Ruth Kam Heart & Arrhythmia Clinic
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“A lurCh In my hEArT”, “A ThumpInG fEEling In my chest”, “Feels like I have just been running, except that I haven’t!”, “A fluttering feeling in my chest”, “Like bubbling in my chest”. Have you ever felt any of these? These are actual descriptions of what “palpitations” feel like, from the mouths of patients themselves.
Palpitations is simply “an awareness of the heart beating” Ordinarily, the heart beats without us ever being aware that it is.
Palpitations may occasionally be accompanied by other symptoms, like an urge to cough, or difficulty in breathing or giddiness, even chest pain and blackouts or sudden collapse.
Whether palpitations are serious or not depends on the point of origin (i.e which part of the heart they originate) and whether the structure and function of the heart is normal. The heart is made of two upper and 2 lower chambers. In general, palpitations that originate from the upper chambers (atria) are more benign whereas those that originate from the lower chambers (ventricles) tend to be life threatening. If the heart is structurally abnormal (has disease) and the heart function is weak (low ejection fraction), then any palpitations (from upper or lower chamber) can cause low blood pressure, blackout or collapse.
My job is to tease out which palpitations are serious and which are not and treat appropriately. A stepwise approach is:
  • Take a good history and perform a good clinical examination, looking for heart disease, thyroid disease, lung disease and anemia.
  • Document an ECG during the palpitations – this sounds very simple, but in fact can be difficult as the palpitations do not occur all the time and often the ECG is done when there are no palpitations and looks normal. Therefore a few patients have been diagnosed wrongly with anxiety or other psychiatric problems. In my clinic I have many different types of monitors that increase the chance of capturing the ECG during palpitations – these recorders can be worn for 24 hours, or for 2 weeks continuously or there are other recorders that the patients put on their chest when they have palpitations.
  • If all these fail, then the only solution is to perform an electrophysiological study to diagnose if the patient’s palpitations are due to an arrhythmia. This involves inserting catheters through the veins to get inside the heart to record electrical signals and provide small pulses of electricity to initiate or trigger the arrhythmia causing the palpitations. After the cause is confirmed, and if it is found to be due to the presence of extra nerves in the heart, the extra nerve can be ablated with the same catheter, during the same procedure, using radiofrequency energy. This is called radiofrequency catheter ablation and it is a minimally invasive procedure and is done under conscious sedation. The patient stays overnight in hospital for observation and can go home the next day after the procedure.
Radiofrequency catheter ablation (RFCA) offers patients with arrhythmia the chance of a cure without the need to take medication for life. RFCA can be performed for a variety of arrhythmias (atrial or ventricular). Success rates, complications and recurrence rates vary for each type of arrhythmia being ablated and should be discussed with the electrophysiologist.
However not all palpitations need ablation. Some types are caused by beats that occur slightly ahead of the next scheduled beat. These are termed ectopic beats. They are annoying to the patient but do not pose a threat to the patient if there is no underlying heart disease. In those cases, only reassurance is needed. Finally anxiety and stress can cause palpitations, although the heart rate and rhythm are normal. After all “palpitations” is merely the “awareness” of one’s heart beat and does not necessarily mean that there is something wrong with the heart rate or rhythm. In such cases, addressing the cause of anxiety or stress is all that is needed.

MBBS (Singapore)
MRCP (Int Med) (UK)
M Med (Int Med) (Singapore),
FAMS (Cardiology), FRCP (Edin)
Ruth Kam Heart and Arrhythmia Clinic
3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre.
Tel: 6333 6866