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Are relentless heart fluttering felt in the chest area a cause for concern?

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Posted on Fri, 20 May 2016
Question: I have been getting these relentless heart fluttering felt in the chest area from sternum up to the neck area sometimes. It's been happening for four weeks now and it's worse in the mornings right through to early afternoon. Palpitations lasts anywhere between 30-60 seconds..... Stops for around 4 minutes then palpitations again over and over for most of the day. It's really concerning while it's happening and mabe the panic makes it worse. Please see attached a copy of the report given after I was connected to a 24 hour holter monitor.

My question is.... Is it serious and I need to further investigate it?
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully reviewed your Holter reports and would like to explain that those monomorphic premature ventricular complexes are not dangerous on their own, but they ma be an expression of certain cardiac or extra cardiac disorders:

Ventricular extra-systolic arrhythmia may be caused by myocardial ischemia or non-ischemic cardiac cardiomyopathy.

To exclude these possible causes it is necessary performing a cardiac ultrasound to examine the cardiac structure and function; excluding that way possible presence of cardiomyopathy.
A cardiac stress test is necessary to investigate the presence of cardiac ischemia.

If sufficient suspicion is raised about possible coronary artery disease, other imaging tests may be helpful:

- cardiac stress echo (echo dobutamine)
- coronary angio CT
- nuclear perfusional cardiac stress tests (CARDIOLITE)


Regarding extracardiac cause I would mention :

- Lung disorders leading to acido-basic imbalances
- Electrolyte imbalances
- Chronic anemia
- Thyroid dysfunction

For this purpose I would recommend performing:

-a lung chest X ray
- lab blood tests (complete blood count, blood gas analysis, blood electrolytes, kidney and liver function tests, thyroid hormone levels).

You should discuss with your attending physician on the above tests.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (16 hours later)
Thank you for your response. I have had blood tests regarding these palpitations which were done at a ER in a hospital i attended. (Though i dont know exactly what type of blood test ws done but i can assume whatever was needed to rule out heart atack) and all the results came back as ok.

Something else ive noticed but forgot to mention....
Its worse in the mornings about 15 minutes after i get out of bed then lasts all morning till just after mid day.Sometimes it wakes me from sleep early inthe mornings.

Another trigger is, often during i go to the toilet, mainly when im urinating and i get that pee shuder feeling triggers off the palpitation momentarily.

Something else i discovered last couple of days thats odd or just mabe a coincidence is that when i eat say late morning or lunch time.... The palpitation goes away and stays away usualy till the next day.
doctor
Answered by Dr. Ilir Sharka (48 minutes later)
Brief Answer:
My opinion:

Detailed Answer:
Hello again,

Thank you for the additional information.

I would say that it is important to review all the already performed medical tests.

The fact that the tests performed in ER during your visit have resulted OK, doesn’t mean that a coronary artery disease is totally excluded, as this latter may be done only with more extensive investigation (the above mentioned tests and also coronary angiography).

They only have excluded an acute cardiac ischemia symptomatology.

If it is possible I would like the whole Holter report (what is the exact number of isolated ventricular extra-systoles? What is their exact distribution throughout the day-night period?)

Could you upload any available already performed tests?

I still recommend that the above tests (mentioned at the beginning of our thread) should be checked.

Also the level of circulating catecholamines should be tested.

I also recommend you monitoring closely your blood pressure values to exclude any adverse implication of hypotention on premature occurrence during urination or after having meals.

I remain at your disposal for further discussions.

Please upload any available test reports.

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 8608 Questions

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Are relentless heart fluttering felt in the chest area a cause for concern?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! I carefully reviewed your Holter reports and would like to explain that those monomorphic premature ventricular complexes are not dangerous on their own, but they ma be an expression of certain cardiac or extra cardiac disorders: Ventricular extra-systolic arrhythmia may be caused by myocardial ischemia or non-ischemic cardiac cardiomyopathy. To exclude these possible causes it is necessary performing a cardiac ultrasound to examine the cardiac structure and function; excluding that way possible presence of cardiomyopathy. A cardiac stress test is necessary to investigate the presence of cardiac ischemia. If sufficient suspicion is raised about possible coronary artery disease, other imaging tests may be helpful: - cardiac stress echo (echo dobutamine) - coronary angio CT - nuclear perfusional cardiac stress tests (CARDIOLITE) Regarding extracardiac cause I would mention : - Lung disorders leading to acido-basic imbalances - Electrolyte imbalances - Chronic anemia - Thyroid dysfunction For this purpose I would recommend performing: -a lung chest X ray - lab blood tests (complete blood count, blood gas analysis, blood electrolytes, kidney and liver function tests, thyroid hormone levels). You should discuss with your attending physician on the above tests. Hope you will find this answer helpful! Kind regards, Dr. Iliri