Question: This message is for Dr. Ilir Sharka, Cardiologist

Hello Dr. Sharka,
You helped me with many questions that I had about heart palpitations back in 2017 and 2018 and you made me feel better about my situation so I wanted to ask you my questions today.

I am a 46 year old healthy, non-smoker. I began having heart palpitations in 2017. I saw a cardiologist and the tests I had back then included a 24 hour and 48 hour heart monitor, ECGs, chest X-ray, a lot of blood work, echocardiogram and stress test. I know those tests results are 6 years old, but I’ll attach them for you anyway. The cardiologist said he saw nothing wrong with my heart and diagnosed me with PVCs.

In early 2019 I had a flare up of palpitations for about 3-4 weeks. Since they were uncomfortable my doctor put me on 5mg of Bisoprolol which I still continue to take. I still get palpitations on the bisoprolol, but it has helped a lot. Some days I have little to no palpitations at all. Sometimes I get a flare up where I might have a few days of more palpitations than usual, but it subsides after 2-3 days. Sometimes they are caused by movement, sometimes they just occur when resting.

Over the last 4 to 5 days I have been in a flare up which is causing me a lot of discomfort and anxiety. During this flare up I don’t have many palpitations while sitting or laying down, but as soon as I get up and move around, I start getting a lot of them. They feel like the type where your heart skips a beat and then you get a big thud (I’m not sure if those are PVCs or PACs). When I get the thud, I often get that feeling of adrenaline going through me which makes me feel very uncomfortable. Since I am getting several palpitations (probably 1 palpitation for every 10-20 beats, but as little as 5-10 beats) that feeling of adrenaline keeps going through me over and over. It makes me feel weak, a little short of breath and my arms and legs feel like jelly (or like I’ve run a race) and I have to sit down. I’m not out of breath, but I kind of feel short of breath - like it takes my breath away. It’s happening with almost any type of movement, but of course it’s worse with the more movements I do. When I sit or lay down and relax they settle down (unless I start to get anxious about it all - then they continue to happen, but once I relax the palpitations settle down and I feel normal).

I am not sure what triggered this flare up. I don’t think I’m any more stressed than usual, but maybe I am?? My period is due in a couple of days and I did have cramping and spotting last week for several days. I’m not sure if my hormones may be playing a part in this (plus I am 46 and I’m noticing changes in my periods and hormones).

I saw my doctor today. My blood pressure was normal and my blood oxygen level was 100%. My doctor listened to my heart. He heard a couple of my palpitations and said they seemed to happen at the same time I was breathing. He said my heart rate sounded normal otherwise. He said he is not worried about it, but he’s sending me for a 48 hour holter monitor which I will wear from Wednesday to Friday this week. I guess I will not get the results until the following week. He said that maybe I will need a different medication than bisoprolol, depending on the results.

I am just wondering if you have seen this in patients before?

When it feels like my heart skips a beat and then I feel a thud, do you know what causes that adrenaline feeling to go through my body and make me feel weak? Is it actually adrenaline? Is it dangerous that that is happening?

Is it possible that hormones or stress triggered this flare up?

Since I get the palpitations and that awful feeling mostly with movement, I am nervous to be very active. Should I be resting more or is it safe to continue my usual activities? I do not do anything strenuous, just cleaning, cooking, etc. We do have a vacation coming up in two and a half weeks which will require a lot of walking. I’m nervous about the trip now.

Thank you for your help. I appreciate any advice or information you can give me.

Hi Dr. Sharka,
Thank you for your previous answer! I am just reopening this question I asked you over a week ago about my heart palpitations because I have more questions.

I wore the 48 hour holter monitor and returned it 8 days ago. I do not have a copy of the results, but my doctor went over them with me. He said out of the approximate 200,000 beats I had in the 48 hour period, only 0. 2% were palpitations. There were no strings of palpitations. They were all individual. He said they were benign. My heart rate was normal and there was no arrhythmia. He said my results indicated no issues. He and I think that the flare up was likely caused by hormones because a few days after my period started, the palpitations went away. We also agreed that the symptoms of weak legs and shortness of breath I experienced were due to the anxiety that the palpitations were causing me. Those symptoms also subsided.

Now through the night and into this morning I have been getting short, intermittent pains in the left side of my chest. The pains only last 1-2 seconds and come about every 5 to 30 minutes. The pain is usually dull (not very sharp). It is pretty much always in the same place and I could probably pinpoint where it is. I have no other symptoms such as shortness of breath, dizziness, nausea, etc. I have a lot of trapped gas in my abdomen through last night and this morning as I have been dealing with some constipation. My abdomen is a bit bloated and sore from the gas.
I also have general back problems and when I press on my ribs in the area I am getting the pains, it hurts.

I am just concerned why I am getting these intermittent pains in the left side of my chest. They just come out of nowhere for a second and go away. Does it sound like the pains could be coming from my heart? Would the holter monitor have detected if there is a blockage or other problem with my heart? Is it possible this pain could be from trapped gas or my back problems? Do you think I should see a doctor today or go to the emergency room? I am not in discomfort. I am just anxious about why this is happening.

Thank you. I appreciate any help or advice you can give.