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Dr. Andrew Rynne

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What causes severe heart palpitations and dizziness?

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Dr. Sameer Maheshwari

Cardiologist

Practicing since :2010

Answered : 754 Questions

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Posted on Thu, 13 Apr 2017 in Hypertension and Heart Disease
Question: I've always had a palpatation here and there, but now I'm having a episode about every hour. More so every time i stand up or walk around. It makes me really dizzy and lightheaded. Should I be worried.
doctor
Answered by Dr. Sameer Maheshwari 34 minutes later
Brief Answer:
Needs evaluation

Detailed Answer:
Hi,
This is Dr Sameer, cardiologist.
I went through your earlier questions & found that you have been having these palpitations since long. Cardiology related tests for palpitations like Stress echo, Holter monitoring, echo & thyroid profile has already been done & they are absolutely normal.

Considering all these, the most probable diagnosis looks like Anxiety causing all these palpitations.
But to be 100% sure, i want you to do one more test called ILR(Implantable Loop Recorder). It is similar to holter but can monitor the ECG for 1 month. We put in patients similar to you who have frequent palpitations but holter(which is for 1 or 2 days) is normal.
Excessive palpitations due to anxiety (as a result of excessive sympathetic surge) needs treatment in addition to anti anxiety drugs. We generally give medicine called BETA BLOCKER which blocks the sympathetic receptor & helps relieve palpitations.

One another condition causing excessive sympathetic surge leading to palpitations is Adrenal gland overactivity. We recommend test called 24hr Urinary Metanephrine & catecholamine to rule it out. Treatment is again beta blocker.

Coronary disease is extremely rare possibility for you & you should not even think about it.
Go for these tests (24 hr urinary metanephrine & catecholamine and put a ELR) and you will know the exact diagnosis.
If both comes normal treatment will be a anti anxiety drug + a beta blocker.

Thanks & take care
Above answer was peer-reviewed by : Dr. Remy Koshy
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Follow up: Dr. Sameer Maheshwari 16 minutes later
Without a beta blocker is it harmful? What's the difference between the loop recorder and a 30 day holter monitor
doctor
Answered by Dr. Sameer Maheshwari 6 minutes later
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back.
Beta blocker are just to block the increased sympathetic surge due to anxiety. Without them you will probably continue to have palpitations.
We start from a very low dose i.e. 12.5mg of Metoprolol & increase the dose as per patient tolerance & symptoms. And believe me it is really effective.
30 day holter & ELR have same function. If you have done a 30 day Holter, you need not to repeat that again.
I can understand what you are going through with your health problems. But you should try to not think about it which will reduce your anxiety & you will gradually see that these palpitations will disappear.
Thanks & take care
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Sameer Maheshwari 22 minutes later
I know I suffer with anxiety but you see no need for repeat tests??? Even if 6 to 12 months ago??
doctor
Answered by Dr. Sameer Maheshwari 12 minutes later
Brief Answer:
Please see detailed answer

Detailed Answer:
Welcome back.
If the palpitations have increased in intensity from that of previous time than only you should go for 30 days holter. If it happens daily & every time than 24hr Holter will be enough. But get that urine examination done for sure.
Your main problem is anxiety & you should focus more on that. Once that goes away their will be no palpitations. Thinking Excessively about the palpitations & desire to do more & more tests will only increase the anxiety further & thus the palpitations. You can also try doing Yoga to relax your mind & body and you will be definitely benefited by it.
If you have any more question, I'll be happy to help.
Thanks
Above answer was peer-reviewed by : Dr. Remy Koshy
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