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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Feeling cold, shaky, fluttering in chest. Blood and urine test fine. What could this be?

Answered by
Dr. Anil Grover


Practicing since :1981

Answered : 922 Questions

Posted on Sat, 15 Dec 2012 in Hypertension and Heart Disease
Question: hi i keep feeling shivery really cold episodes and twitching , shaky, trembling type spasms and having fluttering in chest like palpitations i had a heart echo two years ago and stress test have had numerous ecgs and blood tests 24 blood pressure and urine tests but doctors have always said i am fine what could this be ? i do feel very unfit and unhealthy and am overweight but i do really want to get fit and maintain it so i am fit as poss and start eating really healthy but just dont know where to start and how fast how many days for how long to push my body i dont work cause have just been diagnosed with aspergers adhd after at 28 years old been through lots of stress over number of years and anxiety am on anti depressents 45 mg of mirtazipine, have been for about 5 years i keep thinking i need to see dietician and have full body check up etc get proper help with fitness from gp or fitness instructor but have never been refered or gps just say there is no such plans to build up,please could you help me with this i have also been on blood pressure register since 2001 but have never been put on meds it is up high reguarly and been told by nurses that i should be on them could you helpme with this hope to hear from you thanks, XXXXXXX male
Answered by Dr. Anil Grover 3 hours later

Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence.
Apart from some symptoms which can be attributed to anxiety the symptoms of skipped beats, is definitely not due to Heart Disease (I noted at the age 26 you have been tested thoroughly). You said you are overweight but not mentioned your height and weight. For the purpose of treatment let us divide your problems into three: 1. heart related: Skipped Beats and high blood pressure 2: Anxiety/ Stress related and thrid weight related.
Heart Related:
What you have described are the symptoms of heart beating out of rhythm that is arrhythmia. Normally, heart beats for about 100,000 times a day (72 x 60 x 24); one percent of these beats can be normally out of rhythm, to a sensitive and more perceptive person, these may be perceived as missed beats. You have 40 that is 0.004% abnormal beats as recorded by Holter which you know A further test of Holter may be needed if your ECG suggests or cardiologist feel, wherein 24 recording of ECGs is done by a portable i pod like device to be analyzed by a computer, In normal persons Holter has revealed that at times heart can beat faster rate it can be due to rhythm disorder which can be:
1. Paroxysmal Supra Ventricular Tachycardia (PSVT), comes like a bolt from blue and after few minutes to hours stops as abruptly as it came. Manifests as Palpitation. This is not the symptom you are having.
2. Inappropriate Sinus Tachycardia: Similar to above but gradual set in and set off also manifests as palpitation that is not the situation with you.
3. Irregular beats inappropriately timed ventricular or supra ventricular ectopics (Paroxysmal Atrial Ectopics or PAC's) which may manifest as missed beats or at times as palpitation. If ventricular function is normal (as determined by clinical examination, echocardiography or when there is normal ability to perform adequate exercise in form of stress test it is normal) then these ectopics are of not much significance except a little apprehension for the person who perceives them. All of us are exposed to stress, how we react to that is what counts. Once investigated and declared normal heart I assume anxiety will also be alleviated.

Personally, I feel a cardiology consult, where a cardiologist will thoroughly examine you and may plan ultrasound of heart that is echocardiography which would confirm normal structure and function of the heart. . These are needed to find whether remotely, you need any medication or not. There is nothing to worry, the whole thing could be normal aberration and after illness have become more perceptive.
2: Anxiety and Stress Related (even first and third could be due to this)
Meanwhile, start doing yogic exercises which act as stress buster. You must remember stress is universal it is reaction to stress which matters and wrong reaction or aggressive reaction is the one which causes harm. I have taken this translation of original Sanskrit description of one of the yogic asana. It can be done without much effort ten minutes in the morning and ten minutes in the evening.
I quote:
How do you do Savasana?
1. Lie with your back, legs straight, and arms at your sides. Rest on your hands five
inches apart from your body with palms facing upward.
2. Rest on your feet drops open and closes your eyes.
3. Let your breath occur naturally, when breath is free mind also free. When the
breath is, allows moving naturally, the mind settles into itself.
4. Allow your body and mind to feel heavy on the ground.
5. From your feet soles to head-crown, consciously set free every body part, organ,
and cell.
5. Relax your face; make your eyes drop XXXXXXX into their sockets.
6. Welcome peace and silence into your mind, body, and soul.
To exit savasana:
1. First take a XXXXXXX breath followed by gentle movement from toes to head (head
be the last part) and awareness back to your body.
2. Then, slowly roll to your right side and rested there for few seconds, inhale and
comfortably move to seated position.
Hindrance or obstacles to the savasana
The most common obstacles to a Savasana practice are:

Nap (a brief sleep),
Mental agitation,

Although Savasana is the most difficult asana to perform, the focus is simple - relax everything (every body part and mind). If you get distracted or agitated, you can always undo, unwind, let go from the start
End of quote
Weight Related.
Please write in follow up how much do you weigh and what is your height. Also add what exercise you undertake and let us evolve a solution of balanced diet, no junk food, exercise and no junk thoughts. You will do well.
The other symptoms you described are related to stress and touch of depression. Let me hear from you a little more, so that I can offer suggestions on that count as well.

If there is further query which you might have I will be most happy to answer. Good Luck.
With Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Anil Grover 4 hours later
hi thanks for replying with your answers, i am around 5 ft 11 and weigh around 12 half to 13 stone, i am quite concerned about the shivering and jitery feeling feeling cold and trembling could you please update me on this? well i have been eating lots of junk food but am trying to eat salads etc it is really hard for me to get my head around cooking and making things as i live on my own and split up with girlfriend dont know many people round my area and i want get as fit as poss, well i would like to have a goal of 2 hours 6 days a week of vigourous exercise but worried about pushing my body too fast, how can i build up slowly? also people tell me that i dont need to be a sportsman etc even though it will be good i have not done much excercise for years but now is time to start, also what can i do with work etc as i do have people who will help me get back in as i am signed off? also the life stressers and mental health problems do get in the way but am getting support finally.I am worried about my blood pressure and have been told i need meds by various people but gps seem to differ please could you let me know what you think about this. hope to hear from you soon XXXXXXX
Answered by Dr. Anil Grover 42 minutes later
Hi, thanks for writing back. I calculated your BMI on the basis of height and weight you provided, it came out as 27 that is not OBESE but mere overweight and exercise alone can help you a lot, if managing food is very diffficult.
Underweight = <18.5
•Normal weight = 18.5–24.9
•Overweight = 25–29.9
•Obesity = BMI of 30 or greater
By exercise I mean, brisk walk, for about 40 minutes as a speed of 3.5 miles per hour. Use parks where you can use walkman and music. If the weather is not conducive you can do this while doing window shopping in malls and please avoid esclators and elevators as much as possible. That should not be difficult.
That brings us to shivering and jittery feeling; get yoen ur thyroid function tests done if those are normal, try to get around this feeling by concentrating on something else.

Blood Pressure: buy a digital self recording recorder (for arm). Go for CE certified or FDA certified model. Once get it standardised at your GP's clinic: a nurse or physician's assistant will help you there ought not be any randomn error in it. Then maintain a thrice week record of different time of day (not more than twice a day) recordings for about three weeks. You will know whether anything needs to be done for it. You can ask me if you feel it is abnormal.

With the measures listed in previous mail and this mail you will feel definitely better, if not ask me again, I will be only too happy to help. Good luck.

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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