This is the awareness of your heart beating. It is extremely common – most people experience palpitations at some point in their lives. Think of yourself in a very scary situation where you are aware of your heart racing and pounding? So it is not necessarily a sign there is a problem. Of course if it is happening without an obvious cause then it needs investigating. Although this can cause a lot of anxiety and distress it is often not a significant rhythm problem to be afraid of.

The most common cause will be extra beats called ectopics. Ectopics are extra beats which start in parts of the heart that are outside the usual conduction circuit. Ventricular ectopics start in the large muscular chamber of the heat called the ventricle and atrial or supraventricular ectopics start in the small chamber of the heart called the atria.

The most common significant rhythm abnormality Cardiologists treat is atrial fibrillation (AF or A Fib). Other rhythm abnormalities we see are Atrial Flutter, Supra Ventricular Tachycardias (SVT) and (rarely) Ventricular Tachycardias (VT). If the heart goes too fast it is known as a tachycardia.

Sometimes the heart goes too slowly – this is called a bradycardia. This can be treated by a pacemaker.

A typical investigation pathway would be a consultation and an ECG. We often order an echocardiogram to make sure the heart is sound. But a prolonged rhythm recording of your heart such as a 7 day Holter monitor to capture your symptoms and to match this to your symptoms is probably the most common and important test. This allows us to correlate your symptoms with any rhythm abnormality and diagnose the condition.

If you do have atrial fibrillation of recent onset then sometimes a cardioversion can be helpful. This is where a patient is administered a light, short general anaesthetic and while asleep we ‘defibrillate’ the heart with an electric current through a defibrillator. This can reset the heart rhythm back to normal. Normally it is a short minor day case procedure where you come to hospital in the morning and go home in the afternoon. Occasionally we need a very powerful drug called amiodarone to help keep the rhythm normal through this process.