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Getting fluttering in chest with esophageal reflux and myocarditis. EKG came normal. Chances of deficiency of nutrients?

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I am a 31 year old male with no long term health problems. About 3 weeks ago, I felt flutters on my chest that became repetitive over the next few days. These flutters would happen if I did any movement, even walking around would cause the feeling of chest fluttering and for a split second, shortness of breath. I also had very short duration chest pains, usually in the middle of the sternum, either a bit to the right or to the left. I went to my local GP who first diagnosed me with some sort of esophageal reflux, since my EKG came clean and she couldn't hear any distinctive murmurs in my heart nor I had any movement pains in my chest. A couple of days later, I had a severe onset of these palpitations and went to the ER, where I was diagnosed with extrasystoles and a possible hint of myocarditis. The myocarditis was not evident on a further echocardiogram, although the cardiologist told me that my left ventricule is slightly larger than normal (~58mm) but otherwise my heart was working fine. Over the following days, the chest pains and flutters became less common and now they are almost gone, but substituted with a constant feeling of lightheadedness/drowsiness. It is ever present, no matter which position I'm in, although it's not severe enough to make me lose my balance. There is also a slight feeling of pressure in my throat that comes and goes, along with a slight stiffness to my hands. I seem to feel better after a good night sleep, but if I don't get enough rest, like today, it gets worse. I also seem to be unable to sleep on my left side, since the pain on the chest reappears after a while - and I can pinpoint it to the middle of the sternum, slightly to the right (between ribs).

I am still holding on the results of a 24-h Holter monitor, but the dizziness is worrying me. By BP varies between 115/75 and 130/80 depending on the time of day, which I assume is normal. Sometimes I have small twitches randomly on my body (thighs, back, etc) and my hands get cold rather easily. I have no other symptoms (cough, loose bowel movements, fever, etc). I had a blood exam in the ER that found no evidence of ischemia or other apparent blood issues but since they did not control for iron or B12 levels, I wonder if I might be defficient in one of those nutrients. One of my doctors tries to make a connection between these symptoms and anxiety which I totally refute as I dealt with anexiety many years ago

Can someone point me to possible causes of this situation or further tests that I should ask my doctor to perform? I would be very appreciative.
Posted Tue, 30 Apr 2013 in Lung and Chest disorders
Answered by Dr. Shailja Puri 19 minutes later

Thank you for posting your query on Health Care Magic.

The detailed history that you have mentioned suggests extra-systole, which has been diagnosed by your doctor.
The other symptoms that you have mentioned- that of light-headedness, drowsiness, feeling of pressure in the throat, stiffness of hands and chest pain suggest a heart problem which is causing decreased blood flow to head & region and the upper limb.
A 24 hour Holter is required which is already done.

Besides a Carotid Doppler can be ordered.This test will help to determine the status of blood flow in the blood vessels supplying the head & neck region.

The status of the functioning of the heart is determined by an array of investigations which includes ECG, echocardiography, 24 hour Holter and Doppler studies.
You have had majority of the investigations.
Consult your treating doctor in case the Doppler is required.

If you have more queries, I will be glad to answer.

Dr Shailja P Wahal
Above answer was peer-reviewed by
Follow-up: Getting fluttering in chest with esophageal reflux and myocarditis. EKG came normal. Chances of deficiency of nutrients? 1 hour later
Hello Dr Wahal,

It is a bit confusing to me that so far all heart-related exames (blood pressure, auscultation, multiple EKGs, Eco-cardiogram) revealed no hints of heart insufficiency. My ejection fraction was normal and there were no signes of exertion from my heart muscle. Plus, the pain is not constant and does not occur on exercise - I cycle somewhat regularly, as far as I can say it is rather random or slightly postural, even though the lightheadedness is constant, getting better with rest.

Can there be a motive behind this that is not heart-related? Something to do with the autonomous nervous system, nurtrient deficiency, or adverse reaction to the pronton pump inhibitor I have been taking, maybe? What other exams would you recommend to differentially diagnose?


Answered by Dr. Shailja Puri 1 hour later
Hello and welcome again,

Yeah, I agree that your ECG is normal but there is evidence of left ventricular enlargement on echocardiography.
Initial stages of any cardiac disease do not produce any substantial change in parameters like ejection fraction volume, etc.
However, the symptoms are not diagnostic of cardiac disease but it has to be ruled out as it is the first differential.
Proton pump inhibitor is unlikely to produce such side effects.
These symptoms can be related to autonomic system but cardiac disease is the first differential.

Since, you are taking proton pump inhibitor, the chest pain is not likely due to reflux.

If you have more queries, I will be glad to answer.
Dr Shailja P Wahal

Above answer was peer-reviewed by
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