Dr. Nicholas Pegge : Cardiologist
Again, an awareness of a variation or disturbance in the heart rhythm is a very common symptom. Luckily, the majority of people who report palpitations don’t have underlying heart problems: simple extra beats (so-called ectopics) or awareness of the normal variability of the heart’s natural pacemaker account for most cases of palpitation.
An accurate diagnosis requires a careful history of the patient’s symptoms, physical examination, and ECG or electrocardiogram recordings. Sometimes the ECG done at clinic gives the answer, but many patients need heart rhythm monitoring.
In deciding how to look after a patient with heart rhythm disturbance, knowledge of the structure and pumping function of the heart from echocardiography or cardiac MRI is sometimes required.
Some patients have symptoms, perhaps especially blackout or syncope, which can be infrequent and therefore difficult to investigate. Long term heart rhythm monitoring can be achieved with a small monitor which can be introduced under the skin at the front of the chest under a local anaesthetic. This is called an ‘implantable loop recorder’, but often colloquially referred to as a ‘Reveal’ device, after the trade name of one of the best known manufacturers.
Occasionally, tilt-table testing and electrophysiology studies are required.
Dr Nicholas Pegge MA (Cantab.) MB BS (London) FRCP