Brief Answer: please see details. Detailed Answer: Dear Sir 1. The work up of palpitation aims at identifying the rhythm you have at time of palpitation. Once the rhythm is identified, we look for a structural heart disease on cardiac ultrasound/ ECHO. Most of the time palpitation is caused by PREMATURE CONTRACTIONS. When these premature contractions are associated with a structurally normal heart, there is nothing to worry and we look for precipitating factors. We avoid precipitants like tea/ coffee/ anti-asthma drugs/ stress/ anxiety/ fever/ anemia/ thyroid diseases/ chest diseases etc. At times we use medicines to suppress them. 2. Airflow restriction, when severe enough to cause decrease oxygenation, may cause premature contractions. However, if there is no sleep apnea, it is not conducible to my mind that your day time tiredness is due to it. Second, how EP concluded that you have airway restriction by sleep apnea study. Airway restriction is diagnosed by pulmonary function tests. If you have undergone spirometry ? 3. Palpitation due to premature contraction can occur due to a variety of stimuli which may include a disturbed sleep or respiratory disorder. But work up will be as detailed in first para above. Hope this gives some insight into the issue. Feel free to discuss further , especially if you can upload your reports for discussion. Sincerely Sukhvinder

---

Brief Answer: please see details Detailed Answer: Dear Sir A bad sleep and airway restriction are two different things. A Bad sleep can make you feel bad in day, tired, listless, sleepy and may cause a number of psychological symptoms. however restrictive airway disease is entirely different. In a typical case it develops over years and causes dry cough and shortness of breath. It is very important to differentiate between two, as treatment is entirely different. A sleep specialist will look into issues of bad sleep. however a pulmonologist will treat restrictive lung disease. To rule out restrictive lung disease, you need to see a pulmonologist and a spirometry done. Snoring itself is not a diseases unless it is associated with evidence of sleep apnea. Since there is a minor airway restriction as per EP, see a sleep specialist first. You may only require a few tips about good sleep hygiene. All the best. Sincerely Sukhvinder

---

Brief Answer: please see details Detailed Answer: Dear Sir 1. I agree with your cardiologist. If holter and ECHO are normal, practically work -up for palpitations is over. 2. Although I do not agree that sleep study can diagnose airway restriction but still I can understand what he wants to say. 3. Yes, for deviated septum , ENT specialist should be consulted. He will also tell if it is really causing airway obstruction or not. I think a sleep specialist should also be consulted. If the problem of palpitations still persist after their treatment, the cardiologist can always use the drugs which can suppress palpitations. Sincerely Sukhvinder

---

Brief Answer: see details Detailed Answer: Dear Sir "BREATH RIGHT" strips are mechanical nasal passage dilators which increases the area of nasal passages by lifting the nose. Hence help in decreasing airway obstruction at nasal level. Now again, these are two different etiologies of obstruction at nasal level. 1. Congestion (a phenomenon reversible by drugs/ steam/ strips) 2. Deviated septum (mechanical obstruction which mostly requires surgical correction). Hope the answer is clear to you now. For deviated septum you need to see ENT specialist but congestion can be tackled by other means. If the deviation is too minor and there is some congestion, BREATH RIGHT may help. The best judge is your ENT specialist. Sincerely Sukhvinder

---

Brief Answer: please see details Detailed Answer: Dear Sir 1. Both of these may coexist. Both have different treatment and evaluation. An ENT surgeon is best to guide you about deviated septum. A sleep specialist can guide best about sleep issues. Both of these are treatable conditions in most of patients. As I detailed earlier, it does not seem to be a cardiology issue. Sincerely Sukhvinder

---