Palpitations diagnosed

How are palpitations diagnosed and  treated?

Palpitations are diagnosed by recording the heartbeat at the time of the patients symptoms. As most patient’s symptoms occur intermittently (called paroxysms) a routine electrocardiogram (ECG) may not capture the rhythm change.

Devices are now available that allow the heartbeat to be monitored over 24 hours or even several days while you go about your normal activities. This increases the chances of detecting any abnormalities of heart rhythm.

Other tests that may be required are determined by the rhythm changes detected. These may include:

  • Blood tests to look for electrolyte (chemicals in the blood that conduct electricity) problems or thyroid disease.

  • An ultrasound scan of the heart, called an echocardiogram. This is a painless test that provides important information about the way the heart is working. It provides pictures of the heart in motion and allows the doctor to assess the pumping action of the heart and how the heart valves are working.

  • Cardiac catheterisation, an X-ray/dye procedure done under local anaesthetic, that provides information about pressures in the heart, the function of the heart muscle, valves and arteries.

  • Electrophysiological testing (EPS) a procedure performed under local anaesthetic where fine tubes called electrode catheters are passed into the heart in order to give information about abnormal heart rhythms.

The treatment of palpitations depends on the type of arrhythmia found. Often no treatment is required other than lifestyle changes and avoiding triggers such as:

  • Caffeine
  • Alcohol
  • Stress

If these fail to control symptoms, medication may be required, such as:

  • Beta-blockers
  • Calcium channel blockers
  • Digoxin
  • other anti-arrhythmic drugs can be used to control symptoms

Rarely, more invasive procedures may be needed:

  • Cardioversion; a procedure performed usually under general anaesthetic where a controlled electric shock is given to try to restore a normal heart rhythm.
  • A pacemaker, if the heart is beating too slowly.
  • Catheter ablation; a procedure to destroy tiny abnormal areas of the heart which are causing the arrhythmia.
  • An implantable cardioverter defibrillator; a complex pacemaker for dealing with fast and potentially dangerous arrhythmias.
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