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What causes heart palpitations, flushing and tingling arms?

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Posted on Mon, 14 Dec 2015
Question: I have been diagnosed with heart palpitations (pvcs). Occasionally when I feel a palpitation it is followed by a flushing, tingling down my left arm that dissipates after 10-15 seconds. Sometimes the flush goes across my back between my shoulder blades. I also have GERD and this happens sometimes after I eat, though not always. I'm scared that I might be having a heart attack or this is a signal one could happen. I've been in the er twice this week because of these symptoms and both times I checked out fine, still it's a scary sensation.
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I understand your concern and would explain that it is important to perform a careful differential diagnosis of different causes that may lead to your symptomatology:

- cardiac ischemia can not be excluded as it may mimic this clinical scenario and also be the cause of PVCs. Do you experience other symptoms like shortness of breath, chest pain, etc?
- flushing may also be a sign of the possible beginning of menopause. Do you have irregular menstrual cycle? At your age a possible hormone imbalance preceding the menopause could be the cause of flushing.
- a backbone disorder: a slipped disk in your cervical column could cause neck and back pain with tingling in the left arm.
- Gerd could also cause pain irradiating between the shoulders and heartburn, but with no relation to palpitations.
- thyroid dysfunction could lead to cardiac arrhythmia and flushing too.
- anxiety could mimic all this clinical scenario.

I would like to know what are your previous cardiac tests (which lead to the diagnosis of PVCs)? Could you please upload them for me to review? Have you performed cardiac enzymes in the ER during these episodes? Could you please upload them for me to review?

I recommend performing some tests to investigate for the above mentioned disorders:

- a stress test or a stress echo to rule in/out for possible cardiac ischemia.
- an ambulatory 24-48 hours ECG monitoring would be helpful to examine your heart rhythm trends during the day (if you have not performed yet this test)
- a cervical column X ray study and a nerve conduction study to investigate for possible backbone disorder and nerve compression in the upper limbs.
- blood lab tests (complete blood count, PCR, sedimentation rate, kidney and liver function tests, blood electrolytes, thyroid hormone levels, fasting glucose, sex hormone plasma levels)
- if you have an irregular menstrual cycle a gynecologic ultrasound would help besides the sex hormone plasma levels.

If all the above mentioned tests result normal, the main cause of your troubles would remain anxiety.

Hope to have been helpful!

Please feel free to ask any other questions whenever you need!

Best wishes!

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka (19 minutes later)
Thank you for the information! About 10 days ago I had an echocardiogram which came back fine. While in the ER, blood tests were run including troponin which all also came back fine (the doctors didn't give me the actual results, but said the tests looked good). Basically, in the last several months I've had many tests (with the exception of a stress test) and everything checks out. That will be my next step. Since the echo looked good, could there still be a hidden issue?
doctor
Answered by Dr. Ilir Sharka (4 hours later)
Brief Answer:
Alternative (non-cardiac) reasons seem to be most probable.

Detailed Answer:


Hello again,

Though it doesn't seem that your symptoms to be cardiac related, I recommend you to proceed with the cardiac stress test as the next step to be followed.

As I advised you above, a comprehensive differential diagnosis is necessary to conclude the right responsible cause.

I strongly insist you should follow a scheduled diagnostic strategy including the above mentioned tests (those not already checked).

Please let me know about the test results (by uploading them for a direct review)!

Wishing you a pleasant weekend,

Kind 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 : 8485 Questions

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What causes heart palpitations, flushing and tingling arms?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! I understand your concern and would explain that it is important to perform a careful differential diagnosis of different causes that may lead to your symptomatology: - cardiac ischemia can not be excluded as it may mimic this clinical scenario and also be the cause of PVCs. Do you experience other symptoms like shortness of breath, chest pain, etc? - flushing may also be a sign of the possible beginning of menopause. Do you have irregular menstrual cycle? At your age a possible hormone imbalance preceding the menopause could be the cause of flushing. - a backbone disorder: a slipped disk in your cervical column could cause neck and back pain with tingling in the left arm. - Gerd could also cause pain irradiating between the shoulders and heartburn, but with no relation to palpitations. - thyroid dysfunction could lead to cardiac arrhythmia and flushing too. - anxiety could mimic all this clinical scenario. I would like to know what are your previous cardiac tests (which lead to the diagnosis of PVCs)? Could you please upload them for me to review? Have you performed cardiac enzymes in the ER during these episodes? Could you please upload them for me to review? I recommend performing some tests to investigate for the above mentioned disorders: - a stress test or a stress echo to rule in/out for possible cardiac ischemia. - an ambulatory 24-48 hours ECG monitoring would be helpful to examine your heart rhythm trends during the day (if you have not performed yet this test) - a cervical column X ray study and a nerve conduction study to investigate for possible backbone disorder and nerve compression in the upper limbs. - blood lab tests (complete blood count, PCR, sedimentation rate, kidney and liver function tests, blood electrolytes, thyroid hormone levels, fasting glucose, sex hormone plasma levels) - if you have an irregular menstrual cycle a gynecologic ultrasound would help besides the sex hormone plasma levels. If all the above mentioned tests result normal, the main cause of your troubles would remain anxiety. Hope to have been helpful! Please feel free to ask any other questions whenever you need! Best wishes! Dr. Iliri