Has a tooth infection caused my heart to race? DR MARTIN SCURR explains the possible causes of heart palpitations

I have impacted wisdom teeth and recently had one removed because it caused an infection. I also started having heart palpitations, which went away when I was taking antibiotics for the infection but came back after I finished them. My breathing is laboured, too. Is this connected to my tooth infection?

Sav Huntington, by email.

Heart palpitations are defined as an awareness of forceful, rapid or irregular heartbeats. Although they may feel significant, their root cause is often innocent. Mostly palpitations are due to extra systoles, or heartbeats, which occur in all of us at times and are more common when we are under stress or drink excess caffeine, for example.

Now that your symptoms are occurring with breathlessness you do need further investigation, as this can happen when there is an underlying issue, such as a heart rhythm problem.

There are any number of possible causes, and without knowing about your medical history, age, current medication and other symptoms, it would be misleading to speculate whether or not there is a connection with your tooth infection.

Dental infections — such as your recent wisdom tooth problem — are usually localised to the jaw and soft tissues. But there are occasions when infection can spread elsewhere in the body, including to the heart.

Endocarditis — when bacteria travelling in the bloodstream alight on one or more of the heart valves, causing infection there — can be secondary to a dental infection.

The condition usually develops gradually over weeks and you may experience fatigue, sweats, flu-like symptoms and, eventually, shortness of breath and palpitations. However, although there is a potential distant connection between palpitations and your recent dental problem, the most important point is that your heart symptoms should be investigated.

Your GP will carry out an electrocardiogram (ECG) to record the electrical activity of the heart, which should then identify any abnormal rhythm.

If there are no palpitations at the time of the tracing, you might be offered a 24-hour continuous ECG (often known as a Holter monitor), or referred for an echocardiogram (an ultrasound scan of the heart).

It is most likely that these investigations will be achieved by referral to the cardiology department of your local hospital. The cause is undoubtedly treatable.

In short, the task is a quest for an exact diagnosis. 

In my view... Doctors must see patients face-to-face 

Opposition from teachers and unions to reopening primary schools is less about the welfare of children than the concerns of the adults. I fear something similar is happening in general practice.

My former practice nurse gave birth to her first baby five weeks ago. A first-time mother in her 40s, she is receiving none of the usual support; her health visitor, midwife and GP all unwilling or unable to see her as normal.

She contacted me as the baby developed a crusting rash on his face and ear. It appeared infected and in need of urgent treatment.

Her GP offered a series of excuses as to why there was no point in seeing the baby or taking a swab to confirm infection and identify the correct antibiotic to treat it.

The mother insisted, and the GP eventually agreed to see them, took a swab, and the mother delivered it to hospital herself.

I was shocked by her experience. If you find yourself in a similar situation, my advice is to write down what happened, pass a copy to the practice and ask them to ensure the report is included in appraisal documents of the relevant GP.

The mother is awaiting the swab results. But my diagnosis, from photos, is impetigo, a highly contagious bacterial skin infection, potentially dangerous in one so young. We do not need GPs refusing to see patients for fear of catching the virus: there are times when physical examination is essential and lab tests have to be obtained.