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Heart palpitation, low and irregular heart rate, dizziness, chocked chest, taken diltiazem. Cure?

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Practicing since : 2002
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Hi, I am 31 yr old female with the weight 115 ponds, 6'5" height. I have history of heart palpitation. I was on new drug - ditiazem - for nearly three months and just stopped. Now I just have been on Flecainide acetate for two days but the palpitation doesn't improve that I am having an episode from 10:30 am till now (17:21 pm). What should I do?
Posted Fri, 27 Apr 2012 in Heart Rate and Rhythm Disorders
Follow-up: Heart palpitation, low and irregular heart rate, dizziness, chocked chest, taken diltiazem. Cure? 8 minutes later
In addition, the heart rate wonders about 50 beats per minute. The rhythm is irregular, and skips beat very often. I feel dizzy, short in breath, and need to lean on something when I stand. The chest feels like it is stuffed.
Answered by Dr. Robert Galamaga 12 minutes later
Hello and thank you for submitting your question.

Your question is a very good one and I will work on providing you with good information and recommendations regarding what is going on with your heart.
My first question in concern is why the diltiazem was discontinued. If it was working fine. I wonder why your doctor discontinued this.

Regarding the other medication. It may take some time for you to get to a therapeutic level. However if you are experiencing these symptoms of palpitations I recommend that you see a physician as soon as possible for a complete examination and consultation. I think you should call your doctor tomorrow morning for a close conversation and immediate follow up.

I cannot think you're dealing with any type of life threatening situation right now. I think the rhythm disturbance would you are experiencing may require further intervention. I think you need to see a cardiac electrophysiologist. Sometimes there are procedures which can be done to actually minimize this type of rhythm disorder. For now trying to worry very much until you see your doctor tomorrow.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. One other thing I cannot mention earlier is that I recommend you discontinue the use of any type of stimulant for depressant medications including alcohol caffeine and nicotine.
If you have any additional concerns regarding this I would be happy to address them.


Dr. Robert.
Above answer was peer-reviewed by
Follow-up: Heart palpitation, low and irregular heart rate, dizziness, chocked chest, taken diltiazem. Cure? 1 hour later
Thank you Dr. XXXXXXX

Your response was helpful which makes me more aware of the level of urgency. I just began to feel back to myself an hour ago.

I was seen by a doctor specialized in arrhythmia. We stopped diltiazem because of the frequency of the palpitation and fatigue didn't ease but gained more after two months. Therefore the cardiologist decided to make me take the Flecainide. I will be seen by another cardiologist who is specialized in "electrophysiology" in two days, as you pointed out. It makes me feel like I will be on the right track very soon.

The primary doctor and the cardiologist seem to ignore that the each individual has different stress and tolerance level. My primary concern is that an episode lasting over 3 hours is definitely going to wear me down (and I just had one lasting over 6 hours). This is unacceptable. Since I am going to see a specialist very soon, according to this minimum information, what should I emphasize during the appointment? And what kind of information would a "electrophysiology" doctor would look for? I am hoping to well prepare for the meeting. Your recommendation would be very very helpful. Thank you very much again for your attention and time.

Best Regards,



Answered by Dr. Robert Galamaga 2 hours later
Hello and thank you for your follow-up question.

I would also like to thank you for involving me in the decision-making process what you are going through right now. Certainly when you have issues with your heart. It is very concerning and can be a very significant source of anxiety.

I am very happy to know that you will be visiting with an electrophysiologist very soon. The things that you should emphasize with the electrophysiologist are the degree to which the issues with your heart are affecting your activities of daily living. It is important for him to know how well your functioning on a daily basis.

Also you should make it very clear to the position that you would like to have this managed aggressively. There are procedures which can be done which may lead to a situation where you may not have to rely on medications. These procedures are referred to as ablations.

I also think that you should emphasize to the electrophysiologist that you are open to pursuing a procedure to address this issue. I have seen many patients do very well with this procedure and I think it could possibly provide you with a great benefit.

I thank you again for submitting your question. I hope my response has surf to be helpful informative and reassuring. If you have any additional concerns I am still here for you.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Heart palpitation, low and irregular heart rate, dizziness, chocked chest, taken diltiazem. Cure? 3 days later

I am pleased to let you know that I followed your advice and expressed to the electrophysicologist how much the palpitation (which is mostly irregular beat - namely symptomatic PVCs) had effected my daily life. The new doctor located that it is the spot near the arota, LV where the abnormal electric triggers the skipping beat. Upon my visit, I was frustrated by 6-hr long of irregular beat, BP 90/52, pulse 55. The doctor thought that the Flecainide is not an appropriate prescription to my condition and asked me to stop taking it immediately. We wait for few days till the effect of the drug ceased, then we will do Holter test, stress test, and MRA in order to have a closer look at the structure of the heart. Due to the risk, the operation may very likely not able to perform. And the rate of the PVCs recorded in XXXXXXX was fairly low. We will see how the symptom goes and the test result. After knowing those information, I was much relief. The appointment was made on 9/13.

Strangely, after stopping the Flecainide (as well as Diatizem which seemed to worn me down in the past two months), the dizzines, fatigue, and the skipping beats are gone. For two days, my body has been so harmonious with a well-performed heart (with the exception after the meal, which is quite normal to me). In the meantime, it is also almost a week after I cut off all the coffee and tea. I also allow myself to be easy to my work and he colleagues since the business are getting on the right truck. I wonder if this is merely a temporal condition.

Of course I wish that the Holter will be able to record the type of symptom which I experienced during the past 1.5 month. More do I enjoy the harmony provided the health, but in the meantime I am amazed by how rapidly the body changes and reacts.

Question: do you think that the symptoms - such as dizziness, fatigues, feeling weak (almost about to tremble), short in breath - might contribute to the side effect of the dosage?

This question was denied by the first doctor (who gave me dialtizem and flecainide). And it still puzzled me.

Prior to the whole scenario, I occasionally took Inderal when the irregular beats perform. It was pretty as much as I needed till to the point that the drug couldn't suppress the symptom - the drug might be too old, or the dosage was too light.

It would be wonderful to hear from you again. Your advice has been very helpful. I found that your profession has sufficed my question. Your opinions are very valuable to me. Thank you for reading this long letter. I am looking forward to your advice again.

Best Regards,


Answered by Dr. Robert Galamaga 14 hours later
Thank you for the follow up question.

First of all, I completely understand your concern in this situation. I want you to go to the specialist in the near future with a full knowledge of what is going on as well as full priority in knowing exactly what you need to discuss.

I think what you need to make abundantly clear to this physician is that this condition is certainly affecting your quality of life as well as your ability to complete all of your activities of daily living. This is a very important thing to consider when talking about what types of interventions can be done.

I would like you to inquire about the possibility of a procedure which he might be able to perform which has the potential to provide you with situation in the future where you do not need to rely on medications. These types of procedures have advanced tremendously within the last five years. Electro cardiologists or electrophysiologists have really learned quite a bit in this field and are able to significantly impact the quality of life of their patients.

Regarding your question about the side effects of medications you are on. Fatigue and weakness are among the side effects of Diltiazem. But we can not blame only the medicine for these symptoms. You can discuss these issues also with your Cardiologist.

In summary my recommendations to you are to provide a good deal of information to your specialist and let him know how significantly this is really affecting your life. This is having both a physical and mental impact on you and in that sense it is potentially disabling. I think he will be very open to discussing all of the options with you and I hope you are able to have an excellent and open discussion with him.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Wish you speedy recovery.


Dr. Robert
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