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Heart palpitations since long, nausea, hot flashes, sharp short headaches, skipped heart beats, ECG and blood tests normal.Worry?

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Cardiologist, Interventional
Practicing since : 1996
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Ongoing heart palpatations :

Hi everyone, I'm male, 23 and reasonably healthy, for about 5 years now i've been suffering with heart palpations. To be more specific my heart will occasionally skip a beat or do some kind of double beat, for years it really bothered me, i made several trips to the doctors, had two ECG's and a blood test, but nothing was found to be wrong. Over the years i've came to live with it and learnt that generally i think its caused by anxiety, stress and in some cases food/caffeine. Most of the time i try to not let it bother me, but it's always a niggiling concern in the back of my mind and i have been given no explanation by a doctor as to what it could be (even if it is just anxiety, that has not been suggested to me). I'm sure anxiety plays a big part but i don't think i can be the sole cause.

Anyway, over the past few days i've felt myself feeling quite under the weather. I've been feeling nauseousness, had hot flushes and random sharp short headaches, today it went a step further and actually got a little scary for me. I began the day feeling quite weak and my heart felt very obvious to me in my chest, i was very aware of its beating, but it wasn't beating particularly fast. It skipped a beat and i didn't think much of it and then it did it a few more times, at one point after a skip (which probably happened once every 3-4 mins) i would sometimes feel a sudden rush of blood around my chest, my face became very hot and i became instantly nauseous. I tried to calm myself down and it probably only lasted for about 20 minutes on and off and i spent the rest of the day just trying to be relaxed and calm.

What i want to know, if this is something to be worried about? Is my doctor right and it's nothing to be worried about, or is there some underlying condition that i'm perhaps making worse by thinking about it.

Are there any other tests i could request to have done to help put my mind at ease?

Posted Sun, 6 May 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Raja Sekhar Varma 17 hours later
Thank you for your query.

I have gone through the details that you have provided.

It is apparent that you probably may be having occasional ectopic beats, also called as extra-systoles. These may be atrial, junctional or ventricular types. They may occur singly, in pairs. It may be regular or irregular. Very rarely, this may trigger a rapid heart rate (tachycardia).

The first step is to document the exact arrhythmia. If your skipped beats occur on a daily basis, the most reliable way to document this is to do a 24 hour Holter monitor, wherein ECG leads are attached and your ECG recorded continuously for 24 hours. You can press a button when you feel the symptoms and this can be correlated with the ECG at that particular instant.

If your symptoms do not occur on a daily basis, there are event recorders which will record your ECG for upto 72 hours (usually, only when you press a button, not a continuous recording).

If it is even more infrequent, you will have to resort to an implantable loop recorder which is surgically placed below your skin. This will enable diagnosis of very infrequent events.

Depending on the diagnosis of the arrhythmia, some ancillary tests like serum electrolytes, thyroid function tests, echocardiography of the heart, etc may need to be done. In case of any significant arrhythmias, an invasive cardiac electrophysiological testing can be done to confirm the diagnosis and also pave way for definitive treatment of the arrhythmias with procedures like radio-frequency ablation.

Most skipped beats are usually benign, and do not need any specific treatment other than regulate stress, anxiety, excess of tea/coffee, avoiding sleeplessness, taking care of electrolyte imbalances, etc.

However, I would advocate the necessity of documenting exactly what is going on. Once you know for sure what the arrhythmia is, you can be reassured about its harmless nature. In case there is anything significant, a proper diagnosis will help you to take definitive/curative treatment.

I hope this answers your query. Feel free to get back to me for any further clarifications that you may need.

With regards,
Dr RS Varma
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