Reviews – The Student Physiologist

Review: The Bunch of Grapes

14 Silver Street
BRADFORD ON AVON
BA15 1JY
To book, call 01225 938 088

Price: Lunch £20 (3 courses), Dinner £6.50-£18.50

I (probably) know exactly what you’re thinking; “why is a a cardiology website reviewing a restaurant?”

The reasons are three-fold: firstly, before I began this career, I was a professional chef, and as such, I know my way around food and kitchens. Secondly, The Bunch of Grapes features a menu developed in part by Ali Khavandi, the man behind Cardiologist’s Kitchen, and finally, I was invited to an evening hosted by Ali himself and project manager Mary, and we ate some of the food, so it seemed entirely appropriate.

I’ve always had a lot of love for Bradford on Avon. It looks like the generic description of a town in this country that you’d receive if you were to ask an American to describe “England-but-not-Central-London” – picturesque, quaint, cobbled, Downton Abbey, etcetera. Its subtle gentrification has given rise to a few more shops with the word “craft” in the name, but it isn’t a detriment to the town, and I didn’t see pulled pork on any menu as I wandered around. In fact, this shift has kick-started the local economy, and allowed middle-to-high end gastropubs like The Bunch of Grapes to open.

The eatery sits at the end of a terraced row, and looks rather unassuming from the outside. Once through the doors, however, oak furniture leads you past the deceptively wide casual dining/drinking area, and into the bar.

Now, if you’ve ever been to an establishment that serves both Butcombe Bitter and duck confit (read: gastropub), you’ll know two things are an absolute certainty:

1) Refreshments are the usual fayre, encompassing local ciders, lagers, ales and fancy-looking soft drinks (if you’ve ever tasted an “artisanal” cola, you’ll be well aware that they’re not bad, but they aren’t normally any better than the usual suspects). There isn’t a huge selection of each, but all are reasonably priced and work well with the surroundings and menu.

2) The bar area is found before the more formal dining room, which features smaller, more intimate tables and is far enough away that one can avoid the loud, busy Friday and Saturday evening drinkers.

Both of these things are true here, but The Bunch of Grapes still has a certain individuality to it.

The restaurant offers two main types of menu, one that presents as a kind of upmarket but classic pub food list, and another, more refined selection that seemingly draws more influence from French cuisine. There exists a third nestled in amongst them, however: the CardioKit menu. Consultant Interventional Cardiologist, Ali Khavandi and head chef Steve Carss have joined forces to create a professionally cooked, heart-healthy range of dishes for patrons. Dishes which I was invited to sample.

First up, the whole roast poussin. It arrived on a heavy, ceramic plate (not a wooden board, thank heavens), and despite having a rather downplayed menu description, was something of a delight! Liberally doused in apple and wholegrain mustard during cooking, and stuffed with whole sprigs of rosemary, the slow roasting process meant that not only was it incredibly tender, but the flavour of both the baste and the rosemary permeated through the wonderfully textured skin and the soft meat. The accompanying mixed leaves and ash roasted leeks were a more underwhelming by comparison, but they weren’t a bad thing by any stretch. Besides which, they were never really going to be the star of the dish. Both elements combined didn’t quite sate my hunger as I wished, and could have done with a starch to accompany them, but it didn’t detract from what was there.

Whole chicken picked clean, dessert was served, and it was another knockout. Indulgence and healthy don’t usually go together when dining out, so it was a refreshing change to be presented with just that. A sweet, roasted half peach served on a just-bitter-enough berry compote. On top of that was a big scoop of vanilla ice cream and a smattering of cress, because healthy eating is boring without something that feels a lot naughtier than it actually is.

In all honesty, it’s just nice to eat a dessert in a gastropub that isn’t cheesecake, or something that’s been baked in the same ceramic bowl that you eat it from. The peach had a lovely crunch to it, and given that the rest of the dish effectively existed as a cold sauce, it summed up both courses; this was an exploration of textures as much as it was of healthy flavours.

I didn’t know what to expect from the CardioKit menu items, to be completely truthful, as I doubted how versatile it was possible to be to justify charging restaurant prices for healthy food, but I was (and still am) happy to be proved misguided. I worked in kitchens that revelled in being an unhealthy treat, but I almost find myself regretting not having brought something like this to customers myself. As a result, I’ll be championing The Bunch of Grapes and Cardiologist’s Kitchen, and I’ll be back to taste the rest of the menu.

Oh, and CardioKit patients get 50% off their food, so there’s no excuse for those in the South West not to visit.

For more information abut both The Bunch of Grapes and Cardiologist’s Kitchen, visit their websites:

cardiologistskitchen.com

thebunchofgrapes.com

Review: R-CAT ECG Analysis Badge

Price: £9.99/ $8.00

Developer: EKG Concepts (U.S. only. UK Stockist here)

I’m used to reviewing mobile apps and, to a lesser extent, PC and Mac software, so this is something of a new experience for me. I’ve frequently used rate rulers and pocket tools in the past, but the Rapid Cardiac Analysis Tool (R-CAT) is seemingly different to such an extent that I felt it made sense to put it through its paces.

This tool is designed to enable a healthcare professional of any specialism to quickly assess some of the basic criteria of a 3 or 12 lead ECG, such as heart rate, interval and segment duration as well as waveform deviation from the isoelectric baseline.

20161117_000357 1.jpg — *I prefer landscape orientation, but the R-CAT accommodates portrait also.*

First, the card itself; it’s well crafted, durable, flexible at the same time, is roughly the same size as an I.D. card/driving licence, and its structure and non-embossed build mean it’s easily disinfected, much the same as many other pieces of equipment you would use in a clinical environment. There are two cutaway sections that allow you to attach R-CAT to your lanyard in either a portrait or landscape orientation, and it sits snugly behind the badge holder without getting in the way.

It is, however, too large to slot into the standard NHS card holders which is a minor niggle, but this isn’t too much of a bind as it doesn’t take a huge length of time to remove, and if you have a pull-reel badge holder, it’s no problem whatsoever, as you can use it without removing the card or your lanyard.

The R-CAT focusses specifically on heart rate, segment and interval length, and baseline deviation (if you’re looking for a cardiac axis diagram, then you’ll have to keep looking, I’m afraid). The heart rate measurement works in exactly the same way as a regular rate ruler, with a similar error margin. It doesn’t have as many timing markers as similarly priced full rulers, but I guess it was a necessary concession to make in order to accommodate everything else on its small frame. Whatever the reason, you get a rough to fairly accurate indication of the true R-R interval.

*R-CAT HR circa 37bpm. The HR given by the equipment and my own calculation was 36bpm*

The segment/interval indicators are found on the opposite side of the rate calculator, and span two of the outer edges of the card. The smallest measurement is 0.03s, and the printed values then increase from 0.04s by two, up until the largest at 0.44s. In practice, this system takes a little longer to use than simply measuring with a ruler, but once you’ve used it a couple of times, and get an eye for it, it doesn’t add too many vital seconds to quick analysis.

*R-CAT measured the PR interval at 0.36s, as did my pencil and paper, and standard rate ruler*

The hook, as it were, that R-CAT introduces, is in the big window through the centre of the card designed to be used in ST segment and Q wave analysis.
Whereas using the edge of some paper, or a ruler can obscure or distort the view of 50% of the waveform under scrutiny, R-CAT uses a thin, red bar in the middle of a clear window, allowing for quick assessment of Q waves and ST segments simultaneously.

20161117_003046 — *It’s possible to view both positive and negative sections of a waveform at the same time*

The window works well, and also functions in the presence of baseline wander, so when such an occurrence is unavoidable, it isn’t a detriment to your analysis.

The company website states it to be more accurate than marking in pencil, as graphite marks can be up to 0.4mm thick, and that is has a greater longevity than callipers, which can loosen with time, and be moved involuntarily. These are excellent points, but with wear and tear printed graphics deteriorate, so I assume that scratches on the measurement indicators could reduce the accuracy of this tool, rendering these comparisons obsolete. Nothing lasts forever, though, and out of the box it works perfectly well.

All in all, I can’t really see this product replacing already-existing products en masse, as this is £10/$8 and the analysis aids already circulating are either slightly cheaper or free, and some provide more functions, but as a learning tool the R-CAT is really effective. During my testing for this review I asked a few cardiology veterans for their immediate impressions, and all shared this opinion. New products in this category are often more of the same; a different colour here, an additional picture there, but R-CAT isn’t one of these products. It shines with its novel portability, and its gimmick; the window. I almost feel bad calling it such, as I feel the word “gimmick” detracts from the product which is, overall, a very cool bit of kit. I won’t say this is an absolutely essential purchase for current professionals who operate outside of an A&E or non-cardiac ward, but it’s certainly worth a purchase. Universities and students however, should take the plunge.

Ah what the heck, it’s unobtrusive and is genuinely helpful when you don’t have a calculator or a rate ruler to hand. If you’ve got a spare £10/$8 kicking about(!), then you should definitely buy one.

Review: Epicardio Simulation v1.5 (Full Version)

Download for Windows/OSX:

Trial (Free)
Paid (£149-£215)
60% discount for full-time students

Developer: Epicardio.Ltd

After my review of the temporary access trial of Epicardio Simulation (which offered a great deal of praise, I might add) I couldn’t wait to have a look at the full version’s features. I still can’t afford it yet even with the 60% discount offered to full-time students, but thankfully, the good people at Epicardio.Ltd allowed me to access the complete package so that I could review it. As I’ve already covered some of the functions of the program, I won’t re-tread old ground, but you can check out what I thought of the trial version here, and consider this a continuation of those original opinions.

So, what functionality is offered by the full version? Let’s go over it now.

The previously-unavailable tutorial section has some marvellous interactive elements; a view of the electrical action and a live ECG accompany the written tutorial pages, allowing the user to view the very thing they’re reading about in real-time. The procedurally generated ECGs are very accurate (I’ve measured them), but if you want to see a genuine patient-obtained trace recording, then one is included with each arrhythmia, too, which really helps with comparisons to the actual recordings one is likely to find in practice.

Almost everything you can think of is covered in some capacity, both on its own, and linked with other, relevant arrhythmias, so you really get a feel for just how interwoven some conduction and rhythm abnormalities can be.

A marvellous inclusion is the level of interactivity within the tutorials; degradation from VT to VF, for instance, is displayed live on the ECG strip and the defibrillator (that I didn’t really have cause to use in the trial version) can be charged, and a shock administered, altering the rhythm strip as it would a real patient.

The pacing tutorials are easy to use and easy to follow; they walk you through the physics of single and dual chamber, as well as biventricular pacing. In using them to learn the basics of pacing, I can appreciate how effective the arrhythmia sections are and how useful they would have been during the early days of my studies. The interactivity of the aformentioned tutorials remains, too. Placing a pacing wire in different sites allows the user to view live rhythm changes, and sensitivity, HR and pacing rate can be toyed with so as to identify intrinsic rates and pre-pacemaker abnormalities such as 3rd° AV Block on the real-time trace.

The test area throws generated ECGs at the student, and offers multiple answers from which to choose. Much like any degree-worthy multiple choice test, they range from incredibly easy to downright tricky, but a review section allows you to view the areas that might require further learning before each future run-through. As with the main bulk of the software, measurement calipers are useable during the test, allowing for some precise questions to be given. Importantly, this software allows and encourages repetition; fundamental to successful learning. It may seem obvious, but I noticed that my understanding of unfamiliar areas increased the more I explored them. What won’t be obvious, is just how quickly this occurred. With the addition of the test function, the user can consolidate what they have learned at their own pace, and not have to exit the program find a different testing app.

My time with the trial version of Epicardio only threw up a couple of minor issues. Whilst these are still present, they detract from the simulator even less than before, due to the myriad of extra content present in the full release. My only new problem came in the single chamber pacing tutorial, wherein I was instructed to reduce the pacing rate to 45bpm, yet I couldn’t lower it past 50bpm. This made it impossible to view the intrinsic rhythm of the digital patient (the point of the page in question’s existence), but only in this instance. It’s worth pointing out that regular updates exist to iron out glitches such as this, so errors needn’t remain for long.

If, like me, your learing speed is increased by doing, as oppose to just reading or seeing, then you’ll find this tool invaluable. To be able to safely induce life-threatening ventricular rhythm is, understandably, an uncommon occurrence, so a method to facilitate this, and things like it, is always going to be welcome for students. In Epicardio, however, you get so much more than that. Pacing of all types is covered in depth, real and digitally created ECGs, and an effective test facility really do set this above any of the other programs that I’ve used. It’s also incredibly simple to get the hang of, too. The things it does well far outweigh its minor issues, so I can wholeheartedly recommend this program to everyone who wants learn about cardiac arrhythmia and interventions. Whilst the implementation of a 60% student discount brings the price down to the £59-£89 mark, it is still expensive, but you really do get what you pay for.

Review: Epicardio Simulation v1.5 (Trial)

EDIT:

After writing this review, I got my hands on the full version. So this review continues here.

Epicardio offer a 60% discount to full-time students

Download for Windows/OSX:

Trial (Free)
Paid (£149-£215)

Developer: Epicardio.ltd

Studying ECG can be one hell of a mountain to climb, especially when you’re at the novice level of cardiac education. Due to how vital it is, it’s imperative that you can not only make the distinction between Mobitz II AV Block and sinus arrhythmia, but also understand the intricacies of the cardiac conduction behind them, and all of the other rhythm abnormalities. Learning these things like the back of your hand is one thing, but combining all that knowledge is, at times, overwhelming. So after 12 months of scouring the internet, trying to find a decent cardiac anatomy and 12-lead ECG simulation tool, I was over the moon to stumble upon Epicardio Simulation; a cardiac electrophysiology tutorial application, developed by Epicardio ltd.

The program is available in 3 main forms; Epicardio ECG, ECG and Pacing, and 3-day trial. As I don’t have £149 kicking around (the price of the basic ECGcentric offering), I can’t review the full version and all of its features, but the 3 day trial version (which is £0), is well within my price range. Thus, I shall only be commenting on the features with which I have been able to sample.

Thankfully, the collection of features available to trial version users is still extensive, so I have lots to cover, and perhaps I’ll spring for the full version when funds allow. The question is: does the trial impress enough to warrant the large expense? Let’s investigate further:

Almost as soon as you open Epicardio, the vibrant display hits you; a large, anatomically accurate heart fills most of the screen as colourful depolarisation waves travel across the atria, and down through the ventricles. The live single lead ECG tracks with concordance, and the right hand menu buttons are nicely presented and clearly display exactly what they do.

Depolarisation mechanics can be viewed through the heart as a whole, or each section on its own. Atria, ventricles, bundle branches and coronaries, can all be viewed independently whilst depolarisation occurs, so it’s possible to learn how the various components of the cardiac system operate during each cycle.

Further structural overlays can be added, in the form of the vena cava, thoracic cage and a translucent torso, further adding to the ability to understand the heart’s positioning in humans.

The electrical readout on the lower region of the screen comes with the option of cycling through all 12 leads on the standard ECG, individually, but as well the real time single lead ECG, users can also activate a live 12-lead, which again updates in real time with each cardiac cycle. This mode itself allows for different viewing styles, including the layout presented on most standard ECG printouts, which is perfect for students. It also features all the subtle morphology differences and minor, unavoidable muscle tremors that one would find on a real ECG recording. Calipers are a welcome feature, too, and they work well in Epicardio, allowing for measurements that students will definitely have to become proficient in throughout training.

Further customisation options are numerous; the colours of the depolarisation waves are changeable, as is the colour of the backdrop. Rather than simply offering pre-set rhythms, Epicardio allows you to manually alter heart rate, and, possibly more importantly, AV delay, so it’s possible to visibly alter the depolarisation wave on the beating heart in the centre of the screen, and see the live trace display a prolonged PR interval.

A most welcome feature is the electrode view option. A click on this button brings up a moving image of the heart within the thorax, and the standard precordial electrode sites. These electrodes can be moved anywhere and the real-time result displayed on the recorded trace, so it’s rather nice to be able to explore the difference in the voltage/time graph that occurs with electrode misplacement.

A defibrillator option allows you to shock the heart, although this was of limited use to me, as I did not have access to the fibrillatory rhythms that come with the paid version, but the artificial pacemaker below it allows the user to alter pacing pulses and observe the changes on the ECG.

My issues with Epicardio range from those that exist simply because the version I tried is restricted, to those that are nought but minor niggles, so I shall focus on those minor niggles, as oppose to content I simply have not paid to access.

The ECG trace, whilst being incredibly customisable, would feel much more authentic if it were set against a proportional image of standard ECG paper; being able to view the trace against the background most students will see throughout studies would be a great primer in the early days of study, and considering the trace speed is adjustable, I was disappointed it wasn’t a feature.

The option buttons look lovely, offer genuine function and, once you’ve been through the tutorial and played around with them, make perfect sense. It would perhaps be helpful if a brief explanation appeared when the mouse pointer was placed over each one, however, as it was a struggle remembering what the more vague options actually did, especially for the first few hours of using the program.

However, as I stated, these are only minor gripes. Epicardio is a wonderful and genuinely fun bit of software to use. I’ve got a feel for how beneficial having this in the beginning of my studies would have been. The layout, options, functionality and simplicity of using Epicardio are all near-perfect, so I can’t wait to get a hold of the full version, complete with pacemaker-specific options. If you have a spare weekend, then follow the link at the top of the page, and download the free trial. If you have a spare £149/£215, then follow the same link and download the full version, as if it’s provides even 50% more features than the demo, I can be certain it’s worth it.

I will review the full version as soon as I can.

Review: BMJ Best Practice

Download the IOS app: Free

Download the Android app: Free

(In-app Purchases: £5-£60 approx.)

Developer: BMJ, London

BMJ Best Practice is an app that aims to aid diagnosis and guide the practitioner through the treatment process of a number of pathologies. Guidelines on examinations, tests and medications are provided across 977 topics. These are not all available initially; some conditions are presented as a free sample, whilst the rest must be purchased either in one go (£59.99), or by categories such as Critical Care and Emergency Medicine (£15.99), and Cardiovascular Disorders, Vascular and Cardiothoracic Surgery (£7.99). Institutional access is available, so if your trust/ university subscribes to the service, you can access all of the content for free.

These are the good things BMJBP does. Unfortunately, it does a great deal worse when it comes to every other aspect of its content and execution.

Whilst the level of content is very good, straightforward and to the point, it’s unlikely that you’ll actually get to see any of it, as the sample pages don’t always load, and when they do, they don’t save. Frequently, I left the app to take a call, and returned to it to find it had rebooted. In addition, whilst the developer’s ability to extract the subscription fee for paid content suffers no problems, their ability to supply said content is non-existent. I purchased the “Cardiovascular Disorders…” category for £7.99, and was told by the “My Topics” section of the app, that I didn’t own any of the documents, yet was told by the “Subscribe” page, that I did..! Either way, I couldn’t (and still can’t) view any of the content I have paid for.

I sent an email over to the BMJ customer service department, and was politely informed that subscriptions were handled by Google, and there was nothing that BMJ could themselves do. As it turns out, subscribed content is entirely the responsibility of the BMJ, so when I pointed this out, and asked for a refund, I was met with a wall of silence that is currently ongoing.

Although it may be tempting to download this app, I strongly recommend that you do not; the content isn’t there, the app itself is buggy and the developer’s desire to help with problems is as present as the paid topics, in that both have yet to materialise. Judging by the user reviews left on Google Play, I am not the only user to have faced any of these problems, so it’s not as though the devs are unaware.

This app doesn’t do enough, regarding functionality, to warrant being this unfinished. It genuinely frightens me to think that someone was paid a wage to develop this, and even more frightening, is that the BMJ are charging for content, despite the numerous complaints of bugs and such. The app lists its last update as 2015, but lord knows what it addressed, or how much worse it was before, if this is considered sufficient.

This, dear reader, is how NOT to make a mobile app.

Review: Acadoodle

Acadoodle.com – online

Price: $99/ £66 per annum (approx)

Authors: Dr John Ryan, Dr John Seery

Acadoodle is a subscription-based online resource for ECG training that boasts a large selection of video tutorials which can be viewed individually, or as part of a tested course. The ECG Teacher sections are the primary focus of this review, but other courses such as blood gas analysis are available, however.

Produced by Drs John Seery and John Ryan, I found these courses to compliment my study, and even when I wasn’t watching them directly, I found myself letting them play in the background as I read a textbook, or went over my lecture notes.

The videos themselves are well produced and make understanding the ECG and its subsequent analysis much easier. The animations are slick and the narration is clear, concise and full of all the pertinent diagnostic information you will require.

Each area of study is tailored to a specific area of electrocardiogram diagnostics, so each playlist/module flows from one video to the next. In addition, the flow of the modules themselves makes sense, and the learning curve increases in a logical order and as such, each section follows on from the one that precedes it in a manner that doesn’t overload you with information before you’re ready.

A small selection of the videos are available on YouTube, so if you wished to try before you buy, then searching for “Acadoodle” would throw up some of the more basic tutorials for you to have a look at. I noticed that these YouTube videos are also embedded in the Acadoodle site proper, giving rise to a sometimes noticeable drop in picture quality, on occasion.

It’s nearly impossible to fault the content and structure, as these videos have helped me immeasurably throughout the last six or seven months, but it is an expensive purchase for anyone, let alone students, especially when you consider that almost all of the content is in some way available via lectures or found in other, similar video courses on YouTube. In that respect, despite the quality of the content, I find it hard to recommend Acadoodle to physiology students who are considering purchasing a personal subscription, but for lecturers or professional bodies and universities, it should prove to be a valuable asset when clarifying concepts to a class full of students.

That isn’t to say that a student purchasing a subscription wouldn’t get a lot out of Acadoodle; it’s certainly worth it, it’s just expensive at a time when disposeable income is generally spent on textbooks or… food and shelter. If splitting £66 is something that you and a few peers feel is possible, then I highly recommend it, as the website can be used from multiple PCs with little to no issue.

Review: AliveCor Mobile ECG Monitor (3rd gen)

Download the android app: Free

Purchase the monitor: £75 approx.

Developer: AliveCor, David Albert

Thus far, my reviews have been mostly confined to apps, with the only exception being Windows/Linux software, simECG. This review is quite exciting for me, as it involves a physical monitor as well as a companion app. I picked up the now world-famous AliveCor Mobile ECG Monitor a couple of days ago to road test it, and I’m pleased to say that for patients, it’s fantastic, and for students, it’s just as good.

As far as functionality goes, this app serves as a personal event monitor with a particular focus on atrial fibrillation, and it has a ton of nice features that make it a worthwhile investment for patients regular to cardiac departments.

Out of the box, the dual-electrode plate can be attached to the back of your mobile device via an adhesive strip, or kept separate; AliveCor works either way, and if you do attach the monitor and change your phone, you can pick up additional attachment plates for around £6.

Obtaining a trace is a very quick process; it only took me a few seconds to open the app and begin recording, and the trace is saved automatically after 15 seconds, with the limit set at 30. The user is then presented with a series of tick-able boxes such as hand or chest ECG, and a notes section to document any symptoms. These are then stored with the trace.

In this video, you can see that AliveCor jumps straight into recording once fired up.

Heart rate and beat fluctuation are tracked and graphed automatically to allow patients to relate multiple recordings in conjunction with the particular activity being performed during monitor operation.

In addition to this, the app comes with an algorithm that determines the presence of atrial fibrillation and keeps track of how many instances this occurs.

AliveCor offers a great deal of options when it comes to sharing data and to physical useage: once the trace has been recorded, the user can email it, save it as a fully notated PDF and print either from the app or a different program.

Holding the device in your hands, as shown in the app instructions gives you a trace in lead I, and it’s possible to obtain leads II and III by placing the two electrodes in different areas of the body (I have provided these instructions at the bottom of the page). Handily, AliveCor doesn’t just measure biopotentials in the peripherals, but also in the chest. A Lewis lead configuration is possible to view atrial activity with more clarity.

I experienced a minor issue with artefact at the start of recording, but this was almost definitely user error, as AliveCor ‘steadies’ itself pretty quickly if you remain relaxed and support you arms. This learning curve is honestly the only problem I had with the product, and after 10 or so minutes, it wasn’t a problem at all. I don’t want to speak for everyone, but I feel it’s fairly easy to get to grips with, so I doubt that your average patient would have too much trouble with it after a short while.

Traces themselves look very clean and, thanks to the standard calibration and the inclusion of a regular ECG paper grid, various amplitudes, intervals and waveforms can be measured manually. The trace screen also gives the option to invert the recording, and filter enhancement is selectable for each one.

As an event monitor, this device is invaluable. It comes with its own built-in symptom sheet and it’s incredibly quick and easy to record a good quality trace. AliveCor has been given the thumbs up from the FDA and NICE, so it’ll be interesting to see how the SCST view the monitor; I’ve reached out to them, but haven’t heard anything yet. If I do, I shall update accordingly.

I assume that in the U.S. this app allows patients to forgo some of the high cost of continued medical care by way of allowing the trace to be sent directly to a clinician for review. The UK version gives the option to send the trace to a Cardiac Physiologist for £5 and provides the analysis results within 24 hours, allowing the patient to present an official ECG report to their GP, should they need to.

As an added bonus, the AliveCor app has an educational area that features breakdowns of common arrhythmias and cardiac anatomy. The illustrations are aesthetically very pleasing and straightforward. The information contained within it is not as comprehensive as the information you’ll find in your lectures or textbooks, but it isn’t designed for the use of practitioners, so what is there is entirely sufficient.

All in all, AliveCor truly is a technical feat and not only does exactly what it sets out to do, but gives a glimpse of the future of ECG technology. This is an extremely good way for patients to become actively involved in their own heart health, with a relatively small price tag. The app provides a simple, intuitive UI and doesn’t require any Bluetooth connectivity between monitor and phone: it works right out of the box so that any patient can use it with ease. There’s a reason this product has garnered praise around the globe.

I will add that the device’s creator, Dr David Albert, is one of the nicest individuals with whom I have ever had the pleasure of conversing. His instructions for getting the most out of AliveCor for the purposes of this review have been invaluable, and even though he really didn’t have to, he answered every question I asked him, swiftly too. I’d like to thank David for being kind enough to help me get to grips with the product all the way from his residence in Oklahoma. Students need input such as this; it cements that we are valued and encourages learning outside of regular studies.

Positioning data:

Lead I: LH – RH

Lead II: LL (knee) – RH

Lead III: LL – LH

Lewis: Electrode 1 on V1, device angled vertically

Review: simECG: ECG Simulator v1.186

Download for Windows/Linux: Free

Developers: Antonio Cardoso Martins, Paulo Dias Costa, Joao Miguel Marques

I’ve been searching for a half-decent ECG simulator since last year, but hadn’t found one that costs less than “more than I have”, so I was pleasantly surprised to find the rather unnecessarily named simECG: ECG Simulator for free, on Windows and Linux.

simECG offers a number of functions in its current version. The operator can select from a series of common arrhythmias at the click of a button, and observe the associated waveform on the display. Unfortunately, only a handful of options are actually selectable, at present, with the others showing as greyed out, presumably, as with many Open Source programs, until they are finalised by the development team.

The custom settings tab provides the means to alter each area of the trace individually, adjusting heart rate, P wave amplitude/duration and more, and watching the displayed trace change in real time. The program hints at future save/load functions for your altered settings, too, which will be a nice inclusion for educators to make use of.

All of the aforementioned are easy to use and clearly marked, even if there aren’t currently all that many of them.

The option exists to change the background between ECG paper and a monitor screen, although the ECG paper skin is purely cosmetic. It would have been nice if the paper option was more in correlation with the amplitudes and durations selectable in the readout options. Greyed out sections of the “preferences” tab hint that calibration will soon be able to be changed by the user, so it would be preferable for beginners and students if these proposed calibration options had a realistic background to use in conjunction with the created trace.

I couldn’t find an option to reset the trace at all, even in a greyed out form, and as a result, returning to the default custom settings is something of a chore. Hopefully this is something the developers will consider including in future iterations.

By now you may have noticed the appearance of the waveforms in the above trace. The trace waveform was one of the first things I noticed, as the whole thing doesn’t look right. The P and T waves look malformed, with the latter presenting almost as though the patient was displaying hyperkalaemia despite this being labeled as a normal sinus ECG.

The assessment quiz tab gives the user an opportunity to identify 10 rhythms in 60 seconds. It’s fun, sure, but given the odd appearance of the waveforms, it becomes a case of memorising the traces present in this program alone, as they aren’t all applicable to real life.

I’ll be honest, it’s hard to criticise something that the developers admit will “never be finished” due to its Open Source status, but the nature of this website and Open Source in general means it pays to remain objective. In actuality, whilst I have highlighted a few issues, the fact that this tool is ever-evolving and totally free, means I can only commend the development team for their ethos and hard work.

Martins, Costa and Marquez state their belief that education shouldn’t be a corporate tool, or purchasable commodity, rather it should be accessible to all. The more people there are to flag issues, the better an idea the team can have of what functionality to add, what bugs to fix, and what other changes are felt to be necessary by users. Despite being generally incomplete at present, it’s not only one to watch for in the future, but one I’d ask every cardiac physiologist to download and play around with.

Due to this version still being in the 1.n phase, I have high hopes for the future of this software, as it has great potential as a learning tool. With the addition of more options in the preset tab, further wave/interval customisation, and more accurate waveforms in general, simECG could help physiology students consolidate their knowledge without carting loads of textbooks around, making it an essential bit of kit.

Review: Analyze ECG Reporting

Download for Google Play: Free

Download for iOS: Free

Developer: Cathal Breen

When you’re just beginning to get to grips with analysing a 12-lead, taking a methodical approach is recommended, but in practice that’s easier said than done. Remembering what you’re measuring, and in what order you’re measuring it, is sometimes confusing, especially when, like me, you’re still getting your head around the various concepts behind the plethora of arrhythmias and pathological morphologies you’re likely to find in a patient ECG.

I’ve already covered the tutorial apps documenting normal and abnormal values that I felt were most beneficial to PTP students, but Analyze ECG Reporting by Cathal Breen exists solely to guide the practitioner through each, single analysis and serves as a methodical reminder of everything that should be documented in your report.

Analyse is nicely presented, with a very simple user interface set up for each section. The display contains boxes for measured values, buttons to advance to the next measurement, or to go back to make corrections and some pop-up menus for comments on the ECG waves. It doesn’t suffer from a text overload, or clutter in any way. The colour scheme is visually appealing, but conservative, so when using the app, you’re kept on task and not distracted by needless images or too many different colours.

This app is merely a way to educate practitioners into using the same approach to study each trace. It may seem like an obvious thing to point out, as ECG cannot provide a diagnosis on its own, but Analyse is not an algorithm that will diagnose a pathology for you.
This is not to diminish this app’s merits whatsoever, though. Analyse does a great job of clarifying the process of ECG analysis and provides a list of the necessary things to include when reporting. Since installing it, I have used it to methodically review lots of the traces I’ve obtained, including those set in my coursework.

In fact, my only problem with Analyse ECG Reporting is in correcting mistakes from the drop down menu. A long press on the option that you have selected will remove it from the final list, but this isn’t explained at any point. It took me a little while to figure it out, so some brief instructions wouldn’t have gone amiss upon starting up the app for the first time. It’s a minor niggle and it didn’t detract from my overall experience with Analyse, however.

Consistency and a methodological approach are key parts of analysis, and Analyse ECG Reporting is a great trainer. This app is a must have for PTP students, but I’d recommend it to any student who’ll have more than a passing dalliance with electrocardiograms.

The Best Apps For Student Physiologists

(in my opinion and predominantly found on android)

EDIT: I have added a 5th app at the bottom of the page, “Read by QxMD”.

My bus journey to university can take anywhere from 1.5 to 2.25 hours, depending on how willing the driver is to break the speed limit, so I try my best to make good use of the time available.
It can be rather cumbersome to hold a textbook when the bus is full and the constant movement makes it rather difficult to follow the words on a page, so I downloaded a few apps to help pass the time as well as study and, as you can imagine, some of them have been better than others.
So that you don’t have to spend your wages/student loan unnecessarily, I’ve decided to share those few apps that have either interested me, or helped me during the PTP programme so far.

I’ve omitted any apps that are effectively digital print textbooks, as these are often promoted in both Google Play and the App Store, costing £20-30 and are nowhere near as difficult to find as a couple of these picks.
I’m also not suggesting that you get all of these apps, either; were it not for this post, I wouldn’t have them all. Everyone learns differently, so you’ll probably need one or two at most.

All of these prices are correct at the time of posting, but if any have changed, let me know and I’ll update them accordingly.

1.) ECGsource, Cathsource, Echosource (ECGsource LLC)
Google Play: £1.92, £2.54, £3.03
App Store: £0.79, £2.29, £2.29

These three apps provide a great deal of content and are very reasonably priced, but ECGsource on it’s own is the app that will benefit Y1&2 PTP students the most. It contains information and analysis parameters for a very large number of pathologies, videos to help you understand key principles in ECG science and a tutorial on reading a normal ECG.
This app is a personal favourite of mine, not just for the number of arrhythmias it covers, but for the examples it gives in addition to these.
If you have an android device and you can only get one app, make it this one.

2.) ECG Practical Demo (One 2 One Medicine LTD)
Google Play: Free
App Store: N/A

This app isn’t nearly as easy to follow as ECGsource, but is still packed with content once you know what you’re doing. It also contains a rate/R-R correction tool, a set of digital calipers and an easy to use axis calculator for measurements on the go.
There is a paid version of this app available to purchase, but if you spend a couple of quid, you’ll get all the same information with better quality examples by getting ECGsource or QxMD. For the tools you get with the free version, however, you can check your answers on analysis assignments for free, making this worth a look.

I’m yet to find an app with all of these features on the App Store, but, if I’m honest, I started running out of money whilst wading through the plethora of terrible apps out there, so stopped looking.

3.) 100 ECG Cases for Finals (One 2 One Medicine LTD)
Google Play: Free
App Store: N/A

A quiz featuring (shockingly) 100 ECG Cases for you to analyse and be graded on.
Quizzes are grouped into categories such as Uncommon Arrhythmias, Supraventricular Arrhythmias, etc, so you can really fine-tune your skills in a particular area.
100 ECfF doesn’t offer any tutorials, so obviously it’s recommended that you have some knowledge from other sources before you have a go at it, but it’s made for USMLE finals, so it’s a handy thing to have as you progress.

It isn’t available on iOS, but ACLS Rhythm Quiz is the best option over on the App Store, costing £0.79

4.) QxMD ECG Guide (QxMD)
Google Play: £3.19
App Store: £0.79

Much the same as ECGsource, but seemingly optimised for iDevices, this app has everything a PTP student could need for ECG analysis and arrhythmia recognition. This great app also comes with a handy analysis tool that can you can use to check your answers when you’re practicing.

5.) Read by QxMD (QxMD)

Google Play: Free

App Store: Free

This app is a wonderful way to tailor your journal reading experience to suit your course needs. New updates and articles are available frequently and are all viewable and searchable within the app. I have personally found this tool to be invaluable when trying to further understand the nuances of pathologies within cardiac science.

Hopefully these will help you along your programme as much as they have me.

Thanks!