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Fast Palpitations

 

You may have noticed there are times when your heart beats much faster than you expect. There may be a number of possible reasons for this, but a common problem is when the heart rhythm itself is abnormal. Normally patients with heart rhythm disorders associated with fast palpitations complain of the problem starting and stopping abruptly. Symptoms that are experienced during this time can include, dizziness, a tightness in the throat, chest pain, feeling short of breath and rarely collapsing. Episodes of fast palpitations may last for seconds, minutes or hours. There are a number of specific causes of fast palpitations and you may have been told that you have supraventricular tachycardia, also referred to as SVT, Atrial Fibrillation, Wolff-Parkinson-White syndrome, Atrial Tachycardia or Atrial Flutter or Ventricular Tachycardia. The treatment of each of these arrhythmias is specific.

 

Diagnosis


How you describe your palpitations will often help narrow down the possible causes of the tachycardia. Your consultant will take a detailed history of not only the episodes of palpitations but also of other medical conditions that you have, and in particular whether you have had or are at risk of a heart attack. If you are able to predict when the next heart beat is coming, like a very fast clock, the tachycardia is regular, if the heart beat is fast but irregular, it is more likely that you have atrial fibrillation. You may have been told to blow through a straw by a medical professional to stop that tachycardia, or have found another way to reproducibly stop the palpitations, if this is the case you may have SVT. While the symptoms can help narrow down the type of heart rhythm abnormality that you have, the only way to tell exactly what problem you have is with an ECG taken during your palpitations. 

 

Investigations


Once your consultant has taken a detailed history, and performed a thorough examination a number of investigations will be required. Basic blood tests including thyroid function tests will be performed. A trace of your heart rhythm at the time of your consultation will be taken. A scan of your heart, an echocardiogram, will be performed to assess the heart function. If you already have an ECG trace of your palpitations it is important that you bring this to the consultation as this could direct your consultant as to the most appropriate treatment, if not then some form of monitoring will be suggested. However, it may have been difficult to capture an episode, so your consultant may ask you to wear a small, portable electrocardiogram monitor to record your heart rate either continuously over 24 or 48 hours, or from when you switch it on at the start of an episode. In certain circumstances, a small implantable monitor which lasts for 2 years could be used.

 

Treatments


Depending on the type of abnormality that is diagnosed a number of treatments will be suggested. Not all abnormalities will require medication or surgery. Some palpiations are triggered by things like tiredness, drinking lots of alcohol or caffeine, certain foods or smoking lots of cigarettes.

 

Medication

If necessary, medication can be prescribed to prevent further episodes of palpitations by slowing down the electrical impulses in your heart. These medications are taken as a daily tablet and include verapamil and beta blockers, and you may have already been prescribed these by your GP.
Common side effects of these medications can include dizziness, diarrhoea and blurred vision. Tiredness can occur with beta blockers and men may experience problems getting erections. If the medication you're prescribed doesn't work or has unpleasant side effects, a more suitable alternative can often be found.

Catheter ablation


If episodes of tachycardia occur repeatedly, an operation called catheter ablation is the recommended treatment option. This prevents further episodes of tachycardia by destroying the tiny parts of the heart causing the problems in the heart's electrical system. This is a safe and highly effective treatment and means you no longer need to take medication.

During the procedure, thin wires called catheters are inserted into a vein in your upper leg or groin, before being guided to your heart. These wires record the electrical activity of your heart to pinpoint the precise location of the problem.

When the problem area is found, high-frequency radiowaves are transmitted via one of the catheters to destroy the tissue responsible for the tachycardia, producing a small scar.

You will remain awake during this procedure, but will be given a sedative to relax you. Local anaesthetic is used to numb the area where the catheter is inserted.

The procedure normally lasts about an hour and a half and you can normally go home the same day you have the procedure. However, sometimes you may need to stay in hospital overnight, for example, if you are operated on in the late afternoon.

Catheter ablation is very effective at preventing future episodes of palpitations (19 out of every 20 people treated will never have the problem again), but like all operations it carries a risk of complications. These include bruising and bleeding where the catheter was inserted. Typically any bruising will be small, but even if the bruise is large it will require no treatment and will disappear within two weeks.

There is also a small risk (less than 1 in 100) of the heart's normal electrical system being damaged (heart block). If this happens, you may need a permanent pacemaker to control your heart rhythm. The potential benefits and specific risks of catheter ablation for your tachycardia will be discussed with you prior to your procedure with your consultant.

 

Aftercare


Most patients feel back to normal within a couple of days of the procedure. The DVLA recommends that after an ablation driving is stopped for 1 week. It is not unusual to feel extra heart beats immediately after the procedure and for a few weeks afterwards. This is a normal response of the heart and gradually disappears. Your consultant will see you a month after the procedure to see how you are and to take another ECG to make sure that there are no abnormalities of the heart rhythm. If you need to be seen sooner, a consultant will always be available.

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