What is arrhythmia?

An arrhythmia is also known as a heart rhythm problem, causing the heart to either beat too fast (tachycardia), too slow (bradycardia) or that it has an irregular pattern. This results when the electrical pulses that coordinate the heartbeats do not work properly.

What are the symptoms of arrhythmia?

People with an arrhythmia may not experience any symptoms, but a prominent arrhythmia may result in the following symptoms:

• Chest pain
• Dizziness and vertigo
• Fainting (syncope)
• Paleness
• Difficulty breathing
• Sweating
• A slow heart beat
• A fast heart beat

What causes arrhythmia?

Arrhythmias are caused by problems in the electrical conduction system of the heart. Among the main causes are:

• Abnormal levels of potassium or other substances in the body
• Heart attack or damage to the myocardium from a heart attack in the past
• Hyperthyroidism
• Heart failure or enlargement of the heart
• Congenital heart disease
• High blood pressure
• Smoking
• Too much caffeine or alcohol
• Stress
• Diabetes
• Genetic causes
• Recreational drug use

Can arrhythmia be prevented?

There are certain risk factors that can increase the chances of developing an arrhythmia, detailed above, so the following measures can help to reduce this risk:

• Smoking cessation
• Limited consumption of alcohol and caffeine
• Proper management of diabetes
• Balancing your electrolyte levels (sodium, potassium, calcium and magnesium).
• Reducing high cholesterol levels
• Eating a healthy diet
• Exercising regularly

What is the treatment for arrhythmia?

Mild arrhythmias often won’t require treatment, but when an arrhythmia is serious treatment will be required. Treatment can consist of:

• Medication – to control the heart beat better
• Pacemaker – to help the heart to beat at a regular pace
• ICD – similar to a pacemaker, this device monitors heart rhythm, and uses small shocks to maintain a normal rhythm
• Catheter ablation – minimally-invasive procedure that destroys diseases tissue in the heart causing the arrhythmia
• Cardioversion – electric shocks are used to return the heart beat to a normal rhythm

What is it?

Atrial fibrillation is a heart rhythm irregularity that causes the heart to beat fast or irregularly. It affects around 4% of people over the age of 65. The atria, the upper chambers of the heart that control the rhythm, don’t function as they should and cause the heart rate to speed up, often much higher than the usual regular heart rate of between 60 and 100 beats per minute. Atrial fibrillation can be divided into three categories:

• Paroxysmal atrial fibrillation: a very high frequency fibrillation, which can be transient and not related to any other conditions. It normally doesn't last more than 48 hours, although in some cases it can last up to one week. It does not usually require extensive medical treatment;
• Persistent atrial fibrillation: a lower frequency fibrillation which requires medical treatment;
• Permanent atrial fibrillation: it is often caused by an underlying condition. The treatment will consist in addressing that condition first.

What are the symptoms?

Atrial fibrillation can affect people occasionally, experiencing symptoms for a few minutes, before they cease, or they can be persistent where the symptoms don’t stop until there is medical intervention.

The most common symptoms experienced are:

• Heart racing or beating irregularly, known as palpitations
• Feeling weak or lightheaded
• Dizziness
• Fatigue
• Shortness of breath
• Pain in the chest

Atrial fibrillation carries some risks for the sufferer. Due to the irregularity of the heartbeat, blood can pool and clot within the heart. If the clot breaks away, it can travel around the blood system and cause blockages within the smaller blood vessels. This can lead to stroke in some cases, with atrial fibrillation being one of the main causes of strokes.

Atrial fibrillation can also lead to heart failure, as the heart’s muscles may become weakened, especially if the condition is long-standing.

How is it diagnosed?

Atrial fibrillation can be diagnosed with a heart exam. The main tests to diagnose atrial fibrillation are:

• Pulse rate measurement
• ECG
• Chest X-ray scan
• Echocardiogram

What causes it?

Atrial fibrillation is mainly caused by cardiac disorders, such as:

• rheumatic heart disease
• cardiac valve disorders
• myiocardial infarction
• coronary heart disease
• hypertension

Moreover, the following conditions can also lead to atrial fibrillation:

• hyperthyroidism
• type 2 diabetes
• respiratory diseases
• gastroesophageal reflux disease
• hiatal hernia
• obesity
• smoking, alcohol and illegal drugs
• excessive caffeine intake

How can it be prevented?

You can help to prevent atrial fibrillation by leading a healthy lifestyle: maintaining a healthy weight, exercising regularly and quitting smoking.

How is it treated?

The condition is not life-threatening in the short term, but should be treated where possible to overcome the risks mentioned above.

Treatment usually involves one or more of the following:

• Medication to control the irregular heart rhythm
• Blood-thinning medication (anticoagulants) to reduce the cha
• nce of stroke. This acts to prevent the blood pooling and clotting in the heart’s chambers.
• Catheter ablation surgery which involves the placement of a catheter along the veins of the leg to the heart. The catheter is then heated to burn the section of the heart that is causing the irregular rhythms, effectively killing the source of the electrical signals that are causing the heartbeat.

To make an appointment with a doctor specialising in the treatment of atrial fibrillation, click here.

What is atrial fibrillation ablation?

Atrial fibrillation ablation is a procedure used to treat atrial fibrillation - a type of abnormal heart rhythm also known arrhythmia. It works by scarring the inside of the heart, by burning or freezing parts of the heart tissue, to help alter or break up electrical signals that cause irregular heartbeats.

There are a group of cells in the heart that start the signal which initiates a heartbeat. In people who have atrial fibrillation these cells are overridden by other cells that are faulty and work too fast, causing the upper chambers of the heart to fibrillate (quiver). This creates a disorganisation of contractions in the heart and means that blood may not be pumped around the body efficiently.

Why is it done?

Some people experience shortness of breath and palpitations. In addition, atrial fibrillation can increase the risk of stroke.

Some people take medicine to control the symptoms, whilst for others the medication is ineffective so an ablation is needed to control it.

If your atrial fibrillation attacks are short (less than 7 days long), then it’s likely that an ablation will help in the long-term. If it’s very persistent, then ablation is less likely to work in the long-term. If you have no other heart problems, then this procedure might be a good option for you.

How is the procedure performed?

The procedure is normally performed in a hospital and you’ll be given a sedative to help you relax. The procedure may be performed under general anaesthetic.  A doctor will insert a needle into your vein and place a tube through the needle. After this, catheters are thread through the tube and guided to various places within your heart. These catheters have electrodes at the tips which send electrical impulses to your heart. Either heat or cold is applied via these catheters to the desired area to destroy cells and cause scarring.

The whole procedure can take up to 6 hours. Dye can be used to help the doctor see the blood vessels better. Sometimes, ablation can cause discomfort and slight pain. The procedure would be stopped if the pain is severe or it is too uncomfortable.

How do you prepare for it?

Your doctor will offer advice to you about how to prepare for it. Usually, you are asked to stop eating and drinking the night before the procedure.

You will be advised what medications should be stopped on the day of the procedure. If you are not on a blood thinning tablet normally, you may be asked to take it for a few weeks before and after the procedure.

If you have any other heart conditions or an implanted heart device such as a pacemaker, your doctor will need to advise you on any precautions to take before.

After-care

After the procedure you will need to rest a few hours and your heartbeat and blood pressure will be monitored. You may be able to go home the same day but will likely need a few days of rest before resuming normal activities.

After receiving this treatment, your symptoms should subside and you’ll start feeling better. However, your irregular heartbeat can return years later. This is more common in elderly people.

You’ll likely return to see the doctor after three months to check if the symptoms have reappeared. If they have, you should be able to control the symptoms with medication. If you need another procedure, then it’s advised that you wait until you’ve completely healed before having another one.

You doctor could also suggest that you have a pacemaker fitted if your symptoms keep returning.

What is Brugada Syndrome?

Brugada syndrome is a potentially life-threatening heart rhythm disorder that is mostly inherited. It is much more common in men than women and can be diagnosed with an electrocardiogram.

An echocardiogram is also needed to find abnormalities in the structure of the heart. There is also a genetic test that can identify any genetic alteration confirming the disease.

What are the symptoms of Brugada Syndrome?

The majority of people who suffer from this condition don’t experience symptoms, however, those that do may experience the following:

• Fainting (syncope)
• Dizziness
• Arrhythmias (irregular heartbeats) or palpitations
• Gasping and breathing difficulties
• Sudden cardiac arrest

What are the causes of Brugada Syndrome?

Generally, it is a hereditary disorder, although, in some cases, certain hormonal disorders, electrolyte imbalances or cocaine use may increase the risk of suffering from it. Genetics play a major role, but it is not enough to be the only cause behind the syndrome.

Some people are more at risk of the syndrome than others.

• Brugada syndrome occurs more frequently among Asians than any other race
• Those with a fever can experience Brugada syndrome if the fever irritates the heart and causes a person to faint suddenly or suffer sudden cardiac arrest
• More men are diagnosed with the syndrome than women

What is the treatment for Brugada Syndrome?

Preventative measures can be taken to lessen the risk of developing the condition; such as avoiding certain medications and when necessary, the condition is treated with the implantation of a cardioverter-defibrillator which monitors the rhythm of the heart.

You can usually lead a normal life with Brugada Syndrome, although it is important to attend medical checkups to control the disease.

What is cardiac ablation?

Cardiac, or catheter ablation is a treatment which is used to treat heart rhythm problems such as atrial fibrillation. Cardiac ablation destroys diseased areas of the heart and can prevent abnormal electrical signals from moving through it.

Why is cardiac ablation performed?

Cardiac ablation is performed in order to correct heart rhythm problems (arrhythmias). It is not usually used as a first line of treatment but can be used after medication has been unsuccessful in treating the arrhythmia. It can also be used in those who suffer serious side effects from arrhythmia medications. In certain cases, there are arrhythmias which respond well to cardiac ablation, including types such as Wolff-Parkinson-White syndrome.

What happens during cardiac ablation?

Cardiac ablation is a minimally-invasive procedure. A small incision is made in the forearm, groin, or neck, where a catheter (small flexible probe) is inserted and guided through to the heart. Dye may be injected into the catheter, which can help the specialist see your blood vessels and heart through X-ray images.

Once the catheter is placed, small electrodes connected to monitors are placed on different areas of the heart to detect which areas are causing the arrhythmia. Once the source of the problem is detected, one of the catheter's pathways is used to send electrical energy, causing a small scar and stopping the heart rhythm problem.

The procedure can take between three and six hours. During the process, the heart is monitored very closely, and some discomfort is normal, but you should let the doctor know if you feel any pain or shortness of breath.

Preparing for cardiac ablation

Before the procedure, your doctor may perform tests to check you are suitable for the procedure. The night before the procedure is done, you will need to make sure to stop eating and drinking, and not eat or drink in the morning beforehand. Speak to your doctor about any medication you are taking as they may advise you not to take it in the days running up to the procedure.

Before cardiac ablation is decided upon as a course of treatment, your cardiologist will speak to you to evaluate which path is best, as ablation carries certain risks which must be taken into account. Risks include:

• Damage to heart valves
• Damage to the heart’s electrical system
• Blood clots
• Stroke
• Heart attack
• Kidney damage (from dye used in the procedure)
• Bleeding or infection at the puncture site
• Pulmonary vein stenosis
• Death (in rare cases)

This said, cardiac ablation is considered to be a low-risk procedure. 

Post-operative care

After the cardiac ablation, you will need to rest in the clinic or in the hospital for several hours, so bleeding is prevented at the site where the catheter was introduced, and your heart beat can be monitored. During the two or three days after the procedure you may experience chest pain, fatigue, or fast or irregular heartbeat, which can be relieved by medications prescribed by the healthcare provider. You may also need to make some lifestyle changes as advised by your doctor in order to improve the overall health of your heart, as poor heart health can worsen arrhythmias.

Cardiac resynchronisation therapy is a treatment designed to correct arrhythmias. It involves the implantation of a tiny pacemaker, with three wires connected to the heart to monitor if it is beating correctly. If irregularities in the heartbeat are detected, it sends small electrical shocks to resynchonise the rhythm. The shocks are delivered to the ventricles (lower chambers) on both sides of the heart, making them contract simultaneously, which pumps the maximum amount of blood out of the heart. It has proved an effective way of treating the symptoms of heart failure. In some cases, the device may also contain an ICD (implantable cardioverter defibrillator) to deliver stronger shocks in case the arrhythmia becomes more serious and erratic.

What is a catheter?

A catheter is a thin tube usually made of soft, flexible plastic. It is a medical device used to transfer liquids into or out of the body. Due to the broad number of possible applications of such a device, there are several different types of catheters.

Why is it done?

Urinary catheters are used to drain urine from the bladder in patients who have trouble passing urine or have poor bladder control.

Intravenous catheters, or IVs, are used to deliver medicine or fluids directly to the blood or take the blood pressure in a large vein. They can also connect to a dialysis machine to filter waste materials out of the blood if the kidneys don’t work.

Catheters can also be passed into the heart via an artery or vein to diagnose or treat heart conditions. For example, cardiac catheterisation can be used for the following diagnostic purposes:

• Look for problems with the heart valves
• Angiogram (locating narrowing or blockages of blood vessels that could cause chest pain)
• Measure pressure and oxygen levels in the heart
• Biopsy heart tissue
• Diagnose congenital heart defects

They can also be used in the following treatments:

• Angioplasty
• Closing holes in the heart
• Heart valve repair/replacement
• Ablation for arrhythmias
• Closing off parts of the heart to prevent blood clots

Catheter types

Urinary catheters

• Intermittent catheters: temporary catheters inserted several times a day to drain the bladder via the urethra (the tube that carries urine out of the body from the bladder).
• Indwelling (Foley) catheters: longer-term catheters that remain in the urethra for a matter of days or weeks, held in place by an inflated balloon at the bladder end. They drain urine into a bag that may be strapped to the patient’s leg or bed while sleeping. An indwelling catheter avoids repeatedly inserting the catheter several times a day, but carries a greater risk of infection. They need changing every few months.
• Subrapubic catheters: this type of catheter is inserted into the bladder through a hole below the belly button rather than the urethra. The procedure to install it can be carried out under general, local, or epidural anaesthetic. It is generally used when the urethra is damaged or blocked.

Intravenous catheters

• Peripheral venous catheter: the simplest and least expensive type, it is a short-term IV inserted into a vein in the hand, forearm or foot, and needs to be replaced by a nurse every few days.
• Central venous catheter: inserted into an arm, leg, the neck, or the chest to connect to a large vein leading to the heart. Central venous catheters are used to deliver medicine for long-term patients and can stay in for months or years. They may be used for treatments such as chemotherapy, dialysis, or to deliver nutrients for patients who can’t eat food.

Cardiac catheterisation

• Cardiac catheter: long catheters inserted via veins or arteries and passed along these blood vessels to the heart. They may be used for diagnostic or treatment purposes, such as placing stents or for ablation of cardiac tissue.

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What is dilated cardiomyopathy?

Dilated cardiomyopathy is a disease of the heart muscle that results in the heart not being able to pump blood around the body. It usually starts in the left ventricle. The left ventricle (hearts main blood pumping chamber) becomes weak, stretched and thin and loses the ability to pump a sufficient amount of blood to the rest of the body.

What are the symptoms of dilated cardiomyopathy?

Dilated cardiomyopathy presents symptoms such as:

• Fatigue
• Chest pain
• Swelling (oedema or edema) in the legs, ankles and feet
• Shortness of breath (dyspnea)
• Heart murmurs

If you experience shortness of breath and other symptoms of cardiomyopathy as mentioned above, see your doctor right away and call emergencies if you experience chest pain that won’t go away after a few minutes.

What causes dilated cardiomyopathy?

The main causes include:

• Coronary heart disease (it is the most common cause and can be due to damage to the heart after a heart attack or damage to the coronary arteries)
• Diabetes
• Alcohol abuse
• Substance abuse or certain cancer medications
• Arrhythmias (abnormal heart rhythms)
• Childbirth complications

Can dilated cardiomyopathy be prevented?

By taking certain lifestyle measures, dilated cardiomyopathy can be prevented or the risks of developing it minimized. If a person avoids drinking excessive amounts of alcohol and follows a healthy and balanced diet, they are less likely to suffer from the condition.  Likewise, it is important for people who undergo therapeutic radiation, who take heart medication and pregnant women to have regular check-ups with their doctor to avoid symptoms of dilated cardiomyopathy.

What is the treatment for dilated cardiomyopathy?

Most patients with this condition must take prescribed medication to treat the symptoms and to prevent further complications. In some cases, surgery may be needed, which may include the following techniques:

• Pacemaker
• Defibrillator
• Repairment or replacement of valves
• Coronary artery bypass surgery

If the cardiomyopathy is advanced, the required treatment may be:

• Heart transplant
• Placement of an artificial heart or a device into the left ventricle to assist the pumping of blood around the body 

The electrocardiogram (ECG) is a diagnostic test that records the electrical activity of the heart to test for any kind of pathology. It also constitutes one of the most important tools to find out and evaluate most of the cardiac conditions. Also, electrocardiography provides an invaluable tool for the diagnosis of the growth of the heart chambers (atria and ventricles). In many cases, the diagnosis of congenital heart diseases comes from the characteristic ECG graphic. In fact, the ECG provides important data for the evaluation of more than 80% of heart diseases.

What is it?

An intracardiac electrogram is an exam that tests the heart’s electrical system function, in order to see whether there is any arrhythmia.

What does it involve?

This test is considered an invasive one and is carried out under local anaesthetic.

During the procedure, the doctor will insert electric cables into the chest, which will start sending periodical electric stimuli to the heart. These stimuli will cause small, induced arrhythmias and the leads will record the effects of the arrhythmias. After the procedure, you will be kept under clinical observation and your heart’s activity will be monitored through an ECG.

What is it for?

An intracardiac electrogram evaluates the functioning of the heart’s electrical system. However, it may also be used to investigate the origins of tachycardia or any other cardiac disorders, such as syncope (or temporary loss of consciousness), collapse (fainting) and palpitations (perceived heartbeat irregularity).

How can you prepare for it?

You may be advised not to eat anything before the procedure and you might need to stay in hospital overnight afterwards. After that, you will be able to go back to your normal routine.

What does it feel like during the procedure?

Since the test is carried out under local anaesthetic, the only discomfort you may feel may be due to the induced electric stimuli.

It is very rare for complications to arise after this exam, however in 1% of the cases these complications are of vascular and cardiac nature. In case of vascular complications, the valves the leads pass through may be damaged. This may cause conditions such as venous thrombosis, haematoma and arteriovenous fistulae.

Cardiac complications may include haemorrhagic pericardial effusion (which can be easily treated with a chest drain) or malignant ventricular arrhythmia (which can be treated with electric cardioversion).

This is why a hospital stay after the procedure is important – the medical team can monitor you closely and treat any complications that occur.

What would a “bad” result mean?

An abnormal result may mean that you have a heart rhythm disorder. There are many types of heart rhythm disorder, but most can be treated in a number of ways – including medication, radiofrequency ablation, or the fitting of an artificial pacemaker.

What are they?

Extrasystoles, or premature ventricular contractions (PVCs), are a type of cardiac arrhythmia. They occur whenever a contraction stimulus is sent ahead of time from the sinoatrial node in the heart, which is the normal heartbeat initiator, giving a rather unpleasant sensation of a “skipped heartbeat” or palpitations in the chest.

Prognosis of extrasystoles:

Extrasystoles (PVCs) are not usually dangerous if they are sporadic. Should they become more frequent, you would need to seek preventative treatment. This is because they could evolve into more dangerous arrhythmias in the future.

What are the symptoms?

PVCs are usually asymptomatic, and are diagnosed during exams performed for diagnosing other conditions. When they become more frequent, the most common symptoms include palpitations and an accelerated, skipped or irregular heartbeat, you may also become more sensitive to the changes in your heartbeat. If you also have tachycardia, you may experience dizziness, weakness and breathing problems.

How are they diagnosed?

PVCs are easily diagnosed with an ECG. If it is suspected that you have PVCs, but no conclusive diagnosis can be formulated after an ECG, the doctor may have you wear a Holter monitor for a couple of days, in order to monitor both your resting and active heartbeat. This should give a more complete idea of how your heart is behaving. Under certain circumstances, you may also have to do a cardiac stress test, that is, an ECG while you engage in increasingly intense physical activity. Should the PVCs keep on happening during the test, this could mean that you may be suffering from another condition.

What causes them?

It is not clear yet what causes extrasystoles, especially in otherwise healthy people. The triggers seem to include anxiety, prolonged stress, fatigue or generally feeling unwell. In rarer cases, however, PVCs can be caused by other conditions or problems such as anaemia, hyperthyroidism, hypothyroidism, mineral salts deficiency, hernia or gastroesophageal reflux disease.

How can they be prevented?

It is crucial to find out what may be causing PVCs and act ahead of time to prevent them. First of all, you should avoid stimulating substances, such as coffee, smoking or drinking alcohol. At the same time, you should get started on improving your stress management, and being physically fit. You should not neglect your diet: remember to eat a light and healthy diet.

How are they treated?

It has been demonstrated that exercise can help significantly in reducing the frequency of PVCs. In the most severe cases, you can start taking medications to lower your heartbeat and consequently reducing the number of premature contractions, or you can start taking anti-anxiety medication to help with the stress. Should you also suffer from any cardiac conditions (and based on how severe they may be), you may have to have an artificial pacemaker implanted.

Which doctor should I talk to?

You should see a cardiologist for extrasystoles.

Hereditary diseases are the set of genetic diseases that are caused by changes in the genetic material (DNA) and transmitted from generation to generation, that is, they are inherited from parents to children. Genetic studies allow the identification of genes related to and/or responsible for a specific pathology. In addition, they allow personalized attention to each patient and determine the risk in those cases with a family history of the disease. If a genetic study is performed many deaths can be avoided.

What is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy is primarily a disease of the heart muscle characterised by increased wall thickness due to internal causes of the muscle itself. This thickening of the heart wall is known as hypertrophy, which can make it difficult for the heart to pump blood.

Prognosis of hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is a disease that can cause very serious complications. Some of these are:

• Atrial fibrillation: the thickening alters the structure and normal functioning of the heart's electrical system, speeding up the heartbeat and increasing the risk of a clot
• Sudden cardiac death: Ventricular tachycardia and ventricular fibrillation can cause sudden death. Although it is not very common, people with hypertrophic cardiomyopathy are at greater risk. Sudden death is more common in people under the age of 30
• Obstructions in blood flow: the thickening of the heart obstructs the blood flow from the heart to the rest of the body, which can cause shortness of breath, chest pain, fainting and dizziness
• Dilated cardiomyopathy: the heart gradually weakens, the ventricle enlarges and loses pumping capacity
• Mitral valve problems: blood may flow in the wrong direction, with symptoms worsening if the mitral valve fails to close properly
• Heart failure: when the heart thickens, it may not be effective enough to pump the blood needed for the entire body.

Symptoms of hypertrophic cardiomyopathy

The symptoms of hypertrophic cardiomyopathy include the following:

• Shortness of breath with physical activity
• Chest pain, especially when exercising
• Fainting during exercise or just after exercise
• Feeling that the heart is beating too fast
• Heart murmur.

Medical tests for hypertrophic cardiomyopathy

A series of medical tests can be performed to help diagnose the disease:

• Echocardiogram
• Electrocardiogram
• Stress test
• Holter monitor
• Magnetic resonance imaging
• Cardiac catheterisation
• Genetic analysis.

Cardiomyopathy often goes undiagnosed because there are very few symptoms.

What are the causes of hypertrophic cardiomyopathy?

Most hypertrophic cardiomyopathies are caused by genetic mutations that thicken the heart muscle. The disease cannot be attributed to a specific cause, although in a large number of cases it is hereditary.

Individuals with cardiomyopathy also have an abnormal arrangement of heart muscle cells which can cause arrhythmia.

The severity of the disease varies, but it most commonly enlarges the heart and limits blood flow out of the myocardium.

Sometimes the flow is only slightly blocked, but the heart has lost its pumping capacity.

Can hypertrophic cardiomyopathy be prevented?

As mentioned above, the main cause of hypertrophic cardiomyopathy is heredity, so there is no way to prevent the disease, although early diagnosis is important to avoid complications.

The prevention of sudden death is especially important. It has been shown that a defibrillator can stop and prevent a sudden death from heart attack.

However, since many people are not aware that they have the disease, sudden death from a heart attack may be the only sign that they have the disease, and it can occur in apparently healthy, young people.

As a preventive measure, people with the disease are often advised to avoid playing certain competitive sports in order to avoid sudden death.

Treatments for hypertrophic cardiomyopathy

The aim of treatment is to relieve symptoms as well as to prevent sudden death from a heart attack. Ways of doing this include:

• Drugs: some drugs relax the heart muscle and slow the heart rate, helping it to pump blood efficiently
• Septal myectomy: this is an open-heart procedure in which part of the thickened septum that separates the ventricles is removed, thus improving flow and reducing mitral valve insufficiency
• Alcohol septal ablation: this involves injecting pure alcohol into part of the enlarged heart through a catheter, causing some of the muscle to shrink and die
• Implantable cardioverter defibrillator: recommended for people with arrhythmias. It is a small device that controls the heartbeat and is implanted in the chest as though it were a pacemaker. In the event of an arrhythmia, the defibrillator delivers electric shocks to restore the heart rhythm.

Which specialist treats hypertrophic cardiomyopathy?

The specialists in charge of treating and diagnosing hypertrophic cardiomyopathy and associated problems are cardiologists and cardiac surgeons. 

What is an implantable cardioverter defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a device used as a preventative treatment for people thought to be at risk of cardiac arrest due to ventricular arrhythmia. It is similar to a regular pacemaker, but it is implanted and linked to the heart.

What is it for?

An ICD can be used to treat ventricular arrhythmias, including ventricular fibrillation or sustained ventricular tachycardia (i.e. when your heartbeat is unstable or irregular which could lead to complications at some point in the future).

How does an ICD work?

This device can sense if the heart is beating at a potentially dangerous abnormal rate, delivering a high intensity electrical shock to the heart to disrupt the abnormal heartbeat, returning it to a normal beating rhythm.

How can I prepare for this procedure?

The procedure for implanting a cardioverter defibrillator lasts around 90 minutes. It is done under local anaesthetic and the device is implanted into the thoracic cavity, near the collarbone. Before the procedure, the doctor will programme the device with all the necessary information about you and your condition. During surgery, the heart is monitored with cardiac pacing leads that can send an electrical signal to the cardiac muscle in case of abnormal heart rate.

Post-operative care:

Recovery will take around two weeks and the stitches are removed after ten days. Furthermore, you will need to go for periodic check-ups to make sure that the device is working correctly. Should there be any anomalies, or irritation of the surgical site, or even an ICD malfunction, you will need to go to the nearest A&E or urgent care centre.

What are inherited cardiac conditions?

These are a group of heart conditions that are passed on genetically through families. They can affect people of any age and vary in terms of how serious they are. The following are the main types of inherited cardiac conditions:

• Inherited cardiomyopathies (disease of the heart muscle, affecting size, structure and shape)
• Inherited arrhythmias (abnormal heart rhythm)
• High cholesterol

Prognosis of inherited cardiac conditions:

Some inherited heart conditions can be life-threatening, particularly if they are left undiagnosed and untreated, as this can result in heart failure or cardiac arrest. In fact, it is not uncommon for a family’s first realisation of an inherited heart condition to come after a seemingly sudden and unexplained death in the family.

Symptoms of inherited cardiac conditions:

Often, inherited heart conditions do not have symptoms, however, the following may be experienced:

• Palpitations
• Blackouts (syncope)
• Dizziness

Medical tests to diagnose inherited cardiac conditions:

Inherited cardiac conditions can be challenging to diagnose, however, the following are indicative of such a condition to a doctor or specialist:

• An unexplained death in the family
• Your family has a history premature or sudden deaths
• You were diagnosed with angina or suffered a heart attack at a very young age
• You have a family member with an inherited cardiac condition

What are the causes of inherited cardiac conditions?

Inherited cardiac conditions result from a faulty gene that can be passed on to your children, hence they are inherited from your parents. A gene can become faulty as a result of a mutation or fault in a gene. There will be a 50% chance of inheriting this faulty gene from your parents. If you do inherit this faulty gene, there is also a 50% chance that you will pass it on to your own children.

Can inherited cardiac conditions be prevented?

As these conditions are inherited, they cannot be prevented, however, if you are aware of such conditions affecting family members, you can undergo screening to assess the health of your heart. Some will also undergo genetic testing to check for the faulty gene that has caused the inherited cardiac condition in your family member.

Treatments for inherited cardiac conditions:

Seeking treatment for an inherited cardiac condition will reduce the chance of cardiac arrest, heart attack and developing more serious coronary heart disease. Treatments will often consist of having a pacemaker installed or an implantable cardioverter defibrillator (ICD) device. An ICD sends electrical pulses to the heart to regulate heart rhythm in people who have an inherited arrhythmia. New treatments for inherited heart conditions are always being researched and developed, as well as ways to better identify and test for these conditions.

Which type of specialist treats inherited cardiac conditions?

Cardiologists would treat inherited cardiac conditions.

What is a pacemaker?

A pacemaker is a small electric device which generates electrical impulses to regulate your heart rhythm. It is generally fitted in the chest but can sometimes be fitted in the abdomen. About 25,000 people are fitted with a pacemaker each year in the UK.

Most people will be fitted with a traditional pacemaker, of which there are three types, depending on how many wires it has:

• a single-chamber pacemaker has just one wire, connected to the upper or lower heart chamber on the right side
• a dual-chamber pacemaker has two wires connected to both heart chambers on the right side
• a biventricular pacemaker has three wires, two connected to the chambers on the right side, and one connected to the left ventricle

Some people might be fitted with a special type of pacemaker designed to coordinate the pumping action of the different chambers of the heart. In some cases, a defibrillator is attached. The use of this type of pacemaker is known as cardiac resynchronisation therapy, and it is recommended in people who have heard failure because of their left ventricle.

Who might need a pacemaker?

A pacemaker is a popular device used to treat a variety of heart problems. You might need a pacemaker if:

• you have an irregular heartbeat (atrial fibrillation)
• you have a slower heartbeat than normal due to heart block or heart failure
• your heart is beating too fast (tachycardia) and you cannot control it with medication

If you’ve had a heart attack in the past and your doctor thinks you have a high risk of having another in the future, they might recommend a similar device to a pacemaker called an implantable cardioverter defibrillator (ICD).

What does fitting a pacemaker involve?

Pacemaker surgery is a safe operation generally performed under local anaesthetic, taking about 45 minutes to perform. You can usually go home a few hours after the surgery is complete. The battery in the pacemaker can last for about 10 years, so you’re unlikely to have to get it replaced any time soon.

After your pacemaker has been fitted, you’ll be advised on how to use it, and in particular, what to do to avoid electrical or magnetic devices interfering with the electric signals your pace produces. It’s important to let your car insurance company know that you have a pacemaker, as well as the DVLA.

For more information on pacemaker surgery, click here.

What are palpitations?

Palpitations are heartbeats that feel either too fast or too hard, and sometimes they can feel like your heart is skipping a beat. These are felt in your chest, throat or neck. Often these are not harmful and can result from stress, caffeine, nicotine or anxiety. Pregnancy can also cause heart palpitations at times. Sometimes, heart palpitations can indicate more serious heart conditions, particularly if they happen frequently. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.

Prognosis:

Heart palpitations are usually not severe, but if they occur frequently, a medical examination will be needed to rule out underlying heart problems, such as arrhythmia.

Symptoms of heart palpitations

Heart palpitations can feel unpleasant and feel as though the heart is beating too strong and too fast. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.

How are palpitations diagnosed?

To rule out possible underlying heart conditions, you may need an ECG, a blood pressure test or an echocardiogram.

What are the causes of heart palpitations?

Heart palpitations are usually a result of anxiety, stress or panic attacks; caffeine intake or nicotine; consumption of illegal drugs; exercise and fever, among others. In addition, there are conditions that can increase the probability of having an abnormal heart rhythm, such as:

• Previous heart disease (arrhythmias)
• Hyperthyroidism
• Abnormal heart valve
• Hypoglycaemia
• Significant risk factors for heart disease
• Anaemia
• Electrolyte blood abnormality

Can heart palpitations be prevented?

It is possible to prevent palpitations by doing the following:

• Regular moderate exercise
• Avoid anxiety and stress
• Treat underlying diseases
• Avoid tobacco, alcohol and coffee

Treatments for heart palpitations

Treatment will depend on the underlying cause of the palpitations. If it caused by anxiety or stress, then these can be managed better. If they are caused by a stimulant, then these can be avoided. If there is an underlying heart condition, then this will have to be treated accordingly.

What specialist treats heart palpitations?

Cardiologists would diagnose and treat heart palpitations.

What is a second medical opinion?

A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.

Why would you get a second medical opinion?

Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.

In addition, there are certain situations where a second medical opinion is sought after:

• Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening
• The diagnosis is not clear-cut
• If you are considering a new treatment approach that is experimental

The aims of obtaining a second medical opinion are:

• To confirm whether a diagnosis is correct and/or appropriate.
• To confirm whether a suggested treatment is correct and/or appropriate.
• To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure.

Possible disadvantages of seeking a second medical opinion include:

• The process can delay the start of treatment.
• Logistically, seeing another specialist might be difficult and possibly time-consuming.
• It might be stressful to hear the same diagnosis again.

How would you seek a second medical opinion?

You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.

Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals. 

What is shortness of breath?

Shortness of breath (also known as breathlessness or dyspnoea) is a very noticeable symptom where the patient finds it difficult to breathe properly, tiring out quickly, and not taking in enough oxygen with each breath. The patient’s breaths usually become quick and shallow, perhaps even hyperventilating, and may be accompanied by wheezing, coughing, or chest pain.

What symptoms are associated with shortness of breath?

Shortness of breath is a symptom rather than a diagnosis, and can be symptomatic of many underlying problems. As such, breathlessness may be accompanied by a number of symptoms, including:

• Fatigue
• Wheezing
• Coughing
• Hyperventilation
• Chest pain
• Pleurisy (pain with inspiration)
• Dizziness
• Fainting
• Neck pain
• Feelings of anxiety

By analysing when the shortness of breath occurs (for example at rest or when doing exercise), and the other symptoms that accompany it, doctors can diagnose the root cause.

What causes shortness of breath?

There are many things that can cause dyspnoea, many of which can be serious, and some of which are even life-threatening, such as lung cancer and chronic obstructive pulmonary disease (COPD).

If you have sudden shortness of breath and are struggling to breathe, your chest feels tight or heavy, and you are experiencing pain which spreads to your neck, back, arms, and/or jaw, these are signs that you are having a heart attack or have a serious problem with your airways, and you should immediately call 999, as you will need hospital treatment.

Breathlessness can be symptomatic of:

Lung problems

• Asthma
• Croup
• Interstitial lung disease
• Pulmonary oedema
• Pulmonary fibrosis
• Pleurisy
• Sarcoidosis
• Tuberculosis

Heart problems

• Arrhythmia
• Cardiomyopathy
• Heart failure
• Pericarditis

Other problems

• Inhaling a foreign object
• Low blood pressure
• Anaemia
• Carbon monoxide poisoning
• Anxiety disorder

When to see a doctor

You should never feel you cannot consult a doctor – even if the problem does not seem serious, you are not wasting anyone’s time getting it checked out. You should definitely see a doctor for shortness of breath in the following circumstances:

• It has been going on for over a month
• You have swelling around your feet and ankles
• You have been coughing for three weeks or more
• You experience fevers and/or chills
• Your breathlessness is worse when you lie down or do exercise

What is the treatment for shortness of breath?

The treatment for breathlessness depends entirely on the cause. The possible causes of dyspnoea are numerous and diverse, and therefore, so are the possible treatments. General advice, especially for chronic shortness of breath, would be to stop smoking, lose weight, and avoid exposure to allergens and pollutants that could make it worse.

Sudden death is a sudden but natural death. The main cause of sudden death is cardiac arrest. 

It is estimated that 12% of natural deaths are sudden deaths. In patients with ischemic heart disease, sudden death is the most common form of death. 

Popularly it is believed that there is a relationship between physical activity and sudden death. But the overall impact is small. 

Some drugs, such as diuretics or antiarrhythmics, can cause arrhythmia and therefore sudden death. Drugs, especially cocaine, also can cause this unexpected death.

What is supraventricular tachycardia?

Supraventricular tachycardia (SVT) is a heart condition where the heart suddenly beats much faster than normal. This type of tachycardia originates from faulty electrical impulses in the upper part of the heart, rather than from the ventricles (the lower chambers of the heart). It is less dangerous than ventricular tachycardia. SVT then refers to any non-ventricular tachycardia, such as:

• Sinus tachycardia
• Ectopic atrial tachycardia
• Junctional tachycardia
• Atrial fibrillation
• Atrial flutter
• Atrioventricular nodal reentrant tachycardia (AVNRT)
• Paroxysmal supraventricular tachycardia (PSVT)

However, the term “supraventricular tachycardia” usually refers to AVNRT or PSVT. Supraventricular tachycardia can affect individuals who don’t have any other heart disease.

Prognosis

For healthy people, SVT is usually a non-life-threatening condition. They usually won’t need any treatment, as the episodes will come on and go on their own.

What are the symptoms of supraventricular tachycardia?

During an episode, you may experience the following symptoms:

• Palpitations
• Shortness of breath (dyspnoea)
• Dizziness
• Fatigue
• Temporary loss of consciousness
• Chest pain
• A tingling sensation and other types of paraesthesia
• Rapid breathing (polypnea)

This type of tachycardia usually causes a regular, accelerated heartbeat which changes suddenly, going from 75 to more than 200 bpm. The episodes can last from a few minutes to 48 hours. Medical treatment may be necessary to make them stop.

How is supraventricular tachycardia diagnosed?

If you happen to have an episode during an examination, the cardiologist will check the patient’s heartbeat and then order some other tests, such as an electrocardiogram (ECG), which may require the patient to wear a Holter monitor for 24 hours.

What causes supraventricular tachycardia?

Supraventricular tachycardia is mainly caused by a malfunctioning of the electrical signals between the ventricles and the atria. The atria accelerate, causing a faster heartbeat. When the heartbeats are too close to one another, they are less efficient: the amount of blood pumped around the body is less than what is needed. This ends up lowering your blood pressure.

An episode of SVT can arise after a fairly intense exercising session. As a consequence, athletes - especially those at a competitive level - have to keep their heart under control.

How is supraventricular tachycardia treated?

There are several options for treating supraventricular tachycardia:

• Vagal manoeuvre: these aim at activating the vagus nerve, which slows down the heart. They are most effective when performed at the beginning of an episode. It is best to do vagal manoeuvres under medical supervision. If you suffer from frequent tachycardia episodes, your doctor may teach you how to do some of them on your own, including taking a deep breath, shutting your mouth tight, holding your nose tightly and blowing out as hard as you can; or putting your face in ice-cold water for a few seconds. Another vagal manoeuvre is the carotid sinus massage, which should only be performed by a doctor.
• Electrical cardioversion: a defibrillator delivers tiny electrical shocks to the chest, in order to restore a normal heartbeat. This may be used if vagal manoeuvres don’t work.
• Radiofrequency ablation: the cardiac tissue and cardiac channels which are contributing to supraventricular tachycardia are destroyed by radiofrequency. It may be the best option for people who suffer from frequent episodes.
• Cryoablation: the same principal as radiofrequency ablation, but here an extremely low temperature is used to destroy the tissues. The process is done in two steps. In the first step, the tissues are brought to -10°C. If everything goes as it should, then the second step is to further lower the temperature to -73°C, wherein the tissue is permanently dead.

Medications may also be prescribed when vagal manoeuvres don't seem to be working or in case of frequent tachycardia episodes.

Which doctor should I talk to?

If you’re having frequent supraventricular tachycardia episodes, you should see a cardiologist.

What is syncope?

Syncope, also known as fainting, is the sudden loss of consciousness for a brief period. This is usually caused by insufficient blood flow to the brain, and is often associated with low blood pressure (hypotension).

What are the symptoms of syncope?

Before fainting, you may feel weakness or nausea. The following are also warning signs experienced just before fainting:

• Feeling clammy and sweaty
• Confusion
• Light-headedness
• Blurred vision
• Yawning
• Ringing in your ears

After fainting, you normally regain consciousness within 20 seconds, and you may feel weak for a short period afterwards. You may also not remember what you were doing just before you fainted.

What causes syncope?

Fainting (syncope) is caused by a reduction in blood flow to the brain. This can be disrupted by several factors:

• Triggers (e.g. heat, pain, sitting or standing up suddenly, an unpleasant sight or even swallowing)
• Heart problems
• Reflex anoxic seizures (common in children)
• Low blood pressure (hypotension)
• Low blood sugar levels
• Medications
• Dehydration

Can syncope be prevented?

There is no specific treatment that prevents the onset of syncope, but if a person is prone to fainting, you can either avoid known triggers, or if you feel an episode coming on, lie down and lift your legs or sit down and put your head between your knees. This keeps blood flowing to your brain.

What is the treatment for syncope?

Treatment depends on the cause of the syncope. If there is an underlying health condition, then tests will need to confirm this and treated accordingly. The tests that the doctor can order can include:

• Blood tests
• Heart rate monitoring
• Echocardiography
• Electrocardiography
• Chest x-ray

Often, after fainting, no further treatment is needed, but measures to avoid future episodes can be taken, such as avoiding triggers.

What is a tilt test?

The tilt test or tilt table test is an examination carried out to find out the causes of syncope (collapse) without any specific cause, and that is accompanied by other symptoms such as instability or vertigo. Mainly, the test is based on the evaluation of the heart rate and blood pressure while lying down, standing almost upright, and being in an erect position.

What does it involve?

The test involves lying on a tilt table, where you are tightly fastened with straps and with your feet lying on a foot support at the base of the table in order to help you stand in an upright position. While in this position, the first registration of your blood pressure and heart rate is done. Then you are laid flat and more registrations will be taken at the following minute intervals: 1, 5 and 10. Once 10 minutes have passed, you will be tilted to an almost upright position, between 60° and 80° for 20-30 minutes until you experience the same symptoms as when you suffer a syncope. If symptoms don´t show they will be artificially provoked using medication. The test is considered positive if it induces an episode of syncope, such as a drop in blood pressure and heart rate. These symptoms disappear when you are laid flat.

Why do you need it?

This test allows the doctor to find out the relation between blood pressure and the appearance of specific symptoms, which in many cases, makesdetecting the correct origin of the syncope possible, as it can sometimes be erroneously diagnosed as epilepsy. The test can also determine the origin of orthostatic hypotension and autonomic dysfunction.

How to prepare for it

The test lasts for around 40 minutes, and the only preparation you need is not to eat or drink for at least 3 hours before the test. It is advisable to bring someone along to your appointment as you may feel light-headed at the end of the test. For those suffering from ischaemic heart disease, diabetes mellitus, glaucoma, carotid artery stenosis, prostate enlargement and serious valvular heart disease, this test is not recommended. It is advised that you visit a specialist for advice.

What do you feel during the test?

The tilt test is not considered invasive, although the induced faint can feel uncomfortable.

What is ventricular tachycardia?

Ventricular tachycardia (V-tach or VT) is a type of arrhythmia (heart rhythm disorder) in which abnormal electrical signals in the ventricles (the lower chambers of the heart) cause them to beat unusually quickly and out of sync with the contractions of the atria (upper chambers).

This acceleration and lack of coordination can mean that the chambers of the heart don’t have enough time to fill completely with blood before pumping it on, which results in not enough blood being pumped around the body, and therefore not enough oxygen. This can bring on a number of symptoms (see below).

This disorder can affect both people suffering from cardiac conditions and, more rarely, healthy people.

Prognosis

In the most severe cases, ventricular tachycardia attacks can evolve into ventricular fibrillation, in which coordination between the ventricles is lost as they contact very rapidly. This can cause cardiac arrest, which is fatal if not treated immediately.

What are the symptoms of ventricular tachycardia?

The most common symptoms are:

• Dizziness/light-headedness
• Shortness of breath (dyspnoea)
• Palpitations
• Chest pain
• Anxiety
• Racing pulse
• Laboured breathing
• Syncope
• Hypotension

How is ventricular tachycardia diagnosed?

The most common tests and examinations are:

• Electrocardiogram (ECG)
• Echocardiography
• Chest X-ray scan
• Coronary angiography
• Blood test to look at your magnesium, phosphate and calcium levels

What causes ventricular tachycardia?

Ventricular tachycardia is caused by a problem with the electrical signals that control when the ventricles contract to pump blood. This can be affected by several things:

• Damage to the heart muscle and/or electrical pathways due to other heart conditions, e.g. coronary heart disease, cardiomyopathy, congenital heart disease, or previous heart attacks.
• Electrolyte imbalance
• Substance abuse, especially cocaine
• Certain medications
• Excessive caffeine intake

People who have diabetes or hypertension, those with a family history of cardiac conditions, and heavy smokers and drinkers all have a higher risk of suffering from ventricular tachycardia.

How can ventricular tachycardia be prevented?

You can reduce the risk of ventricular tachycardia by keeping secondary risk factors under control. There are some healthy habits you should adopt:

• Avoid smoking, an excessive consumption of alcoholic beverages and illegal drugs abuse.
• Exercise regularly.
• Adopt a healthy diet, cutting down on red meat, fats and increasing your vegetable and fruit intake.

How is ventricular tachycardia treated?

If the patient has been suffering from ventricular tachycardia for some time or if it has worsened recently, an emergency treatment called electrical cardioversion is often used. Similar to defibrillation, it uses a timed electric shock to restore the heart rhythm to normal. If the patient suffers from cardiac arrest before their V-tach is treated, a defibrillator will be used to restart their heart.

Once the heart rate is under control, your doctor may recommend medication such as calcium-channel blockers, beta-blockers and antiarrhythmic drugs to keep it beating as normal. You should always consult a doctor before taking medication.

Future episodes may also be prevented with the following hospital treatments:

• Catheter ablation – a thin tube is passed through a blood vessel to the heart, where an electrode at the tip will use either heat, extreme cold, or radiofrequency energy to ablate (destroy) defective tissue or electrical pathways.
• Implantable cardioverter defibrillator (ICD) – a small device, which is implanted into the heart. It detects when the heart rhythm becomes abnormal and delivers a small shock to normalise it.
• Heart surgery – in rare cases, where the other options aren’t possible or haven’t worked, an operation may be necessary.

Which doctor should I talk to?

Should you think you’re at risk of ventricular tachycardia, you need to see a cardiologist to choose which tests and treatments are the best options for you.