ASK THE GP: Do I need to worry about my extra heartbeat? Dr Martin Scurr answers your health questions
A few years ago I started experiencing unusual heartbeats. I had various tests, including a heart scan and an angiogram that came back as normal. I also had to wear a monitor for 24 hours, which showed I had an extra heartbeat. But I was told this was normal, so no further action would be taken (though I now take a statin and a blood pressure pill).
The trouble is, how do they know I haven’t got the same irregular heartbeat that can pool blood in your heart and cause a stroke? Sometimes my symptoms are very strong and frighten me — my father died aged 46 from a heart attack. Can it ever be just normal to have extra heartbeats? I am 66 and fit.
Name and address supplied.
The problem here is that, somewhere along the line, there has been a lack of communication about your tests — and, as a result, you remain anxious because your alarming symptom continues. I hope to put that right.
The tests you had were comprehensive — as your longer letter sets out, these included an ECG (electrocardiogram to measure the heart’s electrical activity) at rest and as you exercised on a treadmill, and a 24-hour ECG recording.
Unusual heartbeats? Extra beats are often noted in people with acid reflux, possibly because the main nerve to the oesophagus — the vagus nerve — also supplies the heart
The cardiologist also carried out an ultrasound scan of the heart designed to examine the muscle structure and the function of the four valves within the heart.
You also had an angiogram to give a picture of the blood flow in the coronary arteries. The good news is that all of this exhaustive information failed to show any abnormality of your heart and its function.
However, these tests have shown you have raised blood pressure and cholesterol — two risk factors for coronary artery disease.
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These are being reduced by preventive action (namely the statin, atorvastatin, and a blood pressure pill, candesartan), which is important given that you have a third risk factor, by way of a family history through the untimely death of your father from coronary heart disease.
The abnormal rhythm that you fear you have is called atrial fibrillation. This is the most common heart rhythm problem, and the first rhythm condition that doctors seek to confirm or exclude for the very reason that gives you concern: the possibility of blood clotting in one of the upper chambers of the heart, leading to a stroke.
Atrial fibrillation can usually be detected by feeling the pulse, but it can be difficult to distinguish it from benign ectopic beats (or extrasystoles) — extra heartbeats which we all experience at times.
Safety first: Atrial fibrillation can usually be detected by feeling the pulse, but it can be difficult to distinguish it from benign ectopic beats
However, the simple resting ECG will immediately identify the difference.
Therefore, I believe that you can be absolutely certain that you do not have atrial fibrillation, and I propose that your symptoms are due to ectopic beats. These are sometimes also called premature ventricular contractions, and may not even be noticed by the individual.
They may be felt as a ‘missed heartbeat’, as there is a little pause after the extra beat and it is the gap that is noticed.
While they occur spontaneously, there is a long list of underlying causes including anxiety, alcohol, high blood pressure and smoking. The most effective treatment is to limit the above triggers.
You will note that the symptom is much more evident when resting, and in patients with a normal heart, such as yourself, exercising will abolish the abnormal beats.
Extra beats are often noted in people with acid reflux, possibly because the main nerve to the oesophagus — the vagus nerve — also supplies the heart.
You say you’re taking lansoprazole for heartburn, which works by reducing stomach acid production — it may be that this helps alleviate the extra beats.
So please be reassured. My advice would be to carry on exercising, and above all continue to accept the advice of your doctor about the treatment of your raised blood pressure and cholesterol.
My granddaughter, who’s nearly eight, is very hairy, with thick hairs on her arms and legs. She also has a big ‘V’ of hairs on her back. I am concerned about how much this will increase when she reaches puberty.
Should her parents take her to see an endocrinologist — could she have an excess of male hormones? Both my daughter and I have quite a problem with superfluous hair, but certainly had nothing aged eight.
Ruth Harris, Surrey.
I understand the concern you have for your granddaughter, but the family history of excess hair suggests there is no worrying disorder in the background.
However, I also appreciate such excess hair can appear very alarming. Excess hair, known medically as hirsutism, affects around 10 per cent of women.
Did you know? Excess hair, known medically as hirsutism, affects 10 per cent of women
In both children and women, it can be caused by an excess of male hormones called androgens, which are produced by the adrenal glands. In girls, the excess causes hirsutism, acne, pubic or underarm hair and precocious puberty (early onset puberty, before the age of eight).
However, the hirsutism in your granddaughter has occurred without those other signs of the overproduction of male hormones, leading me to conclude she does not have a hormonal disorder.
Nevertheless, I think you are right to seek the advice of a paediatric endocrinologist. A consultation would involve a blood test to measure androgen levels (dehydroepiandrosterone, or DHEA) to be sure.
Even her GP might be prepared to do this test as a prelude to referral, although a normal result might make a specialist opinion unnecessary.
IN MY VIEW…PROBLEMS PERSIST IN ALL WEATHERS
This extraordinary weather has inevitably drawn comparisons with the record-breaking summer of 1976, but that time remains for me just a hazy memory. Back then, I was a junior hospital doctor and saw little of the hot weather thanks to my 88-hour-a-week rota and having to swot for my entry exam for the Royal College of General Practitioners.
I do recall, however, great concern being expressed at the time about a spike in deaths due to the higher-than-expected temperatures, a pattern that has been repeated this year. Elderly people, infants and patients with heart or lung disease are most at risk when temperatures soar.
Although winter conditions claim more lives, the pressure on healthcare is no less at this time of year — in part due to seasonal factors such as allergies, insect bites and food poisoning, as well as the need for foreign travel immunisations. And, of course, medical staff have to take holidays.
Back in the mid-Seventies the junior doctor had no such luxury, and we were not allowed to take time off during our six-month attachments. Clearly this wasn’t healthy, and now the pendulum has swung firmly the other way: even young doctors committed to their vocation prioritise a satisfying work-life balance.
The problem is that disease doesn’t care about all that, and as long as the NHS door is always open, the pressures of summer — and winter — will continue. The acknowledged crisis in staffing levels underlines the need for a major redesign of the way healthcare is delivered, particularly in general practice. We can but hope, yet as summer turns to autumn, I fear things will only get worse.
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