One of the most common complaints about the heart that forces people to see a doctor is palpitations. It can be seen as a rapid heartbeat that starts suddenly and ends spontaneously or as going out of the rhythmic beat. When the heart rhythm is too fast, darkening of the eyes, weakness and even fainting may occur due to low blood pressure. Rhythm disorders should be investigated in detail and treated carefully with close follow-up after the correct diagnosis is made. First of all, we need to find the disease that causes the rhythm disorder. Because palpitations are mostly due to cardiovascular diseases.
Sometimes people with blocked heart vessels may have palpitations without chest pain. If this is the case as a result of the examinations, you can have a successful treatment without having a heart attack. Palpitations are often associated with diseases related to the mitral valve in the heart. If such a disease is diagnosed by heart ultrasound, echocardiography, the mitral valve can be repaired or replaced with a prosthetic valve before heart failure develops. In the rhythm disorder called atrial fibrillation, a clot may form in the heart and this clot may throw to the brain and cause a stroke.
As you can see, palpitations can lead to the diagnosis of very serious underlying cardiovascular diseases without delay.
Can non-cardiac diseases also cause palpitations?
Yes, they can. Therefore, we first start the investigation with a blood test. Anaemia, anaemia, causes the heart to beat fast. Fast beats and rhythm disturbances are seen in thyroid diseases, commonly known as goitre. Electrolyte disturbances due to medication or food (mostly low or high potassium) cause rhythm disturbances. Some heart medications (such as digoxin) can accumulate in tissues and cause rhythm disturbances. We can detect all these diseases by performing a detailed blood test.
What kind of tests should be done?
If palpitations are intermittent rather than continuous, it may be difficult to diagnose. An electrocardiogram (ECG) taken at the time of complaint leads us to the diagnosis. However, if you have no complaints when you consult a doctor, the ECG may be completely normal. For this reason, the type of your rhythm disorder can be diagnosed by 24 hour electrocardiogram called rhythm holter. Then, echocardiography and, if necessary, angiography can be performed for the cause. When we treat your underlying heart disease, your palpitations will also improve.
Can there be harmless palpitations?
Rhythm disorders called extrasystole, which occur with a sudden extra beat while the heart is working in its normal rhythm, are mostly benign. It can be caused by consuming too much tea, coffee, cigarettes or alcohol, as well as stress. If it happens very often and bothers you, medication can be used for a while.
Should all people with palpitations take blood thinners?
No, they should not. In a chaotic rhythm disorder of the heart called atrial fibrillation, if there are accompanying conditions such as advanced age and valve disease, blood thinners should be used to prevent stroke. However, these drugs are not like aspirin, they are stronger and have bleeding risks in overdose. Your cardiologist will determine the appropriate medication and dose for you and will follow you closely. With the advancement of pharmaceutical technology, we can now safely use new generation drugs that do not require continuous blood tests and dose monitoring and have fewer bleeding side effects.
If the underlying cause of the palpitations is mitral valve disease, should my valve be replaced or is this an open heart surgery?
No, it is not. If the valve is not stenotic but insufficient (leakage), it is more ideal to repair the valve and continue your life with your own valve. However, if the valve is calcified and narrowed, it must be cleaned and replaced with a metal or biological valve. If it is replaced with a metal valve, you will need to use a strong blood thinner for life. If your blood thinning level is too low, a clot can form on the valve, which can be thrown into the brain and cause a stroke; if it is too high, it can cause internal bleeding (stomach haemorrhage, brain haemorrhage). There is no need to use blood thinners in biological valves that are taken from animal tissues and adapted to the human body. However, if these valves are used in people under the age of 65, they bring the risk of re-narrowing and a second operation. We should plan an operation by considering all these parameters.
All mitral valve operations, whether the valve is replaced or repaired, can be performed between the ribs through a 4 cm incision at the right breast level without opening the breastbone. Moreover, the surgical scar is not visible at all because it is under the breast in women. For this reason, I call this type of surgery ‘bikini surgery’. Imagine that you have had heart surgery and no one can tell when you swim in a bikini. Is it only cosmetic? No, the recovery period of the surgery is also very easy. On the 4th day, you are discharged and as of that day, you can drive your car and move your arm as you wish. You can return to work within a week and continue all kinds of social activities.