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Today i wanted to do a video on the best test to capture your palpitations

Palpitations are an extremely worrying symptom for many patients even though the majority are not dangerous. The way you know they are not dangerous is to record what is happening to the heart rhythm when you are having the palpitations and if the heart rhythm is normal then its not a heart rhythm disturbance.

The patient gets the palpitations - he goes to the doctor - after a few days the doctor does an ECG and tells the patient this is ok. the patient goes home and gets more palpitations. The patient goes back to the GP. The GP says you need a 24 hour tape and unsurprisingly the patient doesn’t get any palpitations and therefore when the GP says that the holter was unremarkable the patient does not feel reassured and the palps continue happening and the patient is lost as to what to do next.

So today i thought id talk to you about the various different tests there are what the advantages and disvantages are of each

A simple ECG. This only captures 6 seconds of time and if during those 6 seconds you are having your palpitations then you dont need any other tests but more likely than not, you won’t be and therefore the ECG is useless. We do it because it is easily available and may give insight into any other abnormalities with the heart which may make it more likely that what you are complain of could be heart related.

A 24 holter test. Usually useless because the pick up on these is only 8-10% at most which means that out of 100 patients whom we give a holter to, only 10 will have symptoms during the 24h period and the only reason to have it is if you have your symptoms daily or if there is anything you can do to bring on your symptoms. In which case do whatever brings on your symptoms. A holter records continuously for 24 hours so it will record everything that goes on in the heart and the only way, we will know whether what we see is incidental or related to your symptoms is if you fill in and return a diary declaring the exact time when you had your symptoms. A lot of people also get anxious about the extra information that the holter shows up like number of PVCs and how slow the heart goes but truthfully as these things aren’t causing symptoms they are not important. 48h/72 h holters are better but inconvenient because patients can’t shower etc with them on.

An event recorder. This is a device which will only record what you ask it to record and therefore you can keep it on for longer. The good news is that they have a memory which means that when you press a button after you develop your symptoms, it will record upto 30 seconds of what was going on before you press the button. Problem with these are that they tend to be really taffy to operate and the recordings have to be sent down a phone line which many people struggle with so although the pickup is better than a holter it is not great.

A wearable patch like a zoo or a hardy patch. These are excellent and i have one right here which i will show you. You keep these on for 1-2 weeks. The pickup is nearer 50%. Not only do they record every single heart beat but they also have a button which puts a mark on the recording when you have symptoms. You can shower with them etc and finally when you have worn them for the duration, you simply take it off and post it for analysis and a report appears by email to your doctor who checks it and can send you a result. It minimises having to travel to the hospital first to have it put on and secondly to have it taken off. I have a few patients who were scared to leave the house because of anxiety and who were getting palpitations and i posted one of these to them and they worked a treat. These are not available to individual patients but they are to healthcare professionals and i certainly prefer them to any other monitoring device for my patients. They cost about 380-400 pounds.


Alivecor. This is a really innovative bit of kit which is increasingly being used. Basically if you have a smartphone you can download an app on your phone and as part of the app, you get a case which has a couple of sensors and if you hold the sensors, the app will record a single lead ECG for 60 seconds and this can then be sent and interpreted for a small charge. The advantage is it is there with you. The disadvantages are firstly you only record events after they have started.

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