Dr Virdee
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:
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.
A pacemaker is a popular device used to treat a variety of heart problems. You might need a pacemaker if:
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).
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.
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.
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.
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.
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:
This said, cardiac ablation is considered to be a low-risk procedure.
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.
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.
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.
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.
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 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.
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.
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).
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.
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.
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.
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.
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).
Before fainting, you may feel weakness or nausea. The following are also warning signs experienced just before fainting:
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.
Fainting (syncope) is caused by a reduction in blood flow to the brain. This can be disrupted by several factors:
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.
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:
Often, after fainting, no further treatment is needed, but measures to avoid future episodes can be taken, such as avoiding triggers.
Dr Munmohan Singh Virdee is a leading cardiologist and electrophysiologist based in Cambridge, UK. He specialises in cardiac electrophysiology, performing device implants and catheter ablations for all types of cardiac arrhythmias, including for atrial fibrillation. He has a particular expertise in implanting biventricular pacemakers and defibrillators that deliver cardiac resynchronisation therapy for heart failure, and device extraction.
Dr Virdee graduated in 1994 from the medical school of Guy’s and St Thomas’ Hospitals, having also intercalated a BSc in Radiological Sciences in 1991. He trained as a junior doctor on London's prestigious golden circuit, before becoming a BHF research fellow at St George’s Hospital. In 2006, he was appointed at Papworth Hospital, where he now practices as a consultant cardiologist and electrophysiologist.
He is a proud member of Heart Rhythm UK and the British Cardiovascular Society. His research work with the University of Cambridge, related to his expertise in implanting biventricular devices, has been presented at many international conferences and he has contributed to many medical publications in this field.
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.
People with an arrhythmia may not experience any symptoms, but a prominent arrhythmia may result in the following symptoms:
Arrhythmias are caused by problems in the electrical conduction system of the heart. Among the main causes are:
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:
Mild arrhythmias often won’t require treatment, but when an arrhythmia is serious treatment will be required. Treatment can consist of:
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:
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:
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.
Atrial fibrillation can be diagnosed with a heart exam. The main tests to diagnose atrial fibrillation are:
Atrial fibrillation is mainly caused by cardiac disorders, such as:
Moreover, the following conditions can also lead to atrial fibrillation:
You can help to prevent atrial fibrillation by leading a healthy lifestyle: maintaining a healthy weight, exercising regularly and quitting smoking.
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:
To make an appointment with a doctor specialising in the treatment of atrial fibrillation, click here.
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.
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.
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.
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 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.
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.
The majority of people who suffer from this condition don’t experience symptoms, however, those that do may experience the following:
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.
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.
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.
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.
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.
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:
This said, cardiac ablation is considered to be a low-risk procedure.
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.
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.
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:
They can also be used in the following treatments:
Intravenous catheters
Cardiac catheterisation
.
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.
Dilated cardiomyopathy presents symptoms such as:
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.
The main causes include:
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.
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:
If the cardiomyopathy is advanced, the required treatment may be:
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.
An intracardiac electrogram is an exam that tests the heart’s electrical system function, in order to see whether there is any arrhythmia.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hypertrophic cardiomyopathy is a disease that can cause very serious complications. Some of these are:
The symptoms of hypertrophic cardiomyopathy include the following:
A series of medical tests can be performed to help diagnose the disease:
Cardiomyopathy often goes undiagnosed because there are very few symptoms.
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.
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.
The aim of treatment is to relieve symptoms as well as to prevent sudden death from a heart attack. Ways of doing this include:
The specialists in charge of treating and diagnosing hypertrophic cardiomyopathy and associated problems are cardiologists and cardiac surgeons.
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.
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).
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.
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.
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.
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:
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.
Often, inherited heart conditions do not have symptoms, however, the following may be experienced:
Inherited cardiac conditions can be challenging to diagnose, however, the following are indicative of such a condition to a doctor or specialist:
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.
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.
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.
Cardiologists would treat inherited cardiac conditions.
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:
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.
A pacemaker is a popular device used to treat a variety of heart problems. You might need a pacemaker if:
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).
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.
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.
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.
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.
To rule out possible underlying heart conditions, you may need an ECG, a blood pressure test or an echocardiogram.
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:
It is possible to prevent palpitations by doing the following:
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.
Cardiologists would diagnose and treat heart palpitations.
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.
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:
The aims of obtaining a second medical opinion are:
Possible disadvantages of seeking a second medical opinion include:
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.
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.
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:
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.
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
Heart problems
Other problems
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:
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.
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:
However, the term “supraventricular tachycardia” usually refers to AVNRT or PSVT. Supraventricular tachycardia can affect individuals who don’t have any other heart disease.
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.
During an episode, you may experience the following symptoms:
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.
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.
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.
There are several options for treating supraventricular tachycardia:
Medications may also be prescribed when vagal manoeuvres don't seem to be working or in case of frequent tachycardia episodes.
If you’re having frequent supraventricular tachycardia episodes, you should see a cardiologist.
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).
Before fainting, you may feel weakness or nausea. The following are also warning signs experienced just before fainting:
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.
Fainting (syncope) is caused by a reduction in blood flow to the brain. This can be disrupted by several factors:
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.
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:
Often, after fainting, no further treatment is needed, but measures to avoid future episodes can be taken, such as avoiding triggers.
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.
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.
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.
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.
The tilt test is not considered invasive, although the induced faint can feel uncomfortable.
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.
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.
The most common symptoms are:
The most common tests and examinations are:
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:
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.
You can reduce the risk of ventricular tachycardia by keeping secondary risk factors under control. There are some healthy habits you should adopt:
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:
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.
e-Consultation is a private messaging and video conference service that allows contact with leading specialists at the time you choose, from any place.