EP132: A Patient With Hard-to-Treat Heart Palpitations

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he speaks to the Healthy Heart Network membership group and shares a compelling clinical story about palpitations, a symptom that has been appearing frequently in his practice. Through a patient case study spanning several months, Dr. Bishop illustrates an important lesson about the relationship between emotional wellbeing and cardiac symptoms. Key Takeaways: Palpitations are a common cardiac symptom that can present with rapid heartbeats (supraventricular tachycardia) or irregular beats (ventricular ectopic beats), and diagnosis typically requires monitoring devices like Holter monitors. Medical interventions for palpitations include beta blockers and calcium channel blockers as first-line treatments, with electrophysiological ablation procedures available as an advanced option for certain arrhythmias. Not all palpitations have a purely physiological cardiac cause; anxiety, stress, and emotional distress can significantly contribute to or even be the primary driver of palpitation symptoms. A patient's emotional and psychological state—including relationship stress and anxiety—can manifest as physical cardiac symptoms that fail to respond to standard medical treatments. Sometimes the most important diagnostic tool is asking open-ended questions and listening carefully to patients; Dr. Bishop's direct inquiry about what else might be going on revealed the true underlying issue. Lifestyle interventions such as magnesium and fish oil supplementation may help manage certain types of palpitations alongside or instead of pharmaceutical approaches. Resolution of emotional stressors can lead to complete resolution of cardiac symptoms, demonstrating the mind-body connection in heart health. As a physician, recognizing the limits of medical expertise and acknowledging when issues fall outside one's specialty is crucial for truly helping patients.