What a rainy and miserable day today! Other than a dog walk it’s not been great to get outside, so instead, I’ve made our Christmas gravy. Sounds mad? Maybe, but delicious. For about 15 years now I’ve always made the same Jamie Oliver Christmas gravy recipe in advance and freeze it, with roasted chicken wings, sage, star anise and port. One less thing to think about on the day. It is sensational, so much so I do a batch and use it later in the year also.
I digress. Looking at the topics to cover, I think the next ‘big one’ should be palpitations. There have been lots of AMA questions on palpitations, and I’ll address some of those specifically in next month’s AMA.
Heart rhythm disorders is a huge topic, and one I think best broken down into manageable chunks over the next few weeks. I have written various blogs on the subject in the past, particularly new trial evidence, but not really tackled the subject in a systematic way. The new members site is a good way to do this, and I will post them in an organised way as I go.
One reason there have been so many AMA requests is that they are so common. I expect nearly everyone has had a heart palpitation at some point or other, myself included. I will tell you the symptoms to watch out for, how best to get a diagnosis, and the various treatments available.
A palpitation is the word we typically use to describe the unusual awareness of our heart beat. How aware we are of our heart beat varies a lot from person to person. Some patients I meet are aware of pretty much every beat going, others have some pretty serious heart rhythm issues yet are completely unaware of them! Many of us (myself included) are typically not aware of our heart beating when going about our day to day activities, but are far more so for example at night, when all is quiet and there are no other distractions. For me, this is particularly true if I lie on my left hand side, so much so that I can’t get to sleep in that position.
The sorts of questions I will ask a patient about their symptoms (and therefore ones you might like to consider yourself if you have palpitations) are:
- Do they start suddenly or gradually?
- Do they stop suddenly or gradually?
- Is there a trigger?
- Are there any associated symptoms, for example chest pain, dizziness, or breathlessness?
- Have you ever passed out with symptoms? (this is a serious one – seek urgent attention if losing consciousness)
- Any relationship to exercise
- Is there a family history?
- Any relation to caffeine, alcohol, fizzy drinks, stress?
- Any history of thyroid or other endocrine issue?
- Any previous heart history, particularly heart attacks or heart failure?
- How fast to the palpitations go? (I will often ask a patient to tap it out on the desk)
- Are the palpitations regular or irregular?
- How frequently do they occur?
- How long to they go on for?
Doctors are taught in medical school that up to 85% of diagnoses can be made by ‘taking a history’ ie asking relevant questions to try and work out what the problem is. In the case of palpitations, answers to the questions above will normally give me a pretty good idea of the problem. However, to nail down the diagnosis (and therefore get the treatment right) it’s often necessary to do some testing. Next week I’ll go into the different tests, their pros and cons, and then outline the different causes and how a Cardiologist manages them.