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Tribune News Network
Doha
A PROFESSOR at Weill Cornell Medicine Qatar (WCM-Q) has had his work into heart palpitations published by one of the world's most prestigious medical journals.
Dr Charbel Abi Khalil, assistant professor of medicine and genetic medicine at WCM-Q, and consultant cardiologist at the Heart Hospital Hamad Medical Corporation (HMC), wrote a paper entitled 'Investigating palpitations, the role of Holter monitoring and loop recorders.'
The work has now been published by the British Medical Journal.
Heart palpitations make an individual feel that their heart is racing, missing a beat, or has an irregular rhythm, and although they usually have a benign cause, like stress, they can be indicative of a more serious, underlying heart condition. Holter monitoring involves having a battery-operated monitor attached to a patient's clothing which monitors electrocardiogram (ECG) readings through electrodes attached to the skin. The Holter monitor can be worn for as little as 24 hours or up to two weeks to gain a fuller picture. Loop recorders operate in a similar manner, but are implanted beneath the skin, detecting the heart's electrical activity over time in order to diagnose an irregular pulse.
Dr Abi Khalil has now written about the best approach for doctors faced with a patient who suffers from palpitations, detailing the steps they should take in order to make the most accurate diagnosis and prognosis.
Firstly, Dr Abi Khalil states that physicians must consider the history and lifestyle of the individual. A cardiovascular examination may reveal heart disease so the palpitations could be a sign of congestive heart failure or valvular heart disease.
As well as issues with the heart, palpitations can also be caused by metabolic disorders like hyperthyroidism, induced by certain medications, or even symptoms of a psychiatric problem like panic attacks or depression.
The first medical investigation that should be performed is to get a full blood count, thyroid and kidney function test, and measurements of blood sugars and electrolytes, as Dr Abi Khalil said these give an indication of common metabolic disorders that could be causing the irregular heartbeats.
The next step would be to use a Holter monitor. These can be used as a diagnostic and prognostic tool but also as a method of monitoring patient with a diagnosed condition to ascertain how they are responding to the treatment. If a Holter monitor is used but no arrhythmia is found, Dr Abi Khalil said it is then advisable to use a loop monitoring system, which can be worn for a much longer period of time.
However, physicians should be aware that under certain circumstances, a patient who is complaining of palpitations should be referred immediately to a cardiology clinic rather than undergoing monitoring. These circumstances include a history of cardiac disease or premature death in the patient's family; palpitations associated with chest pain or an abnormal electrocardiogram reading.
Patients should be immediately referred to the emergency department if they report persistent chest pain or display symptoms of heart failure.
The paper was supported by Qatar National Research Fund through the grant NPRP 9-169-3-024.
