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Baltimore, MD
COVID-19: White House Pushes Unproven Drugs—Risk of Arrhythmias and Sudden Death
by Steve S. Ryan
Note: I have already written about the risk of COVID-19 for patients with A-Fib (and other cardiovascular diseases). See my post: COVID-19 Virus: Higher Risk for A-Fib Patients.
In recent coronavirus pandemic press conferences, President Donald Trump has repeatedly advocated the use of the drugs hydroxychloroquine (HCQ) and azithromycin (Z-Pak) to treat the COVID-19 virus.
He often says, “What have you got to lose?” About treating patients, he also said these drugs can “help them, but it’s not going to hurt them.” (Really?)
Hydroxychloroquine & Azithromycin Danger―“What Have You Got to Lose?”
The drugs hydroxychloroquine and azithromycin are currently gaining attention as potential treatments for COVID-19. Hydroxychloroquine sulphate (Plaquenil) is an antimalarial medication. Azithromycin (Z-Pak) is an antibiotic. (Antibiotics in general are ineffective against viruses.)
Each has potential serious implications for people with existing cardiovascular disease.
Contrary to Mr. Trump’s statements, you do have a lot to lose. Medical groups warn that it’s dangerous to be hawking unproven remedies.
Recently, three U.S. heart societies published a joint statement to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.
According to the “Guidance from the American Heart Association, the American College of Cardiology and the Heart Rhythm Society”:
Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death.
The effect on QT or arrhythmia of these two medications combined has not been studied.
With these increased dangers in mind, we must not take unnecessary (or foolish) risks in the rush to find a treatment or cure for COVID-19.
What We Know So Far About These Drugs and COVID-19
COVID-19 Virus: Higher Risk for A-Fib Patients
COVID-19, the disease caused by the new coronavirus SARS-CoV-2, has sickened hundreds of thousands and continues to kill large numbers of people worldwide.
Typically, it’s considered a threat to the lungs, but COVID-19 also presents a significant threat to heart health, according to recently published research.
“But It’s Just the Flu, Right?”
“During most flu epidemics, more people die of heart problems than respiratory issues like pneumonia,” according to Dr. Mohammad Madjid, McGovern Medical School at UTHealth. He expects similar cardiac problems among severe COVID-19 cases.
In addition, COVID-19 can worsen existing cardiovascular disease. For example, Atrial Fibrillation patients may develop myocarditis, an inflammation of the heart muscle. If left untreated, myocarditis may lead to symptoms of heart failure.
And for otherwise healthy people, COVID-19 can cause new heart problems.
Comorbid Conditions Increase Fatality Rate
Many A-Fib patients also suffer from other chronic conditions such as diabetes and hypertension. With comorbid conditions, COVID-19 can increase the severity and fatality of the virus.
According to research from the Chinese Center for Disease Control and Prevention (CCDC), COVID-19 patients from mainland China who reported no comorbid conditions had a case fatality rate of 0.9%.
While patients with the following comorbid conditions had much higher rates:
+ 10.5% for those with cardiovascular disease
+ 7.3% for diabetes
+ 6.3% for chronic respiratory disease
+ 6.0% for hypertension
+ 5.6% for cancer.
Among critical cases, the case fatality rate is unsurprisingly highest at 49%.
Take Away: A-Fib Patients at Higher Risk for COVID-19
Patients with underlying cardiovascular disease (i.e., A-Fib) are at higher risk for developing COVID-19 and have a worse outlook. Prior heart disease is a risk factor for higher mortality from COVID-19. Cardiovascular patients are encouraged to take additional, reasonable precautions to avoid contact with the COVID-19 virus. And to stay current with vaccinations, especially for influenza and pneumonia. Since people can spread the COVID-19 virus before they know they are sick, it is important to stay away from others when possible, even if you or they have no symptoms. • Stay at least 6 feet (2 meters) from other people Social distancing is especially important for people who are at higher risk of getting very sick including older adults and people of any age who have serious underlying medical conditions. For more information: see the article “How to Protect Yourself & Others” from the Centers for Disease Control and Prevention (CDC).A-Fib Patients: Practice Social Distancing and Stay Safe at Home
• Do not gather in groups
• Stay out of crowded places and avoid mass gatherings
Help Michele: Share your A-Fib Experince With Wearable Heartrate Monitoring Devices
One of our A-Fib Support Volunteers, Michele Straube, will be participating as a patient advocate on a panel during the annual Heart Rhythm Society conference in San Francisco, CA, May 2019. The panel presentation is entitled “The Wearable and Apps: Show Me the Data”. The other panel members, and the workshop audience are medical professionals and experts in cardiac rhythm management
To help Michele share a broad patient perspective, she would greatly appreciate you answering a short survey with your thoughts on wearable/portable devices/apps that provide AFib-related information. Your input may influence what new devices or apps are developed.
All answers will be held confidential. Survey results will be compiled in an anonymous way to share with the Heart Rhythm Society 2019 audience. No individual information will be shared.
Michele S.
The 12-question survey should take no longer than 10 minutes to complete. The survey is open until April 15, 2019. To participate, go to survey: https://www.surveymonkey.com/
You can read Michele’s A-Fib story at Cured After 30 Years in A-Fib by Dr. Marrouche.
Personal Update on the Malibu Fires
An update to our earlier post about evacuating our home because of the Malibu brush fires. Rest assured we are okay. Got back into our home this past Tuesday. Still no power, but water (and toilet) is working. Local hotel hosted all evacuees for Thanksgiving dinner. God bless all our fires fighters, first responders and volunteers.
Our home is okay, just a few singed palm trees and spots of burnt brush. Thanks to God.
A few photos for you. Continue to pray and send us your positive thoughts. Will write more soon.
A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate
Some Atrial Fibrillation patients know immediately when their heart is in A-Fib. They experience one or more symptoms including shortness of breath, palpitations, heart flutters, etc. Other A-Fib patients may have subtle symptoms (or silent A-Fib) and can’t be sure.
The following self-care skills will reassure you any time you suspect you’re in A-Fib—how to check for an irregular heartbeat and how to tell if your heart rate is too fast or too slow.
Self-Check if Your Heartbeat is Regular or Irregular
I found an informative post with these self-care skill steps on the Scope Blog by Stanford University School of Medicine. To check whether your heartbeat is regular or irregular:
♥ Begin by placing your right hand on the left side of your chest while seated and leaning forward.
♥ Position your hand so that you feel your heartbeat most strongly with your fingertips.
♥ A normal heart rhythm should feel like a regular drum beat cadence; you can usually anticipate when each beat will come after the last beat.
♥ Because heart rate and the strength of the heartbeat can vary with breathing, sometimes holding your breath for a few seconds is helpful. With an irregular rhythm, it will be hard to predict when the next beat will come.
♥ In addition, some irregular beats will be softer (less strong) than other beats, so the strength as well as the timing may not be consistent.
Self-Check If Your Heart Rate is Too Fast or Too Slow
The Stanford blog continues with a second set of self-care skill steps—how to measure if your heart rate is too fast or too slow so you know when to seek medical care. (An optimal heart rate is 50–100 bpm when you are at rest.) To check your heart rate:
♥ Place your right hand over your heart so that you feel your heart beating under your fingertips.
♥ Use a watch or timer and count the number of beats for 15 seconds.
♥ Be sure to count all heartbeats; including beats that are not as strong or that come quickly following one another.
♥ Take the number of beats you’ve counted and multiply it by four. For example, if you count 30 beats in 15 seconds, then you would calculate 4 x 30 = 120 beats per minute.
♥ Repeat this process three times right away, writing down each heart rate to later share with your doctor.
While an Electrocardiograph (ECG or EKG) or Holter monitor are the only sure ways to document you are in A-Fib, you can use the above self-care skills to recognize A-Fib symptoms of an irregular heart beat or if beating too fast or too slow.
These skills with help you remain calm and confident when you suspect you may be in A-Fib.
Part II Framingham Study: Research Milestones in Heart Disease and Atrial Fibrillation
Now celebrating its 70th year, the Framingham Heart Study (FHS) is a long-term, ongoing cardiovascular study of residents of the city of Framingham, MA, a small, middle-class community 23 miles west of Boston.
Starting in 1948, the objective of the Framingham Heart Study was to identify the common factors that contribute to cardiovascular disease by following its development over a long period of time. Participants would have no overt symptoms of heart disease and not suffered a heart attack or stroke. Today 15,447 people of varying ages, backgrounds and heritage are enrolled including second and third generations.
Findings Integral to Scientific Understanding A-Fib
The Framingham study has contributed greatly to our understanding of Atrial Fibrillation and to the risk of stroke, heart attack and heart failure. A few important milestones about A-Fib include:
1957 High blood pressure and high cholesterol levels increase likelihood of heart disease
1960 Cigarette smoking found to increase the risk of heart disease
1970 Atrial fibrillation increases stroke risk 5-fold
1982 Chronic atrial fibrillation associated with a doubling of overall mortality and of mortality from cardiovascular disease
1991 Atrial fibrillation as an independent risk factor for stroke
1994 Diabetes and hypertension risk factors for atrial fibrillation
2002 Obesity is a risk factor for heart failure
2009 New genetic variant associated with increased risk for atrial fibrillation
2010 Sleep apnea tied to increased risk of stroke
2010 Having first-degree relative with atrial fibrillation associated with increased risk
Framingham Research: Expect More Findings About Atrial Fibrillation
Framingham scientists circa 1948
Framingham data resources are available for researchers to use, and those data continue to spur new scientific discoveries. The study data has spawned over 3,600 published studies in medical, peer-reviewed journals.
As A-Fib patients, we owe a huge debt to the Framingham participants, doctors, scientists and researchers. With continuation of the Framingham Heart Study, we can expect more research findings about Atrial Fibrillation for years to come.
Celebrating 70 Years of the Framingham Heart Study: Solving Mysteries of Heart Disease
When I first started researching my A-Fib back in 1998, I kept coming across research studies that credited its data to the Framingham Heart Study. I had no idea how influential the study has been to expanding our understanding of cardiovascular health.
The Framingham Heart Study (FHS) is a long-term, ongoing cardiovascular study of residents of the city of Framingham, MA, now celebrating its 70th year. The study was commissioned by the U.S. Congress and had been intended to last for only 20 years.
The Lifesaving Power of Scientific Research
Much of the now-common knowledge concerning heart disease, such as the effects of diet, exercise, smoking, good and bad cholesterol and high blood pressure is based on this longitudinal study. As well as far-reaching programs in stroke and Alzheimer’s.
Before the FHS, doctors had little sense of prevention.
–Nancy Brown, CEO, AHA
American Heart Association CEO Nancy Brown said new approaches and therapies have sprung from Framingham’s work. “Framingham is living proof of the lifesaving power of scientific research. It’s no coincidence that deaths from heart disease have declined over the 70 years of this groundbreaking study.”
The study has huge repositories of data, from cell lines and gene sequences to scanned images of the heart, brain, bone and liver.
“Every part of the body that can be measured, imaged or assessed, we’ve done so over the last 70 years,” said Dr. Vasan S. Ramachandran, principal investigator and director of the study for Boston University. “It’s a remarkable human experiment. It’s with humility I say that. It’s unbelievable, and to be part of it is a gift, a privilege and an honor.”
Framingham: The Study and the Town that Changed the Health of a Generation
Framingham doctors in 1948
The study began in 1948 with 5,209 adult subjects (mostly white women and men) from Framingham, (about two-thirds of the town) and now has over 14,000 people from three generations.
Participants, and their children and grandchildren, voluntarily consented to undergo a detailed medical history, physical examination, and medical tests every two years, creating a wealth of data about physical and mental health, especially about cardiovascular disease.
Judie Saltonstall is one of them. She’s a second-generation participant who moved to Arizona 29 years ago and still faithfully logs on to her computer every three months to answer questionnaires and memory quizzes.
The 75-year-old is part of a contingent of FHS participants living all over the country who travel back to Framingham whenever needed for exams and tests. She reels off a list: retina photographs, bone density tests, and MRIs of the brain, heart and abdomen.
“It’s kind of exciting to do,” said Saltonstall, a mother of four and a former teacher. “It’s important for me personally, but also for them to know what’s going on with me and to learn from that, whatever good it does.”
Adding Different Segments (“Cohorts”)
In 1968, despite the recommendation to end the study as scheduled, Congress voted to continue it. Over the decades, the study had been split into different segments, or “cohorts”:
• The Original Cohort (1948)
• Offspring Cohort, the second generation (1971)
• The Omni Cohort asked people of color to volunteer to study race and heritage in heart factors (1994)
• The Generation Three Cohort (2002)
• The Omni Two Cohort, the second generation of Omni Cohort participants (as young as 13 years of age, 2003).
Landmark Study: Inspiring Thousands of Published Studies
Framingham, MA, circa 1948
It’s been 70 years since a small, middle-class community 23 miles west of Boston became the linchpin in helping to solve the mysteries of heart disease.
Framingham data resources are available for researchers to use, and those data continue to spur new scientific discoveries. FHS data has spawned over 3,600 published studies in medical, peer-reviewed journals. (Including many studies about Atrial Fibrillation, heart arrhythmias, and prevention of strokes).
The Framingham Heart Study is a joint project of the U.S. National Heart, Lung, and Blood Institute (NHLBI) and Boston University. Learn more at News on Framingham Heart Study.
As A-Fib patients, we owe a huge debt to the Framingham participants, doctors, scientists and researchers.
VIDEO: Framingham Heart Study: The First 70 Years
Learn about the legacy of the Framingham Heart Study. Includes interviews with participants; current and historical photos and footage. 12:17 min. Go to video.
Apple Watch 4: Do ECG Readings Give A-Fib Patients a False Sense of Security?
Added: 2019
To monitor for A-Fib yourself, the Apple Watch (Series 6, the gold standard of wearable monitors) can generate an ECG similar to a single-lead electrocardiogram. It’s very sophisticated and can monitor both for A-Fib and for many other health parameters. The series 6 has a blood oxygen sensor as well as a heart-rate check. Upon FDA approval, it will have real-time monitoring of blood pressure.
Added: August 6, 2020: Marilyn Shook writes “Love my Apple Watch 5! Great accurate ECG strip to share.” (Read Marilyn’s A-Fib story at https://a-fib.com/marilyn-shook-a-fib-story-86-post-pva-complication/.)
The main alternatives to the Apple Watch are the Samsung Galaxy Watch and wearables featuring Google’s Wear OS softwear. The market leader for Wear OS is Fossil (Generation 5) Another Fossil product is the Diesel On Fadelite. The Suunto 7 from Finland has GPS.
We received a couple of emails about the new Apple Watch 4. As many A-Fib patients may be aware, recently Apple unveiled the next generation of Apple Watch which includes a second generation optical heart sensor.
Among several interesting features, it can generate an ECG tracing similar to that of a single-lead electrocardiograph.
In her Sept. 14, 2018 editorial on Medscape.com, ECG Readings From the Apple Watch? This Doctor Is Leery, Dr. Hansa Bhargava gives her perspective of this feature for those diagnosed with atrial fibrillation. She writes that she finds the Apple Watch’s ability to do a one-lead ECG interesting but has some reservations.
“…Here’s what I worry about: the false sense of security that a person could have.
Apple Watch 4 screens
Being able to do a one-lead ECG is definitely interesting, but does it always help? Here’s a scenario. A 40-year-old runner starts feeling dizzy, lightheaded, and has chest pain. He worries but remembers that there is an ECG function on his watch. He proceeds to do the ECG which then reads “normal.” Because of this he decides to continue to run.
What he doesn’t know is that this is only a one-lead ECG, and even though it seems normal, it is an isolated data point; more information is needed to diagnose what is going on. What if he is having angina? In fact, 30% of cardiovascular events happen to people under the age of 65. One lead on an ECG could certainly miss this; in fact, even a 12-lead ECG, if the only isolated data point, could miss this.
Dr. Andrew Moore, an emergency department physician at the Oregon Health and Science University is also skeptical of the Apple Watch 4 ECG feature:
“The ECG thing is a little bit overhyped in terms of what it will really provide. …The tech that Apple is working with is very rudimentary compared to what we’d do for someone in a hospital or health care setting.”
While the watch can detect changes in the patterns of a person’s heart rate such as too fast, too slow, or beating irregularly—signifying A-Fib, the watch doesn’t diagnose a medical issue.
Apple Watch and Other DIY Heart Rate Monitors
Guide to HRMs and Handheld ECG monitors
Keep in mind these doctors’ concerns apply to all consumer heart rate monitors (HRM), those with optical heart sensors and those with electrode-containing monitors.
Wrist vs. Chest Bands: Wrist-band optical heart-rate monitors (like Apple Watch 4) may be more convenient or comfortable and have advanced over the years. But researchers found that electrode-containing chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent. To learn about this research, read When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?
Blue-tooth chest-band with smartphone app
As an A-Fib patient, when monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).
For help selecting a HRM, see our article: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I). Also take a look at Steve’s list on Amazon.com: Top Picks: DIY Heart Rate Monitors for A-Fib Patients.
Keep in mind: None of these DIY heart rate monitors are diagnostic tools. But they can be helpful once you know you have A-Fib, A-Flutter or suffer from PVCs, PACs, etc. Just don’t make medical decisions based on their readings. See your doctor if you have any concerns or symptoms.
Remember: None of these DIY heart rate monitors are diagnostic tools
September is A-Fib Awareness Month: The Threat of ‘Silent A-Fib’
‘That Demon A-FIB ZEBUB’
During September each year, we focus our efforts on reaching those who may have Atrial Fibrillation and don’t know it. ‘Silent A-Fib’ is a serious public health problem. In his personal A-Fib story, Kevin Sullivan, age 46, wrote about his diagnosis of Silent A-Fib.
“I was healthy, played basketball three times per week, and lifted weights. I started to notice on some days playing basketball, I was having some strange sensations in my chest. And sometimes, difficultly catching my breath. But the next day I would feel fine. I assumed this was just what it felt like to get old.”
At the time, he happened to see a cardiologist about medication for high cholesterol:
“I went to see a cardiologist. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase.”
Like Kevin Sullivan, about 30%–50% of people with Atrial Fibrillation are walking around not knowing they have it. They may get used to their symptoms or they write off the tiredness, dizziness or mental slowness to growing older, but their heart health may be deteriorating.
Untreated, about 35% will suffer a stroke (half of all A-Fib-related strokes are major and disabling).
How You Can Help
A-Fib.com offers an infographic to educate and inform the public about this healthcare issue. See the full infographic here. (See the posters too).
To help spread awareness:
Share it, Pin it, Download it.
Resources for Writers and Journalists
For more about Silent A-Fib, go to The Threat to Patients with “Silent A-Fib” How to Reach Them?
Visit the A-Fib.com Press Room to learn more about Atrial Fibrillation, videos, get free graphics and other resources.
Review: CONTEC Handheld Portable ECG Heart Rate Monitor (PM10)
Tim Zhang from Contec Medical Systems CO., LTD, offered us a Contec Handheld Portable ECG Heart Rate Monitor, PM10, to try for ourselves hoping we would add it to our reviews of other similar units.
Contec PM10/EMAY Ltd EMG-10
The Contec PM10, an FDA Certified device, is also sold as the EMAY Ltd EMG-10. Both handheld portable ECG heart rate monitors are about $79 on Amazon.com. The PM10 is a small 4 oz. unit that can track a single channel ECG waveform. You can observe the scan live, then download the recordings (up to 30) to your computer or smartphone for review and print to share with your doctor. It claims to detect up to 12 cardiac conditions. I don’t have A-Fib anymore (thank goodness), so I wasn’t able to test while in A-Fib.
The user guide’s small size, tiny printing and wording leaves a lot to be desired. (Note: You can find the guide on the internet and download in a normal full-size page layout.)
Easy to Record an ECG, But Requires Software to Review
To charge the PM10 battery: Use the provided micro USB cable to connect the unit to a USB port on your computer. While charging, you’ll see a faint blinking blue light beneath the white plastic at right top front of the curved end.
Taking a scan (no cable or smartphone needed): To turn on, press the blue button (the only button on the unit) and hold down for 3-4 seconds and you’ll hear a beep (it turns off automatically). You’ll notice the metal contacts are sizeable on this relatively small device.
Measurement positions of Contec PM10
Hold the unit as shown in the drawings (between both hands, or hold with one hand and the unit on your chest.) You can watch the unit capture your heart beats. It takes a few seconds for the waveform to stabilize, then start recording for a 10 sec measurement. (There’s a 10 sec countdown on the screen). It displays your heart rate as well.
Summary screen: When completed, the ECG scan is replaced with a summary screen with its best guess about the recording. Examples: No abnormal, Bradycardia, Missed beat. You can’t review the recording on the unit. You must download to software on your computer or smartphone.
Contec PHMS App or Software
The PM10 connects by Bluetooth or USB cable to a smartphone phone or computer. You’ll want to install the app or software so you can download your scans for review or printing. The PHMS app can be found on iTunes and Google Play.
Download screen opens first
For a computer, you can download the PHMS software from the Contecmed.com download page or the EMAY Ltd download page (I found EMAY easier and faster).
Reviewing your recordings: On my laptop I connected to the PM10 just like when I charged the battery. (The first time you might want to open the software, then connect the cable and the PM10.)
Manage tab with downloaded scans
The ‘Download’ tab opens first. Press the ‘Start new search’ and the software displays a list of scans from your PM10. Press the button ‘Download all’. Then switch to the ‘Manage’ tab. From here you can select a scan from the list and press ‘Review’ to see the ECG. A Diagnosis column is on the right.
Review screen with ECG and data
From here you can print the scan. (To close, double-click on the ECG to return to the downloaded list).
Helpful tip: When you ‘print’ you can also select ‘Adobe PDF’ as your printer and save to your hard drive, but I had poor image results. An alternative is to take a screenshot or use the Windows snipping tool. Save the image, then print. Either way, you can attach it to an email and send to your doctor.
Amazon.com Contec Reviews from Customers with A-Fib
A curious point about the Amazon.com reviews: The Contec PM-10 has a customer review rating of 3.1 out of 5 stars, whereas the EMAY EMG-10 has a customer rating of 4.5 out of 5 stars. From scanning the reviews, EMAY purchasers are happier with their contacts with EMAY customer service. (I’ll let you draw your own conclusions.)
Use the A-Fib.com portal link to Amazon.com
I’ve included comments from three reviewers (who mention having A-Fib) on the Contec PM10 product page:
• A Contec review on Amazon.com by Ron Crist noted there’s no hidden fees like other popular devices (e.g. monthly fee for Kardia Heart Monitor by AliveCor). He went on to write: “I have persistent AFib and have had 2 crippling strokes. No more cardioversions (electric shocks) for me. I hope. I Strongly recommend it.”
• A doctor with A-Fib, PD, wrote on Amazon.com: “This is a very good machine but ekg has some static. I am a doc with atrial fib and this helps in terms of heart rate and ekg…took some experimenting [to set up] but the results are gratifying…Once set up I give it 5 stars.”
• An Amazon reviewer with paroxysmal atrial fibrillation writes: “This monitor allows me to see just when my condition occurs and gives my cardiologist a better picture of my condition. Although not a perfect answer it does enhance the overall picture.”
You can read the Amazon.com reader reviews for yourself at the Contec PM10 and the EMAY EMG-10 product description pages.
Lightweight, Easy to Use, But Not a “Diagnostic” Device
Contec PM10 box & contents
The Contec PM10 is easy to use and carry in a pocket or handbag for scans on the go. Or leave with your laptop for periodic checks. While you can observe the ECG scan live on the screen, there’s no review screen. You must download the scan to review it or print it.
Unlike the AliveCor Kardia, no smartphone or tablet is needed to take scans. Observing the live ECG tracing may be enough for most A-Fib patients who just want a quick check of their heart beat and heart rate. I think you get a lot for the $79 price.
But remember this is not a diagnostic device. It doesn’t replace an ECG by your doctor or use of a mobile type of heart rhythm monitor to capture the electrical activity of your heart (e.g., a Holter monitor or event monitor).
I welcome your comments if you have used this unit or others in our reviews, Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I) and Do-It-Yourself ECG: A Review of Consumer Handheld ECG Monitors. Just send me an email.
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