Could you have a dodgy ticker but not realise? How a DIY test for an irregular pulse could help save your life

One in four people over the age of 40 is at risk of developing Atrial fibrillation (AF) - the condition is linked to ageing

‘At first, I just thought it was a missed beat or two, which sometimes happens, as I’d never had any symptoms of heart problems. But when I checked it again it was still irregular. I booked myself in for an electrocardiogram test (ECG) and it revealed I had atrial fibrillation. I felt quite alarmed. I had absolutely no idea how long I’d had it — but it had never shown up in pulse tests when I was a medical student. It just goes to show that if even a cardiologist like me, trained to look for the tell-tale signs, is unaware that he has the condition, then most patients won’t realise there is something wrong either.’

It’s estimated that a million Britons have atrial fibrillation — defined as an irregular, rapid heartbeat or quivering of the upper chambers of the heart — but, like Professor Camm, as many as a third have no obvious symptoms.

Atrial fibrillation (AF) is caused by a fault in the heart’s electrical system — it’s dangerous because it increases the risk of stroke five-fold and heart failure three-fold. One in four people over the age of 40 is at risk of developing AF — the condition is linked to ageing — and it’s predicted that up to three million Britons will suffer from the condition by 2050 as more people survive conditions that predispose them to atrial fibrillation (such as heart attacks).

Indeed, experts refer to atrial fibrillation as the new epidemic in cardiovascular disease. Symptoms vary and can include a feeling that your heart has skipped a beat, followed by a racing of the heart, an erratic heartbeat, strong palpitations or a fluttering feeling in the chest like butterflies, or a ‘flopping fish’ sensation. Other patients experience chest and throat pressure that mimics a heart attack, or a constricted feeling round the top of the left arm that prompts a heavy ache.

In the elderly, the only symptoms might be tiredness and breathlessness. However, many sufferers don’t notice any symptoms or, if they do, tend not to take them seriously, dismissing them as signs of ageing. Research suggests there is an average delay of 2.6 years between symptoms starting and a person being diagnosed. ‘Often patients don’t get diagnosed with atrial fibrillation until they suffer a stroke or heart failure,’ says Professor Camm. ‘In most cases, these complications could been prevented had the patient been diagnosed and treated earlier.’

 

Blood thinning medication - such as warfarin and aspirin - can reduce the risk of stroke by up to 70 per cent

Atrial fibrillation dramatically increases the risk of stroke because blood can pool in the heart and create clots, which may travel to other parts of the body, such as the brain, and block an artery.  Fibrillation can also over-work the heart, and over time can cause heart failure. It’s thought that 6,000 deaths and 8,000 strokes could be prevented with better diagnosis and treatment.

Last week, the European Society of Cardiology called for anyone with an irregular heart beat to see a doctor, explaining that in cases of atrial fibrillation, blood thinning medication can reduce the risk of stroke by up to 70 per cent.  The standard blood-thinning drugs are warfarin and aspirin. Other treatments include catheter ablation, where heat is used to destroy the area of the heart causing the faulty heartbeat, or cardioversion, where a controlled electric shock is given to try to restore a normal rhythm.

Worryingly, though, only 18 per cent of patients with atrial fibrillation are thought to be taking anticoagulant drugs. This is mainly due to so many cases being undiagnosed, but also a reluctance by GPs to administer and from patients to take the drug, as side-effects include nausea and bleeding, and regular check-ups in outpatient clinics are required. Half of the patients who take warfarin give it up within two to three years because of side-effects or interactions with other drugs and foods (including spinach and alcohol).

Patients on warfarin also have to visit a monitoring clinic once a month — more often if their blood thickness is difficult to control. This is about to change as two new anti-coagulant drugs, Pradaxa and Rivaroxaban — the first for stroke prevention in more than 60 years — have been approved for NHS use by the National Institute of Health and Clinical Excellence. The drugs do not have as many problems as warfarin and do not require monitoring. But under-diagnosis is still the main problem, says Dr Adam Fitzpatrick, consultant cardiologist at Manchester Royal Infirmary.

This is particularly an issue in the elderly, who are most at risk of a stroke. ‘Though it can be picked up by routine pulse tests by GPs, it must be confirmed with an ECG recording,’ says Dr Fitzpatrick. ‘These can be time-consuming as each takes up to 20 minutes and requires a separate room and staff — so it can be unfeasible for GPs to run these tests. ‘Up to one in ten people over 80 has AF and many won’t have any obvious symptoms. 'They are often completely unaware they are at a high risk of stroke and are missing out on treatment.’

Dr Fitzpatrick is taking part in the development of a device GPs can use to detect AF. The RapidRhythm ECG is a hand-held device that connects wirelessly to a GP’s computer and can get a result in 90 seconds compared to the 15 to 20 minutes it takes for an ECG reading. ‘We envisage GPs would be able to run the tests straight after a pulse check. 'Our research has already established this device is as effective as an ECG,’ he says.

The Atrial Fibrillation Association says it is also important for everyone to take their own pulse regularly to check for problems — a normal pulse is between 60 and 100 beats a minute and should be regular. Professor Camm takes drugs to slow his heartbeat and is planning to start warfarin. He is keen that others know the symptoms and get the treatment they need, too. ‘Atrial fibrillation isn’t the easiest condition to self-diagnose even when you are a cardiologist, and, as in my case, you don’t always notice anything is wrong,’ says Professor Camm. ‘I feel lucky that a random pulse check picked up my condition before anything serious happened to me — not everyone is so fortunate.

CHECK TO TELL IF YOU'RE AT RISK

Rest for ten minutes before taking your pulse, and avoid caffeine and nicotine for ten to 20 minutes before taking your reading. 

First thing in the morning or last thing at night are ideal times.

Put one of your hands out and rest it on a table, so you’re looking at your palm. 

Use the index and middle finger of your other hand and place the pads of these fingers on the inside of your wrist at the base of your thumb near where the strap of a watch would sit. 

Or, if you prefer, place the index and middle fingers on your neck underneath your chin, in the hollow next to the windpipe.

Press lightly until you feel the thrumming of your pulse, and count for 30 seconds. To obtain beats per minute, multiply by two. 

Feel the rhythm of the pulse and check if it’s regular or irregular — it may help if you tap your foot.

A normal pulse rate is between 60 and 100 beats per minute (however, there are normal reasons why it could be slower or faster including your age, medication, caffeine and levels of fitness).

See your doctor if your pulse appears to be racing or is slow some or most of the time, or if your pulse feels irregular (jumping around). 

Also see your GP if your pulse is above 120 beats per minute or below 40 beats per minute.

For more information on atrial fibrillation or how to take your pulse, go to atrialfibrillation.org.uk or knowyourpulse.org or call 01789 450787.

 Source: Daily Mail UK

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