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Skipped heartbeats, taking Metoprolol, normal EKG, echogram and stress test. What to do next?

Hi, my name is Judy. I have been working out most of my young adult and older adult life. I am 59 years old and recently have been experiencing skipped heart beats that are interfering in my life style being that I am a personal fitness trainer. I have seen a cardiologist , have had EKG , echogram, stress test and all have come back normal . I have been hooked up tp a halter monitor and the doctor has verified that I am indeed experiencing many skipped beats. He has put me on a double dose of metoprolol 25 mg X 2 daily. it seems to take the edge off but whenever I get overexerted or get up quickly it starts again. I am totally frustrated and dont know what to do next. I also have MS which was diagnosed in 2000
Asked On : Tue, 9 Oct 2012
Answers:  1 Views:  148
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Cardiologist 's  Response
Hi Judy,
Thanks for writing in.
I am a qualified and certified cardiologist.
I read your mail with diligence. All your diseases are compatible with near normal life provided we can control these with treatment.
Without the benefit of knowing what was found on Holter there are two possibilities which would have been revealed on Holter:
1. Paroxysmal Supra ventricular Tachycardia (PSVT) then the next step in the treatment would be RF ablation if you are suitable candidate for that electophysiologically. Second option is to switch the drugs either to long acting Verapamil or to Diltiazem. You may need a pacemaker for this condition or the next one so as to take care of heart rate dropping very low. or Holter might have revealed:
2. Intermittent Atrial Fibrillation: Anti arrhythmia pacemaker have not been fully developed. Radio frequency ablation techniques are more complicated then those for PSVT. More dosage of drugs with standby pacemaker and blood thinners to prevent emboli would be my line of treatment. Therefore, treatment depends on the diagnosis arrived in your case.
I am assuming by MS you mean multiple sclerosis which is unrelated illness with no effect on treatment either way; you are not referring to mitral stenosis which is a cardiac valvular disease and has relation to causation and treatment of skipped beats. Good Luck.
With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)

Answered: Thu, 11 Oct 2012
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