Hi friend, Welcome to Health Care Magic It is easier and is often necessary to treat many conditions than to diagnose the cause.... There are two approaches to treatment – 1- Symptomatic relief 2- Disease modifying / Your doctor has justly given symptomatic treatment. You must stop smoking You need further investigations... Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much coffee, cola) / Medicines like Phenylephrine used for ‘cold’; Salbutamol used for asthma and so on are common causes.../ Fever / Thyroid / Vitamin D, calcium and magnesium may all have a role... / Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats / At times, abnormal nerve paths in the heart (bypass tracts) are responsible! HOLTER (24 to 48 hour ambulatory monitoring) is done to analyse and plan for further management, if a routine ECG does not show. 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. 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 investigation – 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. Though the test is the gold standard, it is INVASIVE and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation. Take care Wishing speedy recovery God bless Good luck