When your heart skips a beat - and not because of love


  • Wellness
  • Wednesday, 02 Jun 2021

A pacemaker is placed in a ‘pocket’ just under the collarbone beneath the skin, with two wires connecting it to the upper and lower chambers of the heart. — Photos: Pat-Lin Commmunications

Some of us may have experienced a flutter or a skip of a heartbeat upon seeing the person we are enamoured with.

However, what if your heart gives a flutter or skips a beat even when this person is not around?

In an adult, the normal heart beats 60 to 100 times per minute.

It beats on average 100,000 times a day and about three billion times in a person’s lifetime.

The heart beats faster when we are active or excited, and slower when we are at rest or asleep.

However, physically-active adults such as athletes may have a lower resting heart rate, i.e. below 60 beats per minute (bpm).

Abnormal heart beats

Consultant cardiologist Dr Nicholas Chua Yul Chye explains: “An abnormal heart rhythm refers to heartbeats that are either too fast, too slow or uneven, which are known as arrhythmias.

“Arrhythmias occur due to changes from the normal pattern and conduction of electrical impulses in our heart, causing the heart to pump less effectively.

“Arrhythmias may be brief or long-lasting.

“They can be either completely harmless (benign) or life-threatening (malignant).”

He adds: “For adults, a heart rate of more than 100 bpm is considered too fast and is called tachycardia.

“A slow heart rate of less than 60 bpm is known as bradycardia.”

Arrhythmias can produce a broad range of symptoms and outcomes.

Each person’s experience may differ depending on the nature of their arrhythmia.

A single premature beat may be felt as a palpitation or a skipped beat.

If this happens often or continuously, you may feel a sensation in the chest or neck.

More serious symptoms of arrhythmias include fatigue or weakness, dizziness, fainting spells, shortness of breath, chest pain, and in extreme cases, cardiac arrest.

Dr Chua says that irregular heartbeats that persist suggest an underlying problem in the heart.

He emphasises that it’s important we do not dismiss these symptoms as they can be a sign of serious heart conditions, such as heart failure, coronary artery disease, problems with the heart valves or muscles, atrial fibrillation, or even a previously undiagnosed heart attack.

In such cases, arrhythmias are triggered by changes in heart tissue and activity, or the electrical signals that control our heartbeat.

It can also occur suddenly as a result of imbalances in the blood or narrowing of the heart arteries (i.e. ischaemic heart disease).

Sometimes, the cause is genetic in nature, or indeed, can be unknown (idiopathic).

Dr Chua notes however, that when it comes to a fast heartbeat, not all are dangerous nor are all related to heart problems.

Strenuous exercise, stress, fear, anxiety, panic attacks, low blood sugar, low blood pressure, fevers, anaemia, dehydration, or too much consumption of alcohol, caffeine or nicotine, can also affect the heart rate.

Pregnant women or those having their period may also experience a quick heartbeat.

Consuming illegal drugs such as ecstasy, methamphetamines or cocaine also has a similar effect on the heart.

Meanwhile, bradycardia or a slow heartbeat is common among the elderly.

Ageing can cause our sinoatrial node, also known as the natural pacemaker, to fail to function normally.

As a result, the electrical impulse that prompts our heart to beat fails to be generated more than 60 times per minute, resulting in a slower heart rate.

Some patients may also have undergone surgery or are on certain medications that are known to cause a slowing of the heartbeat.

Prolonged bradycardia can cause metabolic problems such as hypothyroidism (low thyroid hormone), heart failure, fainting, chest pain, low blood pressure or sudden cardiac death.

“Arrhythmias that are recurrent or related to an underlying heart condition should always be evaluated by a doctor.

“Electrocardiogram (ECG) is commonly used to diagnose arrhythmia.

“It is a painless, non-invasive procedure that records the heart’s electrical activity,” says Dr Chua.

Restoring heart rate

First and foremost, it is important to manage the patient’s modifiable risk factors.Dr Chua shows a pacemaker (in the hand on the right) and a transmitter (in his other hand) that is part of a remote cardiac monitoring system.Dr Chua shows a pacemaker (in the hand on the right) and a transmitter (in his other hand) that is part of a remote cardiac monitoring system.

These include reducing high blood pressure (hypertension), controlling blood cholesterol levels, losing excess weight, eating a heart-healthy diet and performing sufficient physical activity.

In treating arrhythmias, doctors will first run tests to determine if there are any related underlying diseases.

The treatment goal is always to restore a normal heart rhythm or control the heart rate, treat the condition that is causing the arrhythmia, and reduce risk factors for heart disease and stroke.

Medications such as beta blockers and calcium channel blockers may be recommended to restore the heart to a normal rhythm or to control the heart rate.

Anti-coagulants or anti-platelet drugs will also be used to prevent the possibility of a stroke.

If necessary, some patients may have a heart rhythm device placed within them to improve their symptoms.

Dr Chua notes that the last 20 years has seen significant developments in cardiac pacing using such devices.

These developments include increased implant rates, technological advancements and implementation of indications in clinical practice.

One example of a heart rhythm device is a pacemaker.

This is a small, battery-operated device with electrical wires (leads) that is implanted in the body and programmed to deliver electrical signals to the heart to keep it beating at a normal rate.

“Patients need not be worried,” he says.

“It’s a simple procedure, requiring only local anaesthesia, and sometimes, sedation. It is not an open-heart surgery.

“A small incision is made below the collarbone to allow two leads or thin insulated wires to be inserted into the heart through the vein, positioning them in the heart’s upper and lower chambers.

“These leads connect to the pacemaker, which then regulates the heartbeat.

“The pacemaker is implanted in a ‘pocket’ beneath the skin at the incision site.

“The incision site will be closed with a few stitches after tests are done to ensure the pacemaker is working correctly.

“Patients are usually discharged the next day.”

Patients will then be given counselling on managing the healing process, which will take about four to six weeks, after which most daily activities can resume as usual.

In general, magnetic fields and electromagnetic radiation can influence the pacemaker’s function.

However, these interferences can be minimised or avoided, and patients will be advised accordingly on how to do so.

Patients will also receive a patient identification card, which they should carry with them at all times.

This will help alert healthcare professionals to avoid running tests or procedures that might interfere with the pacemaker.

Patients are also recommended to follow-up with their cardiologist once every three to six months.

These appointments should include checks on the battery life and functioning of the pacemaker to ensure that the patient is receiving optimal treatment.

Typically, a pacemaker can last between eight to 10 years.

Constant monitoring

Another advancement in the area of cardiac pacing is in the field of remote cardiac monitoring systems.

This is an adjunctive therapy that helps connect patients with their cardiologists beyond their regular in-person consultations.

In the past, remote cardiac monitoring systems required multiple steps and much effort to transmit and receive the data gathered by devices such as pacemakers, implantable cardiac monitors, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy, on the patient’s heart function.

Now, however, Dr Chua says the latest systems have been redesigned so that these steps have been simplified to become much more user-friendly.

With a transmitter the size of a mobile phone, data from such devices can now be sent on a daily basis to a secure server cardiologists can access, with no effort needed on the patient’s end.

This allows the doctor to monitor any abnormal episodes that occur outside of the clinic, which the patient himself may not notice.

Such episodes could include common silent, non-symptomatic arrhythmias like atrial fibrillation, or irregular heartbeats that can lead to blood clots, stroke and heart failure, among others.

Early detection means early intervention and improved chances for a better outcome.

It also provides a positive psychological side effect as patients can feel at ease knowing their cardiologist has easy, instant access to monitor their condition.

Aside from reviewing the patient’s heart functions, doctors can also receive alerts about relevant changes in the patient’s heart, the status of the device and its battery life.

Dr Chua notes that pacemakers give heart patients greater empowerment and freedom to continue leading normal lives.

“All in all, health is a lifelong investment and prevention is always better than cure.

“Stay active and healthy always,” he advises.

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