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Thorough checks needed to pinpoint type of palpitations

One of the initial tests for those with palpitations is an electrocardiogram (above), which can help to determine the cause.
One of the initial tests for those with palpitations is an electrocardiogram (above), which can help to determine the cause.ST FILE PHOTO

Q I am 38 and slightly overweight. I do not exercise regularly. Over the past few months, I have been having an on and off feeling that my heart is beating very hard. I feel breathless even when I am not doing any physical activities. Is there something I can do about it?

A The feeling of your heart beating very hard or fast, also known as palpitations, is abnormal and may be due to a heart rhythm problem or cardiac arrhythmia.

There are several different types of palpitations, some of which are more dangerous than others.

Therefore, people with such symptoms should see a doctor.

Palpitations that affect the upper chambers of the heart (called the atria) include conditions such as supraventricular tachycardia (SVT).

In this condition, there is an abnormal electrical impulse from a small area of heart muscle or an extra electrical connection in the heart.

SVTs can occur in otherwise healthy people and cause palpitations to occur suddenly and unpredictably.

They tend to be benign and are not usually life-threatening, but should be properly treated as they can cause considerable distress to the person.

Other atrial arrhythmias include atrial flutter and atrial fibrillation (AF), which are due to fast abnormal electrical circuits in the atria.

These tend to occur in older people with other conditions, such as high blood pressure, coronary artery disease and heart failure.

AF is a key cause of stroke in older people. So, people with AF may require medication to thin their blood to lower their risk of stroke.

Palpitations that affect the lower chambers of the heart (called the ventricles) can be traced to conditions like ventricular extra-systoles or ectopic beats and ventricular tachycardia (VT).

Ventricular arrhythmias can be potentially dangerous, especially if the heart structure is abnormal - for example, having an abnormally thick heart muscle or an enlarged heart.

In some cases, ventricular arrhythmias may cause the patient to lose consciousness and experience a blackout.

As you are a little overweight and do not do much regular exercise, you have a higher cardiovascular risk and should undergo a thorough assessment of your symptoms.

The initial tests that I recommend include an electrocardiogram; an echocardiogram, which is an ultrasound scan of the heart to assess heart structure and function; and a 24-hour ambulatory heart rhythm monitor or Holter monitor, which detects the type of cardiac arrhythmia that you have.

After this assessment, your cardiologist should have a clearer picture of whether you have any significant underlying heart problem.

He can advise if you require more detailed tests, such as an exercise treadmill test or a further period of cardiac monitoring, if an arrhythmia has not yet been confirmed. The cardiologist should then be able to make a diagnosis of your arrhythmia, assess how dangerous it is and recommend the appropriate treatment.

If the arrhythmia is benign and not too troublesome or frequent, then the patient may just require reassurance and, perhaps, a change in lifestyle. 

Other types of arrhythmias may require specific medication to control or suppress the heart rhythm problem or, in some cases, keyhole surgery may be warranted.  

Some cardiac arrhythmias are potentially more dangerous than others. I recommend that you have a thorough cardiac assessment to determine your condition. 

Dr Reginald Liew

Director and senior consultant cardiologist at The Harley Street Heart & Cancer Centre

Brought to you by The Harley Street Heart & Cancer Centre


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A version of this article appeared in the print edition of The Straits Times on November 03, 2015, with the headline 'Thorough checks needed to pinpoint type of palpitations'. Print Edition | Subscribe