Heart palpitations: treatment options
What are heart palpitations?
Palpitations, by definition, is the sensation of a patient’s heart beating abnormally. In general, it means that the heart is beating a lot faster.
There can be a whole host of diagnoses and the trick is being able to record the heart rhythm when a patient experiences these symptoms.
Some patients have the symptoms all the time and this makes it easier to diagnose. In this instance, they will have an electrocardiogram and we can see what the problem is. Other patients may experience symptoms for a short time, and there are several ways in which we can try and record these instances.
Sometimes, a resting ECG gives us the answer – either if the patient has the arrhythmia at the time (rare), or if we see certain abnormalities that make the patient prone to arrhythmias. We can begin by giving patients a 24 or 48-hour monitor, which records everything. Alternatively, we have some new patches, which the patient wears for two days, or for up to two weeks. The patches record absolutely everything.
We also have monitors patients can carry with them and put them on their chest to record when they have symptoms.
Finally, we can implant a monitor, which stays with the patient for over three years. We do not tend to implant these for those with mild arrythmia; we usually issue this to patients who blackout and therefore cannot take any recordings.
The commonest diagnoses in my older patients is atrial fibrillation. This is an irregularity in the heart rhythm, which some people may not feel at all, while others will experience discomfort. It is a vital diagnosis to make because it can give people a risk of stroke.
We use a special scoring system called CHADS2VASC score - and if the patient reaches a certain point score and has episodes of atrial fibrillation, we have to thin the blood. That is separate to how we treat the arrythmias; if they are high risk, we need thin their blood to prevent them from having a stroke.
After, we try and treat patients with various medication; there is a variety we can use. We’ll try various things but there’s always a possibility of an ablation, where we put wires up to the heart and modify the electrical circuits in the heart.
This is not something I do, but I have a lot of experience as I used to do it as a registrar, and I will refer patients if they need the ablation. The ablation is a last resort option.
Another problem that I see in my patients is supraventricular tachycardia (SVT); this is usually amongst younger patients and is a congenital problem in their heart. It’s a minor problem but the patient will have a fast heart rate. There are many treatment options for this.
Some patients may experience extra beats or ectopic heart beats and may feel like there are butterflies in their heart. Usually, this is not a significant problem, unless it is a sign there is a sign of damage of the heart.
Patients having heart palpitations could have an ultrasound or an MRI scan of the heart, to see whether there is an underlying disease. If not, we try and reassure the patient, and occasionally we give medication, but we try to not give medication for something like ectopic beats.
Another rhythm disturbance of the heart, whereby the patient experiences blackouts, shortness of breath or an inability to exercise, is if the heart is beating too slowly. This is called bradycardia, and in these patients, we will discontinue any medication which may have caused it and consider putting a pacemaker in.
This is an easy procedure and takes anywhere from half an hour to an hour. We use one or two wires, depending on the underlying rhythm of the patient is in.
If they have atrial fibrillation – where the heart is beating irregularly – and we decide we’re going to keep them in atrial fibrillation, we only need one lead to make sure the heart doesn’t go too slow, and that gets put into the right ventricle. If they have normal rhythm or intermittent normal rhythm, we put in two leads – one in the right ventricle and one in the right atrium.
To do this, we make a slit in the skin, under the collarbone on one side. If they are right-handed, this will be on the left, and if they are left-handed, this is on the right. From there, we dissect to find the vein and pass the wires and place them in the right places.
We test that they are stable, and we connect the pacemaker battery under the skin. This will last for 10 years and we can monitor the pacemaker.
After a pacemaker procedure, the patient will go home on the same day. We will monitor them regularly with pacing checks; this involves putting a gadget on their skin to see how much they pace, how much they are using it, how much battery they’re using, and when it needs replacing. The pacing check can be done at Circle Health
This is a successful treatment and we even use it on 100-year-old patients, as there is no age limit.