What is palpitation?

Normally our heart is beating regularly at a rate between 60-100 per minute. But we are not aware of it. In certain circumstances, we become aware of our own heart beat. This is known as palpitation. Very often palpitation is just a manifestation of anxiety. When you are stressed or with exercise, the heart races and we become of our heart beating fast. Though most often palpitation is harmless, in some situations it could be a manifestation of a dangerous disease. For example, abnormal heart rhythms can cause palpitation. Very fast rhythms can be regular or irregular. Sometimes it may not be continuous palpitation, but feeling of an occasional flutter in the chest. This is due to transient irregularity in the heart rhythm, which is often of not much significance.

Serious forms of palpitation occurs in those with severe heart disease – either electrical or structural. Structural abnormalities of the heart which damage the heart muscle or heart valves can cause paliptation due to extra load which it gives the heart. Electrical disorders of the heart often produce either very fast rhythms or very slow rhythms, both of which can be life threatening if severe.

One of the simple tests to analyse the heart rhythm in case of palpitation is an ECG. Structural damage to the heart can be assessed by ultrasound imaging of the heart known as echocardiography. Both these tests are commonly done for evaluation of heart disease. Other more advanced tests are needed only in selected cases. If the palpitation is only occasional, it can be recorded by long term ECG monitoring known as Holter monitoring (typically 24-48 hours) or event monitoring (one week to three months). If still longer recording is needed, we have implantable loop recorders – small devices which can be implanted under the skin under local anaesthesia, which can record electrical abnormalities of the heart for up to 3 years. These devices have wireless options which can relay the signals to a device at home which in turn can transmit it to a central server by mobile networks. The central server could be even located in another continent!

Two Three Letter Words For Saving Lives: CPR and AED

This post is a great supplement to my post on cardiac arrest at:

The Skeptical Cardiologist

Every two years the skeptical cardiologist has to get recertified in Basic Life Support for medical personnel. This involves a review of what, the American Heart Association has decided, are important changes in guidelines for Emergency Cardiac Care and cardiopulmonary resuscitation (CPR).

I highly recommend all of you undergo such training. Although the survival rate of patients with “out of hospital cardiac arrests” is very low, your appropriate actions could be crucial in saving the life of a stranger or a loved one.

About a year ago one of my patients suddenly, and without any warning symptoms, collapsed at work. Fortunately for him, a co-worker had undergone CPR training and initiated chest compressions right away. When paramedics arrived 15 minutes later he was defibrillated from ventricular fibrillation and taken to a nearby hospital.

Our best information on cardiac arrest suggests that without CPR, irreversible brain damage (due to lack of oxygen) develops…

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Compression Only CPR?

Here is a slightly different view on compression only CPR ( from an actual CPR instructor!

Safety un-Limited

Some countries have adopted compression-only CPR as the main method taught to the public, while other countries including Canada have not. All our courses teach you 30 compressions and 2 breaths in a cycle. So why the difference? Aren’t we all human?

CPR 30:2

In Canada the standard of CPR taught to everyone remains 30 compressions : 2 breaths and has been so for a long time. Is this a problem? Well, there was a worry about chest compressions being interrupted frequently to give breaths. When you’re doing compressions, you are pumping blood round the person’s body. Perhaps interrupting this to give breaths would reduce blood flow and maybe reduce the effectiveness of CPR. If that was true, then continuous compressions could be the better choice.

Before you read on, let’s make sure we’re talking about the same thing. Here ‘arrest’ means the person’s heart has stopped working.

To help…

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Compression only CPR

What is CPR?

CPR stands for cardiopulmonary resuscitation given for victims of cardiac arrest. It has two components – chest compression to replace the pump function of the heart and artificial breaths – mouth to mouth or mouth to nose breaths or using a device known as Ambu bag. Ambu bags though available with rescue teams, is not available to lay rescuers on the spot. Hence many potential lay rescuers may hesitate to start CPR, being afraid of transmission of infection from the unknown victim. This hesitation can be avoided by compression only CPR.

What is compression only CPR?

Compression only CPR is usually meant for lay rescuers, in which chest compressions are provided till an AED (automatic external defibrillator) is available or emergency medical service arrives on scene. By providing chest compressions, circulation is achieved, to give enough blood with oxygen to the brain to maintain its viability for a short period. It has been shown to be much superior to lack of CPR and nearing the efficacy of conventional CPR if the duration needed is short. This is because blood in the heart contains sufficient oxygen at the time of most cardiac arrests in adults. This is not the case in drowning and most cardiac arrests in children, where artificial breathing is needed from the beginning.

How useful is compression only CPR?

Efficacy of compression only CPR performed by lay rescuers in adult victims is comparable to conventional CPR performed by them as per recent studies. In children conventional CPR is better. But if the lay rescuer is unwilling to perform conventional CPR (chest compression with rescue breaths), they may perform compression only CPR as it is definitely better than no CPR. Initiation of any form of CPR is associated with a better prospect of survival for the victim.

Cardiac arrest

What is cardiac arrest?

Cardiac arrest is nothing but sudden stoppage of the functioning of the heart. It is different from heart attack which is abrupt loss of blood supply to a region of the heart muscle. Heart attack can lead to cardiac arrest in some of the victims. Though both are medical emergencies, cardiac arrest is equivalent to death unless immediate measures are taken to swing heart back into action. This is usually done by chest compressions and artificial breathing (cardiopulmonary resuscitation or CPR – Basic life support or BLS), to be soon followed by electrical countershock (defibrillation) delivered by a device known as defibrillator, to correct the abnormal rhythm of the heart which caused the cardiac arrest.

How soon should CPR be started?

CPR should be started as soon as possible. The time window for successful CPR is very narrow. Irreversible brain damage can occur if blood circulation stops more than 4 minutes as the brain is very much dependent on oxygen supplied by the blood. Even with CPR, it is difficult to maintain good blood circulation to the brain to sustain it for a long period. Usually CPR provides only about one fourth of the normal blood supply. Hence the time window available to us is about 12 minutes with CPR, unless advanced cardiac life support (ACLS) is available.

What is AED?

AED is short for automatic external defibrillator. AED is an electronic device being deployed more and more in public places to treat victims of cardiac arrest. It is also known as public access defibrillation. AED has two electrode patches which can be applied to the chest. It will sense the cardiac rhythm and interpret it using a built in computer algorithm. If a rhythm which can be shocked back to normal (ventricular fibrillation or tachycardia – fast rhythms of the heart) are detected, the devices prompts a shock delivery. Everyone should clear off the victim when the shock is being delivered. If it is not a shockable rhythm, the device gives audio prompts to continue CPR.

What is ROSC?

ROSC is the acronym for return of spontaneous circulation. Once ROSC is achieved, further care is known as post resucitation care or post cardiac arrest care. This is aimed at minimizing the brain injury caused by the period of lack of oxygen supply to the brain during cardiac arrest.

Automatic Implantable Cardioverter Defibrillators (AICD) Implantation

Automatic Implantable Cardioverter Defibrillators (AICD) or simply Implantable Cardioverter Defibrillators (ICD) is now being used more frequently ever since its original invention by Michel Mirowski in 1980. Read more in this post I found on


acid implantation - manipal hospital

What is an AICD?

AICD (Automatic Implantable Cardioverter Defibrillators) is a device that a cardiologist implants into a patient’s chest to monitor his/her heart rate. An AICD treatment is generally used to treat patients with arrhythmia by correcting an abnormal heart rhythm.

An arrhythmiais a heart rhythm disorder that occur when electrical impulses, that regulate heartbeats, don’t function properly. It can cause the heart to beat too slow, too fast or irregularly.

An AICD implantationpasses electric shock to the heart to make it start beating normally again.

Although there are many types of AICDs, they all have 2 parts in common; a generator and electrodes. The electrodes are used to monitor heart’s electrical activity. The generator is like the brain of the AICDs. It stores information about any arrhythmias.

Who needs an AICD implantation?

A cardiologist may recommend you for AICD treatmentif:

  • You have an increased heart…

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What’s the difference between an event monitor, Holter, and King of Hearts?

This post talks about Holter monitors and event monitors mentioned in my post on Heart Rhythm Disorder ( and other similar devices to monitor cardiac arrhythmia.

The Friendly Intern

A “heart monitor” is a device that is ordered when a patient has a complaint of palpitations, syncope, or a known history of arrhythmia that tracks a patient’s heart rhythm. There are different kinds of heart monitors reviewed below:

  • Holter monitors are about the size of a large deck of cards and continuously record rhythm for 24-48 hours. Patients can’t shower with the monitor on, but sponge baths are ok!
  • Wireless Holter monitors may be used if a regular Holter doesn’t detect a problem, but the patient continues to have symptoms. These monitors can record for days to weeks, until signs or symptoms of an arrhythmia occur.
  • Event monitors, unlike the Holter, only record rhythm at certain times.Patients are supposed to start recording when they feel like they have symptoms. These monitors can be worn for weeks if needed, and can be taken off while patients are showering. They are…

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