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Ask the doctor: My heart keeps skipping a beat

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For a number of years I have suffered from the sensation that my heart has skipped a beat. Tests have confirmed that my heart is sound, but over the past few weeks these heartbeats, which my doctor told me are called ‘ectopic’, have increased in number and severity. My GP has prescribed beta blockers, but what can I expect with these? I am 51 and pre-menopausal. Mrs S. Robinson, Hampshire. Ectopic heartbeats can occur in perfectly healthy hearts

Please do not be alarmed — ectopic heartbeats happen to all of us, it’s just that most of the time we’re unaware of them.

‘Ectopic’ in this context just means out of synch, as the condition leads to extra or skipped beats.

When they are noticed, we refer to them as palpitations — you can experience them as a fluttering feeling, or a sense that the heart has missed a beat, or a sudden forceful beat.

Ectopic heartbeats can occur in perfectly healthy hearts, often without any cause. But they can also be triggered by a number of factors, including caffeine, alcohol or some medicines such as pseudoephedrine, which is found in decongestants.

While there’s no official view on this, I do wonder if perhaps the declining oestrogen levels of the approaching menopause may be a factor, as this hormone is thought to be important for heart function.

Ectopic heartbeats are not a worry if your heart is otherwise healthy and no treatment is necessary beyond avoiding any of the obvious triggers  mentioned above.

Beta blockers are offered only if the symptoms are intolerable.

These drugs reduce heart rate and are generally well tolerated by patients, although potential side-effects include sleep disturbance (they reduce the release of the sleep hormone melatonin), intestinal upset (usually diarrhoea), cold fingers and toes (they can reduce blood flow to the extremities) and low blood-sugar levels.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.

Beta blockers target a type of ‘docking site’ on the muscle cells of the heart called beta receptors.

These docking sites usually bind to stress hormones such as adrenaline, which would otherwise raise heart rate.

However, these receptors are also found in the smooth muscle cells of the airways, so all beta blockers are forbidden in patients with asthma as they can trigger an attack.

Although depression, fatigue and sexual dysfunction are also commonly described as side-effects of beta blockers, detailed studies have found no increase in depression and only the smallest increases in fatigue and sexual dysfunction.

So the use of beta blockers should not be abandoned because of fears of developing these types of side-effects.

After my mother suffered a series of urinary tract infections, scans revealed her bladder is not emptying properly. The only remedy that has been suggested is for her to self-catheterise to remove the excess fluid. However, she has arthritis in her fingers, very shaky hands and does not want to contemplate doing this (she is 84). Are there any other options? K. Flynn, Harrow.

Your mother has found herself in an unfortunate situation, but hopefully there will be acceptable options for her.

She has suffered from what we call recurrent urinary tract infection, meaning she has more than three infections in one year.

Mostly these recurrences are due to reinfection, rather than relapse of an infection that wasn’t completely eradicated — and the important point is to consider what factors are allowing this to keep happening.

The bacteria that cause infection in the bladder normally inhabit the rectum, and can come to colonise the area around the urethra and gain access to the bladder that way.

There is also much evidence proving that the loss of  normal friendly lactobacilli around the vagina may contribute to these infections.

Other studies suggest that in post-menopausal women with recurrent urinary infections, another problem is that the bladder is failing to empty properly.

The problem here is that if there is urine sitting constantly in the bladder, the bacteria in the liquid can trigger infection.

You tell me in your longer letter that your mother had a hysterectomy to fix a prolapse.

There is a good chance she would have also had a degree of bladder prolapse (as the same band of muscles — the pelvic floor ones — hold both organs in position), and this would now contribute to her condition.

Damage to the pelvic floor muscles can prevent the bladder emptying properly.

In order to prevent further infections, your mother needs a high fluid intake, including cranberry juice (although this has not been proved to be an effective prevention, there are some laboratory experiments that suggest it prevents bacteria sticking to the bladder lining), and, most importantly, antibiotics — specifically, a single daily dose of an antibiotic on a continuous long-term basis.

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Sometimes infections can occur even while the patient is taking antibiotics.

However, these are usually less severe and are thought to be caused by a bug that is resistant to the drug.

If this happens, a lab test on a urine sample can be used to identify another antibiotic that would help. Studies show low-dose long-term antibiotics can reduce infections by up to 95 per cent.

Attempting to replace the protective lactobacilli is an attractive idea and involves taking doses of the friendly bacteria called probiotics.

It is not yet certain if this is effective, though it does have  good scientific logic.

Finally, this guide to prevention would not be complete without mention of self-catheterisation.

In both men and women, any retention of urine in the bladder is a significant risk factor for recurrent infections — hence the suggestion from experts that your mother learns to drain off that last bit.

If a patient can learn to do this, using a sterile disposable catheter every time, it offers considerable protection against further infection.

Learning to do this is about as difficult as learning to put contact lenses into the eyes — in other words, it’s possible, but something some people find hard to contemplate for a variety of reasons.

However, if the low-dose prevention antibiotics don’t work, it could be a valuable strategy to reconsider, under the guidance of a skilled urology nurse. I wish your mother the best of luck.

By the way... Doctors need to do more than dish out pills It's not good enough to treat high blood pressure by just prescribing pills

If you're not kind to your body you will have nowhere to live. It might sound glib, but at least it gets the message across.

Getting the message across is a vital part of what doctors do, acting as a source of information and education.

The problem is this has become secondary to slick diagnosis, prompt referral and clever prescription.

But it’s not good enough to treat high blood pressure by just prescribing pills.

It’s a failure if we conclude ‘job done’ when we’ve prescribed sugar-lowering tablets to an obese diabetic, leaving the practice nurse to try to keep the show on the road.

And the smoker with a chronic cough and emerging vascular disease? Tobacco addiction is so pernicious that many GPs have simply given up — another of our failures.

The fact is that we are, in the main, poor at changing the behaviour of our patients, despite the great emphasis in GP postgraduate training on the use of interpersonal skills.

So it was hardly surprising to learn last week that smoking, heavy alcohol intake and poor diet mean the UK now lags behind even impoverished countries such as Greece when it comes to health.

We’ve had more than 60 years of free health care for all, yet we’re below average on a key barometer of health: how long we lead healthy lives before we run into disease and disability.

On the one hand, we have the wonders of the NHS ready to rescue us from our follies and patch us up; on the other, there’s our lack of self-discipline and sense of personal responsibility for our health.

It doesn’t help with the latter that the Government, in its subtle way, really does want you to smoke — there’s the tax revenue, thank you very much, and, conveniently, smoking shortens lives so smokers are not a burden on the State in old age.

In the same cunning way, the food industry makes huge amounts from the cheap and addictive poisons of sugar and salt.

Every dietitian and nutritionist knows this villainy and yet seems as powerless as the doctors to get the message across and change the behaviour of their patients.

We all know that prevention is better than cure, but human beings are lazy.

Most of us are aware that the panacea for health and longevity is regular exercise, yet we prefer to talk about and watch football rather than play it.

Changing behaviour means education, education, education. The problem is that this is dull, there’s not much in the way of exciting technology and it’s hard to measure success.

Our inability to prevent so much disease and merely continue to fight fires is depressing to contemplate, just as the obese diabetic smoker is depressed by their plight.

So sometimes it is easier to do nothing. But is that ethical? Is it what we set out to do?


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