Arrhythmia: The hidden heart problem
It was only when she collapsed suddenly on the Tube that Jane Feinmann learnt she had arrhythmia – and that thousands in Britain die each year without even knowing they're at risk
Tuesday 10 February 2009
It was like a nightmare you wake up from feeling relieved that it was only a dream. Several pairs of eyes stared down at me as I slowly became aware that I was flat on my back on the Metropolitan Line platform at King's Cross with no idea how I was ever going to get up again. I'd lost consciousness mid-stride, while travelling home alone via the Tube station one evening last October. Falling heavily without the ability to protect myself, I'd broken three ribs (as I discovered later) and gashed the side of my head.
Even as I lay there mulling over the blood and pain, in front of a crowd of largely indifferent onlookers, I had a shrewd idea of the root of the problem – enough to be fairly sure that the station paramedic was on the wrong track when he asked if I'd been suffering from stress.
After several decades of uneventful good health, I'd started having persistent short episodes of rapid heartbeat and light-headed dizziness a few months previously. I'd assumed these were harmless – until they increased in frequency a week or so before my fall.
It took a few weeks to confirm my suspicion – and to discover that my experience is relatively common. More than 100,000 Britons have an unexplained fall every year, where the cause is not stress, exhaustion or poor diet. Most, like me, are among the two million who have a heart rhythm disorder, known as an arrhythmia, caused by a fault in the electrical circuit that keeps our hearts beating regularly.
From hospital soaps on television, we know about the most severe arrhythmia, ventricular fibrillation – requiring emergency resuscitation. Few people know about the less spectacular arrhythmias: atrial fibrillation, affecting one million people (mainly the over-fifties) and greatly increasing the risk of stroke; and supraventricular tachycardia (SVT), affecting 125,000 people of all ages and causing symptoms that are unpleasant but not dangerous.
I was diagnosed with a third type: ventricular tachycardia (VT), a fairly common cause of death in people with existing heart disease but thankfully more benign in people like myself, with an otherwise healthy heart. Another plus for me, I eventually discovered, is that I've got the more treatable monomorphic variety; a single rogue electrical impulse in the lower chamber (ventricle) of my heart muscle caused my fall when it made my heart beat too fast to pump sufficient blood to the brain. One of the principal dangers, as my experience showed, is that unconsciousness comes so suddenly that you are unable to save yourself or break your fall – with potentially fatal consequences.
But all that knowledge came later. At my local A&E the morning after my fall, I was given an electrocardiogram (ECG) – and when that showed up as normal, I was sent home with some co-codamol and instructions to get my GP to make a non-urgent referral to the cardiologist. "Your best bet is to try to get back here when you're having a funny turn," I was told.
That's par for the course, and it's a big problem for the many thousands of people who find it frustratingly difficult to discover whether their symptoms are annoying but benign or in urgent need of treatment. While a simple blood test provides a diagnosis of heart disease caused by furred or blocked arteries, capturing evidence of an arrhythmia is more tricky. "The diagnosis can be made only if an episode of the arrhythmia is recorded on an ECG," explains Dr Adam Fitzpatrick of the Manchester Heart Centre. "It's all too common for patients to complain of typical symptoms but to have got back into a normal rhythm by the time the ambulance attends, or the patient gets to the GP's surgery or hospital casualty."
It doesn't help that previous evidence is often ignored. "Its a sad fact that in many cases where a person dies suddenly of cardiac arrhythmia, retrospective review of their case reveals that there had been previous warning of a potentially serious heart problem, such as chest pains, fainting, palpitations or convulsions," says the cardiologist David Lefroy of Imperial College NHS Healthcare Trust. "Not infrequently, such people have seen a doctor for the problem or even been under the care of a cardiologist."
The result is a scandalous lack of urgency in diagnosing a disorder causing avoidable loss of life and health. Of the 120,000 UK deaths from arrhythmia every year, 80 per cent could be prevented, says the charity Arrhythmia Alliance. Thousands suffer a stroke or other serious health problems – or, at best, are left taking medication with serious side-effects.
That could be improved greatly if more people got the care I was lucky to receive eventually. After I was sent home from my local hospital for a second time in spite of worsening symptoms, I heard about the Rapid Access Cardiology Clinic at Charing Cross Hospital, part of the Imperial College group. This one-stop clinic, providing immediate attention for people with people with heart problems including arrhythmia, is surely something every hospital should have. Once the staff there saw my ECG, the confusion gave way to urgent action.
I was sent for an emergency angiogram to rule out heart disease. I was then admitted for three days and kept under close scrutiny before being discharged on a temporary high dose of beta-blockers that kept the arrhythmia under control.
In early December, I was admitted as a day patient at the trust's Electrophysiology Unit, a leading centre for catheter ablation. This treatment, introduced in the mid-1990s, is safe and highly effective. Amazingly, it can cure – and I mean cure – many arrhythmias without recourse to the knife or leaving a scar.
A wire, inserted in the upper leg and passed through a vein to the heart, delivers a high-frequency electric current. Where it touches the inner surface of the heart, the wire heats the tissue to near boiling point, thereby cauterising the short circuit.
It took four hours in early December for a highly trained team to track down the source of the VT, working from a "road map" of my heart. I was fully conscious throughout, and though I could feel the wire as it was applied to the tender tissue, the discomfort was eased with copious doses of valium – "like a G&T for breakfast", a nurse accurately noted.
Despite its efficacy, the procedure is one of the health service's best-kept secrets – perhaps because the £4,000 cost of the most basic ablation is twice what the NHS will pay for the procedure. "A lot of people who could be cured of a potentially fatal problem may not be treated, and that seems both unfair and cost-ineffective," Fitzpatrick says.
What's needed, he says, is an integrated technology network of ECGs across primary and secondary care, with specialist GPs able to interpret the tracings and more cardiologists trained and funded to do ablations. Such a proposal is more likely to yield results if the public understands its importance, according to the Arrhythmia Alliance. "We want arrhythmia, as a symptom, to become as well known and well understood as chest pain," says spokesperson Joanna Goldberg.
In June, the charity will launch a "Know Your Pulse" campaign, encouraging everyone to take their pulse at regular intervals over a two-week period and record the results in a diary. "Your pulse rate is an important and neglected health indicator; as important as knowing your body mass index or your blood pressure, and the easiest way to become aware of an irregular heart rhythm," Goldberg says.
It's so true. All the time I have had my symptoms, it has never occurred to me that I can monitor them myself. My funny turns have calmed down and I've stopped worrying about walking along Tube platforms. But I'm still waiting for the all-clear, and may need another ablation. Meanwhile, a watch with a large second-hand is a vital aid to my healthy future.
Arrhythmia Alliance: 01789 450 787; www.aral.org.uk
You've got rhythm: How to take your pulse
Do it yourself
Take your pulse by holding out one hand, with palm facing up. Put the index and middle fingers of your other hand together, pressing the pads of your fingers lightly on the underside of your wrist, just at the base of your thumb. Your normal resting heart rate should be 60 to 100 beats a minute for an adult, though it may be lower if you're an athlete. Tachycardia is defined as a resting heartbeat of over 100 beats per minute, or 20 to 30 beats above normal heart rate.
An ECG test traces changes in the voltage that is detectable in the course of a heartbeat. It's the most useful record of heart function and the best way to reveal the cause of irregular heart-beats. If an arrhythmia is suspected but doesn't show up on ECG, you can have a 24-hour or even a seven-day ECG, using equipment put in place in the hospital and worn at home.
An exercise ECG, taken while you're on a treadmill, shows how your heart responds to strenuous exercise.
An echocardiogram scan can pick up structural abnormalities in the heart.
The Know Your Pulse campaign will be launched during Arrhythmia Awareness Week, 8-14 June
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