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Strong or Forceful Heart Beats, and missing beats
Many patients complain that they can feel extra heart beats or strong heart beats, where it feels that the heart is trying to jump out of the chest. Normally this sensation does not mean that you are going to have a heart attack or that there is anything wrong with the heart. You may have been given a diagnosis of ectopic beats, and you may have been told that these are coming from the atrium of the ventricle. These type of palpitations often last for a few seconds only and are often described as fluttering. They can, however, be repetitive such that several will come along at once, several times a day. Palpitations may seem alarming, but in most cases they are harmless and are not a sign of a problem with your heart. It is important that a diagnosis is made so that the most appropriate treatment can be given. Your consultant is an expert in the management of electrical conditions of the heart.
Your consultant will take a detailed history of your palpitations, and often this will suggest a likely diagnosis. Sometimes there may be a specific trigger for the palpitations such as stress or anxiety, caffeine, smoking or alcohol. Avoiding such situations may be all that is necessary.
The key to the diagnosis though is to get an electrical recording, an ECG, of the heart during the palpitations. Your consultant will get you to wear a small monitor, which is similar in size to a small pager, which is attached to patches (electrodes) on your skin. These are not visible under your clothes, other than the recorder that you can attach to your belt.
Rarely the palpitations may herald underlying heart disease, and for this your consultant may want to see the function of the heart with an echocardiogram, and possibly a magnetic resonance scan (MRI). Your consultant will order the most appropriate tests for your individual risk.
Once a diagnosis has been made the most appropriate form of treatment for you will be advised. The treatment options include lifestyle measures, medication, and for some patients with very frequent symptomatic ectopic beats, catheter ablation.
Normally, extra beats do not mean that you are at risk of serious heart disease and so the aim of treatment is to alleviate the symptoms. Often, the reassurance that the abnormal heart beats are not dangerous is enough to ease the symptoms. If this is not the case, then medication to slow down the heart rate and suppress the extrabeats may be prescribed.
If these measures fail, or if there is evidence from the heart scans (echocardiogram or MRI) that the heart is not working correctly further treatment will be necessary. Your consultant will make a decision as to why the heart is not functioning properly. It is very important to distinguish whether the extra beats are the cause of the problem, or whether they are merely the result of the underlying heart problem, as the treatments vary dramatically. If the heart is deteriorating due to the extra beats then catheter ablation is an option. If the ectopic beats are due to underlying heart disease, this will need to be treated. We believe that by seeing an expert in heart rhythm disorders the optimal treatment can be suggested straight away.
Catheter ablation for extra beats “ectopics” is only performed when the patient is having very frequent symptoms. If the patient is not having the extra beats on the day of the procedure it is likely that the procedure would not go ahead as the chance of finding the cells responsible for the extra beats would be low.
Normally you are awake for the procedure, but you are given a local anaesthetic in the groin to numb the area where thin wires, catheters, are inserted. When the catheters are inside the heart you are unaware of their presence other than feeling the extra heart beats and the heart speeding up and slowing down as we try to find the source. A 3 dimensional map of the inner surface of your heart is made using the latest computer systems, and onto this anatomical map the source of the extra heart beats is superimposed. This gives your consultant the target to aim for and then the catheter passes radiowaves to the heart muscle to burn away the abnormal area. While this procedure is often successful in making patients feel considerably better, this is only the case when the most appropriate patients are selected for the procedure. The procedure can take upto 3 hours depending on how frequent the extra beats. Painkillers are given intravenously when the tissue is being destroyed, so that you may feel a slight uncomfortable sensation in the chest.
You will be discharged either on the day of the procedure, or you may spend one night in hospital. Following the procedure the DVLA advises against driving for 1 week. Your consultant will see you in a month with a further heart monitor to assess whether the procedure has been successful at eliminating or significantly reducing the number of ectopic beats.