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Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice?

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I had a weird sensation in the middle of my chest . It feels like my heart skipped a beat n paused for half a second n the next one comes with a harder thump. I would have the urge to cough if the "thump?is harder.It can happen non stop for few hours n go away for next half a day only to come back again for the next day. It's been six months. EKG fine. Took acid reflux medi nexium Zantac antacid no help. I'm distressed n very bothered by it..

1. The sensation can be most felt after meal? Y is that so? I took anti acid medi but no help at all.

2. My body movement can trigger it sometimes . I could be raising my arms, bending , stretching , or reaching to get something , why is that so??

3. I could be talking on the phone or doing something else the sensation jux come suddenly.

4. The sensation are least felt when I lay down to sleep or rest. Y?

Thanks !

Posted Sat, 27 Apr 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 4 hours later
Hi friend,
Welcome to Health Care Magic

     Feeling of ‘dropping- skipping- missed- hard- fluttering-’ beat is called ECTOPIC or premature beats / palpitation / arrythmia and so on. The rate may be fast or slow / the rhythm may be irregular / it may be felt in the chest, neck, or stomach
     A beat comes earlier than normal – this itself is not usually felt. The next beat is a bit delayed - longer time to recover form early extra beat – so heart fills more and the beat appears forcible thud / lubb - - dubb - - lubb - - dubb - lub - - - DUBB /
     Ectopic beats can arise from ventricle (lower chamber of the heart - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC). / APCs are generally harmless. Even VPCs are often harmless – ‘benign’. / If they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they should be investigated further.
     It may not be related to any particular event. After meals, the stomach is full, the diaphragm and the heart are pushed up and this could be the reason
     Similarly, body movements are not directly related. If so, a particular movement must invaribaly precipitatate it every time – this can be checked easily and is uilekely to be true. It is only drawing the attention to it.
      It is a random occurence. Hence, it can occur any time.
     On lying down, the heart is a bit away from the chest wall and one may not feel it. Generally, it is the other way around – doing nothing, one is attracted to th event and becomes more aware.
Irregular heart beats need to be DOCUMENTED by ElectroCardioGram (EKG).
Anxiety / Alcohol / Tobacco (smoking, chewing) / Caffeine (too much coffee, cola) are common causes.
Medicines may be responsible – like Phenylephrine used for ‘cold’ / Salbutamol used for asthma and so on.
Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats
At times, abnormal nerve paths in the heart (bypass tracts) are responsible!
It is advisable to have it investigated.
A thorough history and physical examination is the first step -
ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.
     HOLTER (24 to 48 hour ambulatory monitoring) is done to analyse and plan for further management, if a routine ECG does not show. Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occuring during that time only. If the episode ocurs randomly, one needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously; Event monitor usually only at certain times. It may also detect silent (no symptom) ischemia.
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality).
      TMT (Treadmill exercise ECG) is done to exclude Ischemia (reduced blood flow).
     LABORATORY work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) and so on. Your Internist shall suggest based on the situation.
     If there are no clues and if the problem is still bothering to the extent of interfering with life style, there is advanced techniques of investigations – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. The test is the gold standard but INVASIVE. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation. There are also advanced treatment modalities - like RF or cryoablation, which could be done during EPS.
     The first line medicine is generally beta blockers, like Metoprolol – slow release and small dose.      If they are not effective and if the problem is severe, several other classes of drugs are available – acting by different mechanisms - the specialist will decide tailored to your needs.

See your doctor

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 44 hours later
Dear Dr,

Thks for reply. Jux a little bit more on the history of my issues. I'm 34 yrs old male. Healthy weight. I seldom eat junk food and do not drink alcohol at all. There are no history of cardiac issues in my family line.

The skipped heartbeat started six months ago when there was a period of time which l did not eat on a regular basis and have some gastric issues. After that I changed my eating habits but it did not improve but gotten worse. It all started with a thump and I ignore it .. It was less frequent at that time though. However they got more frequent and i began to wait for it to come. It sometimes can be felt at the middle of the chest and also near my lower throat. The sensation can be mild or sometimes harder which gives me an urge to cough ( if beat is harder).

I agree with u that it is random. However, it is more frequent especially after meals. Yes I know that a full stomach pushes up the diagphram which is near the heart. But since is not happening in the past, there must be something "not right" with the nerves , gut etc. that "now" causes this. Could u explain abit more on this?

I read in some googled post that body motion such as bending crouching can trigger that too. Is true for me, as the "pvc" or whatever came when I pick up something from the ground turn my upper torso. There must be "something " in there which is not right I guess.. Touching the heart blocking it. But again , this is random because when I try and do the "action" again deliberately it did not come. Once unnoticed, the annoying twitch or jump come one.
Or the upper stomach is causing it since is triggered by upper motion?

There is no fluttering, no racing heartbeat, no fast pounding, not dizzy or nausea. I felt normal except for this abnormal disturbance . I tried to ignore it but it is almost impossible because "it" is there . But of cos, if can happen when I'm sitting relax or doing nothing. But it seems the least when I lay down to sleep . I slept well and thankfully it hasn't disturbed my sleep so far.

I had EKG which is normal. Went to a gastro give anti acid pills which did not help.
Assuming I go for further test like a 24 hour holter monitor .

What if it comes back normal ? So I gotta live with this for the rest of my life??

If pvc or twitches were recorded, do u encourage beta blockers ? Or is it a must to be on medication.

This issue is interfering with my life . And I'm getting more troubled and can't concentrate on my daily tasks. Pls help me
Answered by Dr. Anantharamakrishnan 6 hours later

It is great that your personal and family histories are good...

It is not possible to say why a particular event or time precipitates this. For example, it is not necessary for an inherited disorder to manifest at birth – it can be decades later... Similarly here, it is not possible to pin point – anxiety can pump adrenaline, change of posture needs redistribution of flow, food stimulates several gut hormones and also diverts blood to intestine and so on...

     Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly or precipitated by a specific activity like exercise, one needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously / Event monitor only at certain times.
     Without exact documentation, things can only be presumptive. Proper treatment demands proper diagnosis. Proper diagnosis needs appropriate investigation. If it is so troubling to interfere with your daily activity and quality of life – you go for EPS
     However, symptomatic treatment helps to ameliorate, though not cure. In many problems of Medicine – like Blood Pressure – it is time consuming, cumbersome and not cost effective, to find the cause / all the same, it can be easily managed...
     Beta-blockers have several actions – especially useful in arrhythmia and anxiety...
     Anxiolytic drugs like Benzodiazepines can also help, in addition.

Go for EPS
Relax. You are young; you sound intelligent – you stand an excellent chance of returning to normalcy.
Be positive – why fear the heart beats more? The problem iis only if it could not beat!
You are tolerating the rate well - means that you may not have any basic disease of the valve, muscle and so on.
Be in touch with your doctor - it is a question of time and you will be well.
Medicine is well advanced nowadays – management is possible for almost all situations...

All the best
Above answer was peer-reviewed by
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 2 days later
Dear doctor,

I appreciate your reply lots.. I am currently on holter monitor .. Before I can wait for the results the next one or two days. I wan to have some knowledge or assurance .

May I know how many pvcs or pacs are considered normal? What is the healthy range limit ? And if its within the normal range, y am I feeling them? What are self help ways to do to get rid of them ?

Can u explain to me how anxiety disorder can caused this? What is happening to the organs??If it is caused by anxiety , y do I stil feel it when in relax mode? Eg. Watching tv .. By the way it is least felt when I lay down to sleep or wake up from sleep?

I heard people who has that for 10 years or more??!!! Then y are they not cured?

Many thks in advance
Just a little bit to add on. The pvcs/pacs did not seem to set off while I'm laying at rest. Once I'm on upright position. Do u think it has got something to do with digestion issues?? Meaning my stomach ?

Y do I say that? A little more on the history since I got them 6 months ago. It began when I felt bloated n have gastric issues . I felt popping sensations in the chest. N my stomach at then were bloated n gassy. Everytime the "pop" came I will have the urge to burp. Then slowly I began to see a pattern and it became more frequent.

I seem the gastro n was given reflux medi. To which it did not help. So I thought it was acid trigger a mild spasm or nerve on my esophagus. But the gastro XXXXXXX think so. Then, I began to felt my pulse and realized is my heat n not my esophagus .

How are the connections explained?

It makes me feel like not wanting to get out of bed. Once up and upright, it will begin .. Laying down to sleep seemed to stop this.. Do u have any idea u is that so?

Thks for your patience
Answered by Dr. Anantharamakrishnan 10 hours later
There are too many questions – based mostly on impressions / In the absence of documentation, discussion will be like building a structure without a foundation! / We should wait for the results...
However, here are a few of my thoughts for your doubts..
•     If they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they should be investigated further.
•     There is no upper limit.
•     The feeling depends on individual sensitivity – some feel every single beat / some don’t feel a dozen beats.
•     One can not rid them by volition / Bio-feed back and relaxation techniques may reduce... or ignore them
•     Anxiety causes outpouring of adrenaline – that in turn causes this.
•     Nothing happens to the organs
•     Anxiety is least when getting up from bed / worsens with exposure and facing the world
•     One does not feel all the things all the times...
Psychiatric assessment and Psychological counselling can clarify the issue better.
•     Some people have had them for several years....
Everything can not be cured / some can be reduced / some made tolerable
The expense, inconvenience and risks of some treatments may not be acceptable to all .
They may not be compliant
They may not be following up
The underlying disease, causing it in them, might have been incurable
•     Digestion can set off several hormones / blood is diverted to the stomach for its work – causing
this. Stomach does not directly influence.
•     So too oesophagus cannot do this – unless it is too big to press or getting adherent...
•     There is no connection / so no explanation
•     Post hoc ergo propter hoc? / “After this, therefore because of this” – is not correct.
It is a common presumption and is wrong.
Above answer was peer-reviewed by
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 4 hours later
Dear Dr,

I will keep u update on the holter results. Meanwhile I would like to thank you for your clear explanation . I appreciate it lots.
Answered by Dr. Anantharamakrishnan 3 hours later

Relax and enjoy
All the best
God bless you
Above answer was peer-reviewed by
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 13 hours later
Dear doctor,

I had my holter monitor results and early skipped beats.
The frequencies as follows :
10am: 6 times
11am: 44 times
12pm: 3 times
1pm: 22 times
2pm: 11 times
3pm: 3 times
4pm: 22 times
5pm: 26 times
6pm: 28 times
7pm: 12 times
8pm: 18 times
9pm: 0 times
10pm: 4 times
11pm: 0 times
12am: 0 times
1am: 16 times
2am: 40 times
3am: 43 times
4am: 31 times
5am: 50 times
6am: 38 times
7am: 8 times
8am: 8 times

9am: 28 times

Total of 461 caught with the holter monitor 24 hours. May I know if this figure is safe ? Also I rember telling u in my earlier email I felt most comfortable when laying at rest, I was surprised that it happened the most when I was in deep sleep.. I felt the least when laying down ..

I'm worried that someday something will happen if I'm sleeping .. I heard people died in sleep!!

Please give me your advice
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 24 minutes later
ST-T is normal. By the way what's that? Do u think is necessary to take medication?? What else can I do?? I'm feeling everyone of them ?? I can't ignore it!!! Help me !!!
Sorry to add on the QRS total of 0000.
Answered by Dr. Anantharamakrishnan 1 hour later
The results are practically normal
This is a normal occurrence - seen in approximately 40 % of the teens / 60 % of adults and 80 % of elderly! Most of them don't know!
Normal ST-T is great news / it excludes silent ischemia (confirms adequate blood supply)

This is called benign (harmless).
The treatment is to ignore.

The risk is no different from those without missed beats.
In the absence of basic heart disease (as in your case), the risk is no different from general population.
In the absence of disease of blood vessel (no ST-T change confirms this) / in the absence of muscle disease (ECHO confirms), bad incidence is out of question...

No untoward event is likely to happen to you.
Fear of disease is worse than disease
Enjoy life... when you start enjoying, the problem will disappear / when the problem disappears, you will enjoy / this is a vicious cycle / you have to kick start it!

Good luck
God bless you
Above answer was peer-reviewed by
Follow-up: Heart Palpitation. EKG came fine. Took acid reflux, antacid. Any advice? 38 hours later
Dear doctor,

I'm trying my best to ignore them as much as possible . But it is always at the back of my head subconsciously that Its going to twitch anytime. Especially after meals, I try n distract myself but yet in waiting that it will come for sure. At least a few times. The heart over head "thing" is too strong .

I find it so hard to stay happy n enjoy life, but I'm trying my best to achieve this.

Once again , I appreciate each and everyone one your professional reply. Thanks

Answered by Dr. Anantharamakrishnan 5 hours later

Be bold / eat expecting that nothing will happen / and whatever may happen is harmless, as it has happened so far and so many times / face it consciously...

It is a question of time
To forget a thing 'consciously' is of course difficult... but will happen

Diversion - doing different things or the same things differently / deep involvement in things you do / Hobbies - will all help.
Having company will reassure...that help is at hand / Keep a short summary of your condition, the hospital and doctor to be contacted / in your that both you and they are comfortable.

Soon you will get over the problem / With time, you may even be able to advise and help others with similar problem!!!...

All the best
Above answer was peer-reviewed by
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