08 Dec Know Your Pulse
As a Clinical Cardiac Physiologist at Taranaki District Health Board, I often get asked what different heart monitoring tests are available to help reassure a patient that they have a healthy heart and that the dizziness, shortness of breath or palpitations they are experiencing are nothing to worry about. I understand why people are concerned – Heart disease is the biggest killer in NZ. However, although heart disease is described as “not curable”, it can be both prevented and treated if diagnosed correctly.
The heart is a very complex organ and one that requires many years of study to even come close to understanding it. Research is continuously taking place throughout the world in order to help treat cardiac patients and there is a huge range of heart monitoring tests available in order to try and help diagnose symptoms correctly or determine if the heart is healthy.
Essentially there are two areas of the heart that often require very different attention – I refer to them as the ‘plumbing’ and the ‘electrics’. The two are not entirely separate however the area I want to touch on in this article is the electrics. The electrics are responsible for what we view as the rhythm of the heart (ECG), so what signs and symptoms can we look out for if you suspect something isn’t perhaps “wired” correctly? Remember this article is not peer reviewed so please seek advice from your GP if you have any concerns over your current health.
Know your pulse
The first two questions I like to ask are: What is your resting pulse rate? Is your pulse rate regular?
Most medical journals agree that a normal pulse rate in adults should sit around 60-100bpm when at rest and should also be regular. If this isn’t the case or you are unsure then consult your doctor.
What symptoms should I look out for?
Classic symptoms caused by an irregular, fast or slow pulse rate can include being lightheaded, short of breath, dizzy, a sensation of skipped beats or extra beats (often described as palpitations) and fatigue. Unfortunately there is a variety of other medical conditions that can also mirror each one of these symptoms so it’s important to start ruling things out.
How to ‘rule things out’?
If you have any of the above symptoms, even periodically you must visit your doctor for further investigation. The following heart tests can then be employed for a more accurate diagnosis:
12-lead Electrocardiogram (ECG): GP clinics usually have an onsite ECG machine which can record the electrical activity of your heart and provide an insight into your cardiac cycle. A lot can be diagnosed from a resting 12-lead ECG however it is important to remember that it is just a snapshot of the here and now. After a basic pulse check, this is probably the most common test for heart conditions but may only provide answers if your symptoms or issues occur during the appointment.
Holter monitor: Used when symptoms are episodic and do not occur during examination. This small portable ECG device is attached to your body with stickers or a patch and can be worn for up to 72-hours to record your heart rate and rhythm in order to identify any complications. Patients are advised to keep a diary during the monitored period so the Physician can correlate any symptoms with the ECG.
Cardiac Event Recorder (EVR): Similar to a Holter, the EVR is used to monitor your ECG over a period of time often when symptoms are less frequent. When a patient experiences symptoms, they press a button on the monitor to activate the recording. This portable device is attached to the chest with stickers which should be swapped out each day to avoid skin irritation. Event monitors can be worn up to 45 consecutive days. Often used if a Holter has failed to produce any diagnosable cause for symptoms.
Exercise Tolerance Test (ETT): This involves continuous 12-lead ECG and blood pressure monitoring during exercise in a controlled environment. Most commonly performed on a treadmill or exercise bike. Some heart problems only appear when your heart is required to work harder. This test helps the Physician understand how well your heart copes under stress and is predominantly the test of choice in patients who are experiencing exercise induced chest pain and/or shortness of breath.
Slightly more invasive cardiac tests which are beyond the scope of this article include: Implantable Loop Recording, Angiography, Echocardiography and Electrophysiology Study.
If you are concerned about any symptoms you may be having contact your GP or if you wish to take one of the above heart tests to find out if your heart is healthy, without a referral from your doctor, contact us directly at info@fastpacesolutions.co.nz.
Please be aware that medication can have a huge influence on your heart, it is therefore important to talk to your doctor about optimisation and whether you need to stop taking any medications before having a heart test.