The 2 most important questions to ask and answer if you have ectopic heart beats

my name is Sanjay Gupta I'm a consultant cardiologist in York and today I thought I would do a video on the subject of ectopic heartbeats this video is entitled the two most important questions to ask and answer if you suffer from ectopic heart beats now a lot of my work involves talking to you and reassuring patients who suffer from ectopic heart beats these seem to cause a ton of anxiety and seem to impact on patients lives very negatively most patients I speak to have already seen a doctor and they've already been told look you have ectopic heartbeats they're not dangerous get on with it but this reassurance is seldom enough the anxious mind needs more than just that cursory pat on the back part of the reason I think this is is because when ectopic beats are felt they are very uncomfortable in very scary and the anxious mind starts asking all sorts of questions some of which are rational questions some of which are irrational questions the poor patient goes looking for answers doesn't find them from his doctor goes looking on the Internet scouring websites and forums and ends up even more confused and terrified in this video I wanted to help reassure patients by helping them asked and answer some rational questions about ectopic heartbeats and hopefully in doing so you'll be able to make more sense of them why things are done and why you should feel reassured when the tests come back normal okay so there are two my mind there are only two reasons why a topic beets are important okay the first reason they could be important is because they may represent they may be a sign of something wrong with the heart and therefore they may represent some sort of warning that something bad is going to happen in the future so if we used an analogy I like to use the analogy of snakes so if we think of ectopic heartbeats as baby snakes the concern is that there may be a mother snake waiting to bite okay so that's the first thing you know are there sign of something wrong are these ectopic beats a sign that there's something going on in with my heart and therefore something bad could happen because they're the first sign that my heart is in some way diseased and the second reason they may be important is if they in themselves are causing the heart and the patients some sort of damage so even though they may not represent an underlying problem could they in themselves be causing any kind of damage to the heart and if we can and those are the only two reasons I think ectopic beats are interesting or important and those are the two most important questions that you have to ask yourself and address and if you can address them then you are well on your way to understanding them and feeling very short okay so so with the second question that's like okay there's no mother snake nearby but can these baby snakes by themselves bite me okay right so let's try and answer these questions the first question is could they be a sign of something wrong with my heart and the answer is sure of course if the heart is in some way damaged then the heart becomes more irritable that will manifest as more ectopic beats and therefore the further away you go trying to answer that question is to do some tests to study the heart and I'll go through all these tests in detail so you understand why they're done and what they tell us okay so the easiest test to do the first and the easiest test to do is to do is a 12-lead ECG a 12-lead tracing of the heart and ECG and this is done virtually in every case in every patient because it's readily available and it gives us a graphical representation of how the electricity is being conducted through the heart if the heart is in any way damaged then this will interfere with the passage of electricity and therefore the 12-lead ECG would be abnormal it is true to say that a completely normal 12 lead ECG makes it very unlikely that the heart is in some way abnormal or it can happen but very very very unlikely so 12 lead ECG is the first step okay even if it's done when the patient is not complaining of palpitations or ectopic just you're resting 12 lead ECG is a great first step because if the 12 lead ECG is completely normal then that's very reassuring the second test to do is to do some kind of prolonged heart rhythm monitoring to capture the symptoms so when the patient has his typical symptoms because the patient will often complain to the GP of palpitations my heart skips or my heart stops or my heart has a little judder or it's sort of I get a few little runs or something like that so when the patient goes to the GP the the most one of the most useful tests is to catch what is happening when the patient complains off this okay if the ECG is completely normal during the symptoms the typical symptoms then one can be very reassured that the symptoms are not cardiac and therefore you don't need to worry about the heart at all at that point okay but it is very important to capture those symptoms now the the most common test done is a halter monitor which is a 24-hour monitor which a person puts on for 24 hours it aims to record every single heartbeat over that 24 hour period the problem with the halter monitor is this that more often than not the patient does not get their typical symptoms during the monitor patient really has to be having their neck topics or palpitations several times a day to having a realistic chance of catching those on the 24 hour ECG and therefore in my own experience it's far better to do a longer monitor or 48 hour monitor is definitely better than a 24 hour monitor but now you can buy these patches which you can put on which go on for seven days or 14 days or even a month and those are much better because they allowed the patient you know you you're recording every single heartbeat over a much longer period of time and therefore you have a much greater chance of catching the and palpitations when they happen and thereby you can see exactly what's going on now and the problem with these monitors is because they're capturing every single heartbeat the battery life on these monitors tends to be limited and therefore you can't really do more you know recording for more than a month so if a person's getting symptoms say once every three months then the chances of picking it up on a on a on a monitor such as these is less and in those patients a better way of catching these when they happen is either event monitoring which is mushy machine which you put on but this does not record every single heartbeat it will only record when you ask the machine to record so you press a button when you get something and the machine will record what's happened for a few seconds before you press the button and when you press the button they tend to be a little bit flimsy and a little bit unreliable the gold standard however is something called a reveal device which is a small device which is around about this big and that can be inserted under the skin okay in a five-minute procedure under local anesthetic very harmless they sit there and they stay there for about two years and they will hopefully capture anything abnormal that's going on within the heart at that time they also come with a trigger so when the patient complains of symptoms then the patient can press a button and the monitor the the reveal device will record whatever is happening when the patient press the button and so they're the most reliable way of catching what's happening the advantage of having some monitoring is it allows you to see exactly what's happening okay because if if your heart rhythm is completely normal when you're getting your symptoms then it's not a hard problem you don't need any further tests the third test to assess whether the heart is structurally normal is an echocardiogram an ultrasound based assessment of the heart this is even better than an ECG because it allows you to look at the heart and it's you know you can see the heart on them on the echo screen this it on the echocardiogram and more importantly it allows you to visualize the heart as it's moving so it allows you to see how well the heart is moving it tells you it allows you to see how the blood flows through the heart it allows you to assess the valves it allows you to assess the pumping ability of the heart a normal echocardiogram is hugely reassuring again a very very reassuring test most heart disease is manifest by structural changes on the echocardiogram the one thing an echocardiogram does not give information about is the state of the blood vessels that actually supply the heart with blood so you can see the heart itself but you can't tell anything about whether that heart is getting all the blood it needs and for this the final test which is really reassuring is a stress test of some sort this gives useful information about the blood vessels supplying the heart ie does the heart at times of stress get all the blood it needs it can give the patient a ton of confidence about this about the fact that he can put his heart through stress like physical exercise without coming to any harm if there's something wrong with the heart it is far more likely to become manifest at times of exercise and therefore a normal stress test is very very reassuring indeed one other useful bit of information is that we know that patients who manage more than nine minutes on the Bruce protocol on the treadmill are by definition in a low-risk category so if you can do nine minutes on this Bruce protocol on the treadmill regardless of anything else the chances are you will do well in the future so that's why an exercise test is cutely reassuring so if someone suffering from ectopic beats the first thing I would say is well if you're trying to say or they find my heart is in some way abnormal then these tests and ECG a halter monitor or a cardiac monitoring over a prolonged period of time an echocardiogram and a stress test will give you a really comprehensive assessment of the structure of the heart and whether your heart is healthy or not okay now the one question to ask yourself is could the heart still be diseased even if these tests were completed normal and the answer is yes but it would be extremely extremely unlikely occasionally some people inherit some form of genetic predisposition which is not manifest as an obvious structural change on the echocardiogram okay so you know you've inherited a tendency for the heart to misbehave but that hasn't manifest as an abnormality that you can see on the echocardiogram and in this setting this is why we ask about family history because the tests made completely be completely normal so we often want to know about family history know if there is no family history of premature cardiac death below the age of 40 in a family member then again this is a very reassuring sign and makes it less likely that you may have inherited a genetic predisposition and finally to my mind there is perhaps the best jest of all and that is the test of time okay I often speak to patients who say they've suffered from ectopic for 20-30 years and they're still terrified by them and I always say to them that if they have had these for twenty thirty years then clearly these are not dangerous if nothing's bad to have nothing Bad's happen to them in 20 years then clearly these do not signify danger if I say to them but if no mother snake has shown up in the last twenty years they can then you can be pretty sure there's no mother snake around okay so that's the answer that's how you go about answering the first question the first relevant rational question do these signify a problem with my heart those four tests family history and also the test of time is all very reassuring the second question Ventura's answer is could the ectopic beats by themselves be causing me any form of damage okay so I know there's no mother snake nearby could these baby snakes bite me and the answer here is that it's important to understand that any heart rhythm disturbance in itself signifies one thing and one thing only okay it signifies mechanical inefficiency the heart is a pump its job is to pump Drowned to do so most efficiently it has to pump at a certain rate and it has to pump regularly if there's any irregularity or any kind of disturbance in rhythm then all that means is that for the duration of that irregularity the heart is less efficient just for the duration of that irregularity and then when the normal regularity is restored the heart becomes efficient again so there's no doubt that this inefficiency could damage the patient but it has to be prolonged and sustained okay it's a little bit like having someone press on your neck if someone presses on your neck for if ten seconds it's not gonna do you any harm but if the person presses on your neck and constricts it for ten minutes then that could do you harm so similarly with this inefficiency of the heart is only really important if it is sustained and prolonged it topics however by very nature tend to be transient they usually last one or two beads then you get normal beads then you may have one or two beats epic topics then you have a few normal beats then you have a few more ectopic so by definition they represent unsustained or non sustained in efficiency and therefore they don't cause any damage again so the ectopic itself does not cause any damage now the next question then to try and ask is well okay I know that the ectopic itself doesn't cause any damage but surely if I had several thousands could that do me damage and there is now some evidence that a very very large number of ectopic over a 24-hour period so if you were consistently getting over 20,000 ectopic cin a day consistently over several months years etc then that can cause the heart to weaken and the answer the question is why does that happen and the answer is that if you think that an ectopic is not as efficient as a normal beat and if you're getting say 20,000 ectopic sand the normal heart beats a hundred thousand times in a day on average then one fifth of the heartbeats are less if less effective and there for the kidneys we'll get 1/5 less blood than they expect and that will then stimulate changes within the kidneys and the kidneys we'll try and adapt by increasing the amount of water they're absorbing from the urine and therefore they try and restore the circulating volume because the kidneys immediately think when they get less blood they think this person is dehydrated let's absorb more water from the urine let's restore the amount of circulating volume so that we get more blood and so the kidneys do that but the problem was never that the person was dehydrated and therefore slowly the patient starts filling up with more volume because the kidneys are doing this and because the aect optics continue to manifest the kidneys continue to get less blood and therefore over a period of time you get into this vicious cycle where you slowly start filling with fluid and the heart starts getting more and more stretched and over a period of time as the heart gets more stretch it becomes weaker and back and cause the heart to weaken and you can see that on an echocardiogram the good news however is that even if that does happen when you suppress the ectopic s' and then the heart usually strengthens back up and therefore this is another reason why a holter monitor or some kind of prolonged monitoring which gives you some kind of a count of how many egg topics you're getting in a 24-hour period is very useful because if you were getting more than 20,000 then there's a good reason there to say okay well let's make sure that the heart is normal and let's try and suppress these because of a prolonged period of time maybe they will cause the patient home even though they even though they don't cause kind of irreversible harm you can restore the heart function if you suppress them even if the heart has started weakening so once you've answered these two questions you can be reliably reassured that no harm will befall you and often this reassurance can go a long way in helping you get rid of the egg topics so as I say always those are just those are the only two things that are important with big topics okay thank you so much for listening and watching I would love to know what you thought of this video I'm planning to do a live facebook chat tonight so at 7 p.m. UK time 7 p.m. UK time if you go to my facebook page it is the way you access my facebook pages to type in at then you know a with the circle around it at York cardiologist in your Facebook search bar you'll find my page if you join that page I'll do a live facebook chat today at 7 p.m. UK time you can ask me any questions there's no charge this is a completely free thing you can ask me any questions and I'll try and answer them interactively I will also post a transcript of this video on my website which is www.hyken.com

Channel: York Cardiology

Views: 87,442

Keywords: Heart palpitations anxiety, Heart palpitations after eating, Heart palpitations causes, Heart palpitations symptoms, Heart palpitations treatment, Heart palpitations cure, Ventricular ectopics, Heart disease symptoms, Heart racing, Heart flutter causes, Heart palpitations at night, ectopic heart beats, anxiety, dr sanjay gupta

Id: B5syRYyNZlA

Length: 18min 40sec (1120 seconds)

Published: Sun Aug 04 2019