Jonathan C. Pitts Crick

Usually you can, as irregular or fast palpitations. But if you have had it for a long time and it's not severe, you can get so accustomed to it that you don't notice.

Best wishes,

Jonathan

There are three basic reasons:

1) Something is wrong with the heart rhythm, an electrical problem.
2) The rhythm is normal, but the heart is not pumping properly and the brain is telling it to try harder.
3) The heart is fine, but something else in the body or brain is making it beat faster, e.g., over-active thyroid, anaemia, too much caffeine, or anxiety.

A good first step is to record the heart (an ECG) when it is going faster than appropriate so we know what kind of rapid beat it is. You can do this with the latest Apple watch or (much less expensively) with an AliveCor phone device, about from Kardia or Amazon.

Best wishes,

Jonathan

Hi Elaina,

The pain you describe is very typical of thoracic nerve root compression, which is in my experience one of the most common causes for persistent localized chest pain. The nerves around the chest run between the ribs and join the spinal cord by passing through a narrow gap between the vertebrae (the segments of the backbone). There are notches above and below which are lined up to let the nerve through. It is not unusual, at any age, for a slight displacement of one vertebra compared with the one below causes the notches not to line up and the nerve root gets squashed. This causes pain at any point along the track of the nerve, especially at the nerve endings (where the ribs join the breast bone). It's similar to sciatica, where the nerves from your legs can get pinched entering the lumbar (lower-back) spine.

The main cause for the vertebra displacement is sitting for a time with a stooped posture, typically working on a computer with the screen below eye level, or sitting slumped in a comfy armchair/sofa watching TV or reading. The solution is simply to avoid this by sitting up very straight on a firm chair, not resting against the backrest, but using your back muscles to hold the position. The muscles also help to keep the vertebrae aligned. Surprisingly, it is quite a comfortable position when you get used to it. It also helps if you get your computer screen positioned at eye level and take regular breaks to get up and do some gentle stretching-type exercises.

With careful attention to posture, the pains usually settle in a week or two. Painkillers and anti-inflammatory drugs are not much help because pinched nerves are going to be painful whatever you do. You just have to stop pinching them.

I hope this is helpful.

Best wishes,

Jonathan

It all depends on what kind of arrhythmia it is. If your heart is OK otherwise most arrhythmias are more of a nuisance than a danger.

Yes, metoprolol can often help to control arrhythmias by blocking the action of adrenaline on the heart. But as it blocks other actions of adrenaline it can cause side-effects such as fatigue, breathlessness, faintness, poor circulation (cold hands and feet) and erectile dysfunction. Depending in what type of arrhythmia you have there may be better treatments, and some arrhythmias can be safely ignored.

In general people feel better once their heart valve problems are relieved. The main exception is aortic regurgitation (leaking aortic valve) as that does not cause symptoms until it is quite severe and it is preferable to replace the valve before that stage – so you don't feel any better except from knowing that you have avoided developing worse (and possibly untreatable) problems later on.

Most kinds of heart disease that don't show up until the age of 19 are either amenable to treatment or not very severe, so the expectation is that it will not shorten her life. But really you need to discuss this with her cardiologist who has the details to give specific advice on her condition.

Cardiac cachexia is weight loss, muscle wasting and severe fatigue caused by longstanding heart failure. It is the body's way of managing with a very weak heart that cannot pump enough blood around to keep a full-size body adequately supplied, a kind of "economy-mode" way of keeping going. When the heart is that weak it can fail completely without much warning, especially if there is another illness such as a chest infection.

The treatment is to ensure ther is not a deficiency of vitamins and minerals (especially iron) in the diet and ensure that the heart failure treatment is optimised.

In general, yes – the heart is permanently damaged. But the crucial question is how much. The normal heart is potentially strong enough to win a marathon and for all normal activity it uses only about one half of its power. So even if your heart is as much as 50% damaged it would not hold you back noticeably in the long-term. The main thing is to avoid having another one by addressing the risk factors that caused the first one and getting any critically narrowed coronary arteries opened up (with a stent) or bypassed (surgery).

Angina can indicate that you are at risk of having a heart attack which could be fatal. So you need to find out exactly what is causing the angina and whether it is dangerous. Stay worried until you know what te problem is (and don't smoke even half a cigarette).

No food will reliably increase your heart rate. A slow heart rate is not dangerous but it can cause debilitating symptoms. If there is no other contributing problem (e.g.thyroid deficiency) then implanting an artificial pacemaker can make you feel much better, though this is controversial.

In general, angioplasty is better because of the lower complication rate and much quicker recovery, but some blockages are in such critical places in the coronary arteries that angioplasty would be at significant risk of causing a heart attack, possibly fatal, and for these bypass surgery is safer.

Yes, diabetes increases the risk of progressive arterial disease. Having both problems makes it even more important to treat the risk factors: statins for cholesterol, strict low carbohydrate diet for overweight, perfect blood pressure control (especially with ACE-inhibitors), regular exercise, good dental care (plus obviously not smoking). Diabetes and previous CABG can also make the symptoms of angina less clear so any progressive reduction in exercise capacity should be investigated with a stress test of some sort (treadmill exercise, stress echo, nuclear scan or stress cMRI)

If it comes on or worsens with exercise (walking uphill) it is probably angina and should be investigated urgently. If not it is probably not a heart problem.

There are risks but a lot less than leaving it alone. His surgeon will discuss the risks with him and you could arrange to be in on that meeting.

Yes and no! Any grumbling inflammation increases the risk of a heart attack but there is no direct connection between dental plaque and arterial plaques.

It is likely the palpitations are caused by a heart arrhythmia, which may or may not be serious. She should have a heart recording for long enough to catch a palpitation attack, to identify the cause. Her GP can arrange that directly or through the local hospital.

It can be hereditary – you could have an echo-cardiogram or cardiac MRI scan to check for early signs. Also consider genetic screening as there are a number of well-established genes linked to the condition and identifying one of them could help guide treatment.

Yes, anemia makes it necessary for the heart to pump more blood around all the time. Also iron deficiency can directly interfere with energy supply to your heart muscle.

There is now strong evidence that your systolic blood pressure should be kept BELOW 125 mm Hg on an average of several readings all at rest. Occasional higher readings are normal and not a worry.