs are routinely performed in the clinical setting to facilitate an accurate diagnosis. Second, the heart rate given is always a solid number in the app, which at most times is flat out wrong, too. For arrhythmia, no one can predict a heart rate to the exact number, and only a range would be logical and perhaps even helpful for the clinician.

Third, the descriptions are confusing, inconsistent, and sometimes even wrong. I am unsure what the descriptions are meant to do as well–are they meant to describe the physiology behind the arrhythmia or are they attempting to inform me on how to diagnose the rhythms? No matter, neither was accomplished for me. Lastly, there are typos.

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The quiz section is a randomly generated multiple choice test. Sometimes you are asked to name the arrhythmia based on an ECG strip and at other times based on the description of the arrhythmia. Because the questions are randomly generated, there have been times when I encountered identical choices for a question with only one of them being the right choice. The quiz will not keep track of an overall percentage score and is endless until you quit.

Review Version: 3.0.1
Phone used for review: Samsung Galaxy S III

Price:

  • $2.19

Likes:

  • Nothing really

Dislikes:

  • Limited library of ECGs-important and commonly encountered rhythms are left out
  • Occasionally the information is wrong
  • Inconsistent and confusing descriptions
  • ECG strips are hand-drawn and consist of only one lead
  • Poorly designed quizzes
  • No reference source and questionable credibility
  • Typos

Conclusion:

  • NP’s Heart ECG Handbook attempts to educate users and even “medical doctors” on ECG interpretation, but fails miserably.
  • Other than the nicely designed scrolling of ECG strips, there is really nothing positive I can say about this app. A quick reference to Wikipedia would have not been a bad idea, I suppose. I will end this review here by suggesting to stay away from this app

Google Play Store link: Heart ECG Handbook – Full version
Developer: NP(npmelanogaster)’s Blog

Author:

iMedicalApps Team

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