Question: I have a problem with my heart beat. It stops and starts at least a dozen times a day. I have gone to a heart doctor and he has given me all kinds of tests. I have done the treadmill, EKGs, echograms, angiograms, ultrasound, heart scans, CT scans. All tests come back normal. What kind of information can you give me?
Dr. Hibberd's Answer:
Skipped heart beats can sometimes be elusive to catch, especially if they occur episodically and are not detected by the studies you have already had. It is time for a 24 hour Holter monitor to try to detect what type of extra beats you are having. The 24 hour tracing is analyzed after it is removed the following day, and this will guide your doctors in their recommendations for you.
If you happen to have no symptoms while the monitor is in place, you can request an event monitor that you can place over your chest during an episode of extra beats. These event monitors are small and non-obtrusive, and should pick up your rhythm problem as long as you correctly place the recorder over your heart while you are having symptoms. Event monitors can be assigned to you for any period of time necessary for detection of your problem. They are often signed out for up to a week at a time for patients whose symptoms do not occur daily.
Once you have identified the type of conduction problem, if any, specific therapy can be provided for you. Most of the time, medications will help unless, of course, elimination of certain medication or supplements corrects it.
More and more patients with serious life-threatening and high-risk conduction disturbances are now studied in an electrophysiology (EP) lab. The more serious conditions are considered for ablation therapy with or without considering a cardioverter/defibrillator/pacemaker implant. By the way, many significant conduction conditions are often seen during a treadmill stress test, so passing this study should be reassuring to you.
The Holter and event recorder studies are very comfortable and are worthwhile pursuing, especially since you have been investigated rather extensively without a definitive answer. Thirty years ago, evaluation for extra beats and pauses in heart beats were done as an inpatient in the hospital on a continuous heart monitor called telemetry, especially if these spells were associated with symptoms of dizziness, pain, or shortness of breath. The advent of event and Holter monitors available for outpatient use have greatly reduced the cost of investigating complaints of irregular heart beat in patients who are felt to have non-life threatening symptoms.
A cardiologist should be your consultant of choice at this point, so request a cardiology referral to help isolate your problem. Simple blood tests are also usually used to aid diagnosis with irregular heartbeat complaints in addition to the monitoring I have described. We have the technology; it just needs to be used correctly.
Be sure you have been honest regarding medication (prescription, non-prescription, all supplements, and additives) and drugs you use, as some can induce dangerous heart rhythms even in normal, otherwise healthy hearts. A prelude to episodic rhythms that progress to more serious situations may simply be an irregular beat now and again, especially if accompanied by a prolonged QT interval on an EKG. In any event, first identify the problem. Only then can reasonable options be provided to you. Avoid self-treating these complaints until their seriousness is definitively identified.
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