Doc, should I worry about my irregular heartbeats?

Dear doctor,

Of late my chest has been feeling tight and I have been getting episodes of the heart beating fast. After a few minutes, the feeling ends. What could be happening to me? I’m only 21 years old.

Brian

Dear Brian,

Being aware of your heartbeat is referred to as having palpitations. It can feel as though the heart is ponding, racing, fluttering or having an irregular beat. Most people will explain palpitations every once in a while, with no serious underlying problems and no negative impact. However, if they are severe, or they occur regularly, they may be a sign of an underlying problem. Triggers of palpitations include excessive fatigue, stress, excitement, anxiety, strenuous activity, exercise, lack of sleep, caffeine, alcohol, nicotine, drug abuse and some medications (some asthma medications, some hypertension medicine, antidepressants, some antihistamines and also some antibiotics).

Hormonal changes due to the monthly cycle, pregnancy or menopause may also trigger palpitations. There are also medical conditions that can trigger palpitations including severe heart burn, low blood level, low blood sugar and deficiencies of potassium and vitamin B12. Serious conditions that can cause palpitations include blood pressure problems, thyroid disorders and different types of heart problems.

It is advisable for you to be reviewed by a doctor to determine the cause of the symptoms so that you can get the appropriate treatment. It is also good to note that in many cases, the palpitations and chest tightness are usually harmless, and the best way to manage them at the time is to practise deep breathing exercises and to relax, and the symptoms will usually pass in a few minutes. Only get concerned if there is also chest pain, severe breathlessness, dizziness and/or fainting, and if the symptoms last for long.

I have an embarrassing problem. I am a 28-year-old woman, and I have some hair that grows on my chin. I try to trim it every week but it keeps growing. Is there anything I can do to get rid of it once and for all? Kate

Dear Kate

When there is excessive hair growth in areas where the hair is usually minimal or absent, this is called hirsutism. It affects about five to 10 per cent of women. It can present either as excessive hair growth in areas that normally have hair or there is growth of hair in areas that are more typical for men such as on the face, the chin,  chest, abdomen and the back. The hair is typically thick, dark and coarse. In most instances, the cause of the excessive hair growth is not known. For some people, it is genetic, while in other situations, it may be due to hormonal disorders, leading to increased androgen (male hormones) levels, which then lead to the excessive hair growth such as in polycystic ovarian syndrome (PCOS), or other disorders of the ovaries, or the adrenal glands. There are also some medications that can contribute to the excessive hair growth like steroid medicines, phenytoin (used for epilepsy), minoxidil (used for hypertension) and cyclosporine (suppresses the immune system). It can also develop after menopause when the oestrogen levels fall.

While completely eradicating hirsutism may be a challenge, it is important to find out if there are any underlying conditions that are causing it. It is advisable to visit a doctor, to have hormone levels checked, especially androgens, plus other tests like an ultrasound or CT scan to visualise the ovaries and adrenal glands, and other relevant tests to identify any underlying causes of the excessive hair growth. Treating the underlying condition may help with hirsutism. Sometimes, however, even after managing some of the underlying conditions, the hair growth may still continue.

In the meantime, try temporary hair removal by shaving, waxing or using depilatory creams (like veet). Eflornithine hydrochloride cream ( such as Vaniqa) can be applied to slow down the hair growth, though it does not stop the growth. Another option is to visit a dermatologist for permanent hair removal using laser/photo-epilation on the affected areas.

If you are overweight, you can potentially reduce the levels of androgen hormones in the body by losing weight through good diet and regular exercise. Reducing androgen levels can also be achieved by taking some medications like the combined oral contraceptive pill and spironolactone, which affect hair growth as a side effect of the drugs, regardless of the original purpose of the medication. The medicine should be taken for at least six months before improvement can be seen. This is because it takes a while for new hair to grow.

I usually experience pain and swelling in my breasts before and during my periods. The pain has increased in the past thee months. Should I be worried about it? Judy

Dear Judy,

This is actually a normal response of the breasts to the hormone progesterone. Progesterone levels rise after ovulation, that is, around two weeks after your periods and stay until your next period. The same thing happens during pregnancy due to very high levels of progesterone. The symptoms may sometimes seem to be different from one month to the next in terms of severity. You can take painkillers to manage the pain and also use bras with good support. It is also advisable to have a breast check-up in a hospital, including a breast ultrasound, to check for any other problems within the breast. Schedule to have annual breast check-ups. In addition, learn how to examine your breasts every month so that you know how they feel like normally, and you can be able to pick up any abnormalities early.

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