Brief Answer:
I would explain as follows

Detailed Answer:

Hello,

Regarding your concern, it is quite possible to have cardiac arrhythmia with a normal heart rate.

This means that you can have skipped heart beats, which do not alter the mean heart rate.

But, you should also know that these types of cardiac arrhythmia are usually associated with symptoms like shortness of breath, palpitations, dizziness, etc.

You can catch them by closely monitoring your pulse, although the heart rate is not high or low.

Regarding atrial fibrillation, it may be paroxysmal and when lasting for some seconds, it may not cause any significant increase in the heart rate. So, it is quite possible.

Anyway, I would like to know your symptoms.

If you experience any of the above mentioned symptoms (shortness of breath, palpitations) time after time, I would recommend performing some tests in order to investigate for possible cardiac arrhythmia:

- An ambulatory 24-48 hours ambulatory ECG monitoring to examine your heart rhythm trends for a prolonged time and investigate for possible cardiac arrhythmia
- A cardiac ultrasound to examine your heart function and structure
- Thyroid hormone levels for thyroid gland dysfunction
- Complete blood count for anemia
- Blood electrolytes for possible imbalances.

If these episodes are rare, a prolonged Holter (one month) or a loop recorder would be more helpful to detect possible episodes of cardiac arrhythmia.

You should discuss with your doctor on the above tests.

Hope you will find this answer helpful! I remain at your disposal for any further questions whenever you need!
Regards,
Dr. Iliri

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Brief Answer:
My opinion as follows

Detailed Answer:

Hi,

The fact that your symptoms improved by Valsalva maneuver, indicates that the autonomic nervous system is playing an important role in these episodes.

Coming to this point, it may be necessary to make a clinical differential diagnosis between a normal sinus tachycardia and a possible supraventricular arrhythmia.

You should know that anxiety, caffeine, or physical activity can activate the sympathetic nervous system, leading to a similar clinical scenario, which is more prominent in susceptible and sensitive patients.

Anyway, I agree with you on the fact that we can not conclude that it is just anxiety and exclude any possible cardiac arrhythmia, just based on the fact that your Holter monitoring has resulted normal.

For this reason, I would recommend discussing with your cardiologist on the possibility of having a loop recorder, which is a more accurate tool to help 'catch' rare episodes of arrhythmia, which can not be registered by a normal Holter monitoring.

I would also recommend performing the above mentioned blood lab tests, in order to exclude a possible metabolic disorder (like anemia, thyroid gland dysfunction or electrolyte imbalance), which can trigger this clinical situation.

Hope to have clarified some of your uncertainties! If you have any other questions, please don't hesitate to ask me again! Wishing all the best.
Dr. Iliri

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