Dr. Praveen Kumar

What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. 
It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?

Normal (Benign) - 
These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal - 
These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures.
Palpitations are more likely to be abnormal In people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
Stay calm. 

Call for help. (If u are alone avoid driving, use a taxi or auto) Go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospita

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. 
They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG - Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter - Externally applied recorder which continuously records heart rhythm for 24 hrs. 
ELR - Extended looper recorder, is like holter, but it records rhythm for longer durations. 
ILR - Internal loop recorde is attached within the body for recording rhythm for long duration. 
EPS - Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained electro-physiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. 
It is a simple and safe procedure of 2-3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).
It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.

In the procedure electro-physiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient - 
Drug therapy 
Cardioversion - where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 

Device Therapy like ICD (Internal cardiac defibrillator) 

Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.

The treatment of heart disease has come a long way and one of the more important and fairly common devices used to correct rhythmic problems of the heart is a pacemaker. A pacemaker is a device which is put inside the chest or sometimes even the abdomen to send electrical pulses to the heart to keep it beating at a normal rate.

Pacemaker for heart failure

However, the implications in case of heart failure make the usage of the pacemaker much more complicated. In such cases, the device used is a special type of pacemaker which is also called a bi-ventricular pacemaker. This device sends electrical signals to pump the ventricles of the heart so that they can pump at the same time.

There are many factors to be aware of before undergoing this treatment. Some of the factors to consider are mentioned below.

• Requirement for a pacemaker in case of heart failure - When a patient has heart failure, their ventricles or lower chambers of the heart aren't able to pump enough blood into it. This could be due to physical problems with the heart or problems with the electrical system within it which cannot function normally. The doctor will perform multiple tests to determine whether a patient is the right candidate for a pacemaker for heart failure.
• The procedure - In most cases the device is fitted into the chest and it is done without an open heart surgery. Precautions and post operative care for a minor surgery should be followed. The doctor makes a minor incision on the chest and then inserts the device along with three leads which are connected to the ventricles to ensure they keep pumping properly. Sometimes another device known as the ICD or the implantable cardioverter-defibrillator may be put in to shock the heart back to a normal rhythm in extreme cases where the change of sudden death from high heart rate is a possibility.
• Immediate post operative care - As mentioned above, the surgery involved in putting a pacemaker is a minor one and the patient is usually discharged in next 2-3 days or may be more depending on the comorbidities & complexity of the scenario. However, in most cases, people can go home the next day fairly easily although some monitoring is done for the next few days with daily reporting.

The heart's electrical conduction system plays a very important role in cardiovascular functioning. Also known as the atrioventricular (AV) conduction system, it regulates and controls the timing of the heartbeat.

How does the heart's electrical conduction system work?

There is a collection of electrical cells in the upper right atrium of the heart known as the sinoatrial (SA) node which acts as a natural pacemaker and generates electrical signals. These signals travel through specialized electrical pathways and stimulate the muscular walls of the heart to contract in a rhythmic manner. This gives rise to the heartbeat that pulses at a specific frequency every minute.

What is the effect of fluctuations in electrical activity on the heart?

The standard heart rate in human being ranges from 60 to 100 beats per minute. It slows down when a person sleeps and speeds up when one experiences physical or emotional heightening. These fluctuations are triggered by the brain or other systems of the body and signal the SA node to generate charges more rapidly or slowly. This leads to spikes and drops in the heart rate, depending on the nature of the situation.

What happens when there is dysfunction in the heart's electrical activity?

When the heart's electrical conduction system does not function properly, it leads to the occurrence of a condition known as arrhythmia or abnormal heart rhythm. This happens when electrical impulses are generated in an irregular manner and causes tachycardia (rapid heartbeats) or bradycardia (slow heartbeats) which takes place in jarring infrequent tempos.

What causes fluctuations in the heart's electrical activity?

There are various kinds of triggers that cause the heart rate to fluctuate. The exact nature of fluctuation also depends on the type of trigger. A few everyday examples of these causes are as follows:

• Exercise and strenuous physical activity increases electrical activity as the heart is required to beat faster so as to increase the supply of blood and oxygen to the muscles.
• Sleep and rest reduce heart rate as the body is not needed to exert itself.
• Release of adrenaline into the bloodstream causes the heart rate to spike up.

In case you have a concern or query you can always consult an expert & get answers to your questions!

A heart attack occurs when the flow of blood to the heart is blocked, often by a buildup of fat, cholesterol, and other substances, forming a plaque in the arteries. If blood flow is not restored quickly, the section of heart muscle begins to die, starving for oxygen. This causes a heart attack. A heart attack can also be caused by the rupture of the coronary artery. During a coronary rupture, the coronary arteries get restricted, reducing blood supply to the heart muscle.

Each coronary artery supplies blood to a region of the heart muscle.

Extent of damage to the heart muscle depends on the area supplied by the blocked artery and time between injury and treatment. Making some changes in your diet; how consistently you exercise; how much you weigh and how you manage stress can help you to recover from a heart disease quickly.

You can undo some, but probably not all of the damage, if you're willing to make big and lasting changes to your lifestyle. To reverse the impairments caused by a heart attack/disease you can become a vegetarian. Filling your platter with fruits and vegetables, whole grains, soy products, non-fat dairy and egg whites while avoiding fat, refined sugar and processed carbs is a sure-shot way of keeping your heart healthy and preventing future attacks. If you wish to discuss about any specific problem, you can consult a Cardiologist.

A cardiac arrest can strike when a person is least expecting it. This is usually termed as a sudden cardiac arrest, which happens due to an unexpected loss of functionality of heart. Does it not make sense to know what is to be done in case one comes across a person who just had an arrest?

The most important thing is Cardiopulmonary Resuscitation (CPR). It is critical for the survival of a victim of heart attack. This is to ensure that there is still some level of blood flowing to the vital organs of the body, without which death would surely be a foregone conclusion.

If you have not received a CPR training, you must do it now. This is because a lot of things can get complicated and go wrong. After all, who wants to make a bad situation worse? In case of sudden cardiac arrest one should drop down and kneel, place the palm of one hand over the back of another and then go onto to perform compressions on the chest at a rate of about a 100 to a 120 beats per minute (BPM). The elbows should be straight and the heel of the hand that is lower should be placed in the centre of the victim’s chest.

1. Call for help: If you are at the scene, but do not know how to provide a CPR, call the emergency helpline number immediately. Medical help should not be delayed so that the cardiac arrest victim can be treated by a medical professional.
2. CPR: In order to perform CPR, after about 30 compressions, tilt the head back and lift the chin to open the airway and give two rescue breaths. This is only if there is no normal breathing. Each breath lasts a second and the chest should rise after the first. If it does not, the procedure must be repeated again.
3. Electric shock: An automated external defibrillator (AED) is very important when treating a cardiac arrest. If there is one available at hand, a shock should be provided prior to starting CPR.

While there may be quite a lot of stuff to take in about the procedures related to a cardiac arrest, it is surely worth remembering. After all, a life may really depend on it!
 

The heart is one part of your body that pumps blood relentlessly; to be grateful to the most important organ, it’s your duty to look after its health. Cardiovascular diseases and heart ailments can be prevented by making minor changes in your lifestyle.

Here are a few tips to keep your heart healthy:

1. Add fiber to your diet: Making fiber a part of your regular diet is a great idea as the heart works best when it runs on natural fuel. You can achieve this by adding more raw fruits and vegetables in your meals as they are an excellent source of fiber and nutrients.
2. Engage in physical activity: Your heart is a muscle and to make it healthier, you need some form of physical exercise. Engaging in cardiovascular forms of exercise for an hour daily keeps your heart in good condition. Engaging in physical activity also reduces the risk of getting a heart disease and acts as a stress buster.
3. Cut down on the salt intake: The sodium content in salt disrupts the balance of fluids in your body leading to high blood pressure. This can affect the functioning of the heart; that is to pump blood, which is a major cause of a heart attack. So, cutting down on salt can reduce stress and the risks of heart attacks.
4. Manage your weight: People on the overweight side run a risk of getting heart diseases more often than fit and leaner ones as they tend to be more inactive and sluggish. The heart diseases caused due to obesity can be avoided by making minor changes to your diet and exercising on a daily basis.
5. Quit smoking: If you are a regular smoker, quitting is the best thing you can do for your heart. The main reason for coronary heart diseases is nicotine present in the cigarette. Once, you quit smoking completely, you will be 50% less likely to run the risks of a heart attack as compared to a regular smoker. If you wish to discuss about any specific problem, you can consult a Cardiologist.