Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, Warrick Bishop here. I'm speaking into the Healthy Heart Network membership group. It's a privilege to be sharing with you guys tonight. Down here in Hobart, it's freezing cold, so I don't know where you are. I hope you're warm and I hope you're enjoying the evening. And I hope you're getting through this COVID challenge as best you possibly can. It seems to be the only thing we hear about on the news. at the moment. So I threw out there the other day a request for any questions. There haven't been too many questions, but what I thought I might do is share with you a little bit of information around palpitations, which have been coming up a bit in my clinical practice lately. So if it's all right with you, we'll talk a little bit about palpitations. So a story, and a bit of teaching. So first of all, a good number of years ago when I first qualified as a cardiologist. So this is over 20 years ago, which is frightening. I was working, living in Hobart and I was doing locum work on the Northwest coast of Tasmania. So every month I would drive up to the Northwest coast and do a clinic for one of the doctors up. there and I'd do a week every month and then drive back home. Now remember I was brand new as a cardiologist, shiny and bright, so I knew everything actually. Fortunately, clearly I was blessed and had the opportunity to share that knowledge with the community up in the northwest coast of Tasmania. So what I'd like to do is tell you a story about a patient who came to see me who had palpitations. Now, this guy was in about his mid-50s. Truth be told, he's probably about the age I am now. And he walked in on one day. And I don't know if you've ever felt it, but this was a guy who, when he walked into the room, the temperature of the room sunk. It just, it got cold. If you like, you could almost refer to this. gentleman as a bit of a negative energy vortex sucking energy from everything around him but clearly without even asking him he was not a happy character and you could feel that when he walked into the room anyway a long story short actually long story not so short because i'm going to tell you the whole story which i think is has some learning to it the uh i said to this guy so what's the trouble friend and he says Palpitations, terrible, terrible palpitations. I'm a builder. Every time I get up a ladder or I'm up high or I'm on a roof or I'm doing something, these palpitations, they just, they come and I can't do anything. My blood pressure drops. I feel terrible. All sorts of strife. Anyway, we put on a monitor and we diagnose superventricular tachycardia. So rapid, fast heartbeat. No trouble. Fantastic. I say, good news. I know the tablet to fix you for that. So I put him on a tablet, happened to be a thing called a beta blocker. And I said, look, I'm back up in a month. I'll see you then and see how you're going. Anyway, forgot about him. Headed back a month later on my return locum visit. In comes this guy. And the temperature of the room immediately drops. How are you going? Didn't need to ask, but no good doc. No good. It's all, it's terrible. My heart's racing. Those tablets are not doing the job. It's just, ah, I'm not, I'm not coping. I can't work and I need to work. No worries. We've got a second line of therapy, which works really well for this condition. It's called a calcium channel blocker. It works better than a beta blocker, in fact. So here you go. Have a crack at these. I'll see you in a month. Well, I was intrigued this time to catch up with him in a month and see how he was going. And lo and behold, that four weeks came around pretty quick. He visited or returned for his follow-up appointment, said, hey, how are you going? Again, on this occasion, I didn't need to ask. His face was long. He was miserable. You could tell he wasn't very happy. And so I said, how is it? He says, oh, terrible, terrible. Wake up. The heart's still racing. I'm not able to work. It's no good. I get up on ladders or in high places and it's playing around. And I said, look, absolutely no problem at all. But because I'm a nearly qualified cardiologist, I know all about treating this condition. And the good news is we've got a special procedure where we can put wires up into the heart and literally eradicate that irregular pulse and nip it. in the above, really break that short circuit and fix you up for good. That has to be done in Melbourne. But do you know what? Because I'm a brand new cardiologist and I've made lots of great contacts over my training, I can organise all that for you. So I put in to train all the requirements for him to go to Melbourne to get an electrophysiological ablation of his paroxysmal supraventricular tachycardia. Sounds great, doesn't it? Anyway, that's what we put in place. That took several months to organise, and after it was done, I contacted him and said, look, it would be great to see you as a follow-up in the rooms after your procedure, about a month, six weeks after. Anyway, he turns up. Fantastic. Walks into the room, and to my shock and horror, the temperature dropped. He looked miserable. He looked bereft. He looked unhappy. I gird the loins, called on my intestinal fortitude, and I said, how are you? Knowing what he'd say, he said, oh, doc, no good. Heart's still playing up. This is terrible. No good at all. Anyway, I couldn't believe this, actually, because I thought we were going to have fixed him. I thought by this stage, a bright, shiny, new, clever cardiologist like myself should have been able to sort this guy out. Anyway, I said, look, we... we'd better just put another monitor on because the palpitations this time sounded a little bit different to previous. So we put on a monitor. I saw him in a month and when he came back, he actually had palpitations that he was documenting on his halter monitor. That's the device that we put dots on the chest and monitor the electrical activity of the heart and you wear it for 24 hours. He was documenting his symptoms correlating with, a palpitation that we call ventricular ectopic beats. So it is an unusual or a slight variance to normal rhythm, but it's certainly not what he got sent over to Melbourne for. Anyway, I gave him a little bit of atenolol, a bit of beta blocker, which should have settled the ventricular ectopic beats down. Also said that you might want to use some other bits and pieces like magnesium. or fish oil and they can certainly help. Now I was fairly optimistic that this should have settled this gentleman's symptoms down and we scheduled an appointment, you guessed it, for four weeks later. Four weeks later I'm very hopeful that I've finally been able to help this man get back to work because he was a daughter and he wanted to really be able to continue with his work and obviously run the business. He came in four weeks later to my shock and horror. I didn't have to ask him how he was going, but I did. How is it? I said, he says, oh, doc, no good. Those palpitations, they're still there. I can't work. I can't concentrate. I can't do what I need to do. I get up on ladders or I'm trying to. and I've got a saw or a power tool and there's palpitations. Anyway, I was by this stage at Wix End. We'd gone through somewhere around six to nine months. I really didn't know what to do. And so I sat back in my chair momentarily. I took a breath and thought about it. I put my pen down on the table and I looked at this man and I said, honestly, mate, I think you know as well as I do, we've done... absolutely everything that we can possibly do to help you with your palpitations. You've had the appropriate medication. You've had a procedure. You've had follow-up and subsequent medication, which should have done the job. And really and truly, it's not working. Something's not right. What's going on? And he sat there for a moment, reflected. for what appeared to be seconds and said, Doc, it's my wife, and proceeded to let me know of all the hardship he'd been having at home over the last year or two. Now, I have to say, I had no idea what to say, but I felt almost pinned back in the chair listening to this man sharing the anxiety and stresses from his relationship. Now, I had figured myself as a bright, shining new cardiologist who knew all about palpitations and how to fix palpitations, but I wasn't someone who could counsel people on home affairs or home issues. But I said to this guy, friend, I don't know too much about this, but what I do get is that somewhere... You have to make a decision to either stay where you are and live in this relationship and choose to be happy with it or choose that this relationship is not for you and get yourself out of it. And I haven't got a tablet for that. I think you just have to think about it and make a choice. And I look forward to seeing you in a month. Well, lo and behold, a month came around. I was looking forward to seeing this gentleman. More out of curiosity than anything else by this time. I'm sitting in my office. He comes into the room. Actually, I wasn't sitting in my office. I went out and got him, brought him into the room, and something was different. The temperature didn't drop. He almost had a smile on his face. I sat down in the chair on my side of the desk to consult and said, okay, how are you going? He said, pretty good. I said, what have you done? He said, Doc, I've left her. I said, OK. I said, how's the heart? He said, no problem. I said, do I need to see you again? He said, no, I don't think so. I think I'm OK. I said, well, I wish you the very best and off you go. Never saw the gentleman again, but I learnt such a lot. That day as a brand new shiny cardiologist, it blew me away. And I've never forgotten the story. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
