Patients come to me all the time and they have palpitations. They feel their heart beating. Most of these people actually it’s their own rate going fast at times. And it’s what I call the princess and the pea syndrome. Some people feel everything and you can put as many mattresses as you want on top of that pea and they still feel it. And that’s very unfortunate.
Whereas other people can be in almost life-threatening rhythms and they don’t feel anything. So the sensation of an arrhythmia is very difficult to pinpoint even for a doctor. You need proof. So if you’re having a feeling of palpitations, it’s a very simple way to figure it out. We just give you a monitor to wear for a given period of time and we correlate your symptoms with the electrocardiographic representation.
We can even use phone apps now to do it, and if your symptoms turn out to be atrial fibrillation then we have to go down that path.
This is not to be disparaging to any doctor who listens for 15 seconds on a patient’s chest but they haven’t figured it out. It’s just like an ECG. An ECG is 12 to 15 seconds of your life. So you come and tell me, “I have palpitations,” we do an electrocardiogram, I listen to you, I don’t hear anything abnormal, I don’t see anything so for maybe 30 seconds of your life I’ve evaluated you. That’s totally inappropriate to make a decision I need to correlate your symptom with the electrocardiogram.
So no, if your doctor doesn’t have the either desire or the knowledge to take it to the next step, you should probably see a cardiologist or an electrophysiologist- they’re going to give you a monitor and they’re going to at least make the correlation. You need documentation of the cause of your palpitations. It might be atrial fibrillation it might be your own rhythm, it might simply be premature beats. The important thing is you need a diagnosis.
it’s easy to get, and there’s no reason why someone shouldn’t do it for you. The more difficult problem is people who may be at risk for atrial fib who have no symptoms but still are at risk for stroke if they get it. And that’s a very difficult group of folks that I’m approaching now in a little different way.
So if I think somebody has a high stroke risk and they have a number of things about their medical history that suggests they’re at a relatively high risk for atrial fibrillation I’ve even done some very long-term monitoring in those people. So if you have symptoms, it’s straightforward: put a monitor on, figure it out, and see where you’re going.
If you have no symptoms, but let’s say you’ve had relatives who’ve had afib, you’ve had somebody who’s had a stroke, and you’re just concerned, “What if I’m next? And how am I going to figure that out?” Then I think depending on how high your risks are for a stroke, you can have that discussion..
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