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Having heart palpitation and fluttering sensation. Normal echocardiogram. Worrisome

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I have had 2 echocardiograms in the last 5 years and all checked out fine. But I still get heart palpitations. This week try have taken on a new form. I get a flutter or a few skipped beats when I get up and walk, walk fast, or if I lean back in my chair or cross my legs. Why? Is this something to worry about? I'm scared.
Posted Thu, 21 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 35 minutes later
Hi friend,
Welcome to Health Care Magic

Feeling of ‘dropping / skipping / missed / flutter / irregular beat’ is known as arrhythmia.
IT needs to be DOCUMENTED.
A thorough history and physical examination is the first step -
ECHOcardiogram has excluded valves (heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality), as a cause. It is reassuring.
Anxiety / Alcohol / Tobacco (smoking, chewing) / Caffeine (too much coffee, cola) are common causes.
Medicines may be responsible – like Phenylephrine used for ‘cold’ / Salbutamol used for asthma and so on.
Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats
Also, abnormal nerve paths in the heart (bypass tracts) are responsible...
These beats are common and often may be normal.
Yet it is advisable to have further investigations, in view of the change in pattern or frequency.

ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.
If a routine ECG does not show, HOLTER (24 to 48 hour ambulatory monitoring) is done to analyse and plan for further management     

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. Your Internist shall suggest based on the situation.

If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced techniques of investigations – 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 has a risk (though minimal) 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.
These ectopic beats are not always symptomatic.
The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat.
Specific treatment may not always be necessary.

The first line medicine is generally beta blockers (like Metoprolol) – slow release and small dose. It will benefit both anxiety and missed beats. Your doctor will give proper prescription and follow up

If they are not effective and if the problem is severe, several other classes of drugs are available – acting by different mechanisms - the specialist will decide tailored to your needs / they may have side effects and need follow up.

There are other advanced treatment modalities - like RF ablation, which could be done during EPS.
Be in touch with your doctor - it is a question of time and you will be well.
Medicine is well advanced nowadays – management is possible for almost all situations...

Take care
Wishing speedy recovery
God bless
Good luck
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