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What causes severe heart palpitations?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5916 Questions

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Posted on Fri, 17 Mar 2017 in Hypertension and Heart Disease
Question: I have been experiencing heart palpitations for 18-20 months - consistently. I am being seen by a cardiologist, but the time between visits and attention is not adequate. I have had EKG, ECG, Zio Patch,Chest X-Ray, Stress Test and blood work. On Dec 22, I experienced an AFib event which put me in the hospital where they administered cardioversion. I went on a therapy of Xarelto for 30 days. I continued to take Metoprolol and Multaq, and now a baby aspirin to replace the Xarelato. While I have not had another Afib event, my palpitations are getting and have been far more aggressive and longer lasting. Currently the doctor is not alarmed and wants to continue to say the metoprolol "should" be keeping the palpitations at bay. By the way - all the tests show PVCs... but I assume these are benign since the cardiologists has not prescribed anything else. I am wanting to know, if I am missing something, should I be doing something to drill down further on this? I am afraid to exercise nor do much else. I am 52 yr old male in otherwise good health. 6'1" 195 lbs I think.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your medical history and would explain as follows:

a - After that successfully converted atrial fibrillation episode, it is necessary to be always attentive of possible recurrences. In this regard, it is important to avoid potential triggering factors such as alcoholic or caffeinated drinks, avoid close smoking contact, maintain a regular life-style and sleeping profile.

I would encourage you to keep being physically active and not be afraid of any deleterious effects of training. Of course it is important to follow a properly scheduled training program under supervision of a qualified fitness expert.

This will improve your physical endurance, cardiac chronotropic response, blood circulation; decrease level of anxiety and burn excessive calories.

b - As you actually have left behind that AFib episode and a month has passed, it is rationale that anti-coagulation has stopped and an anti-arrhythmic maintaining therapy established.

Coming to this point, what is more important seems to be quantification of this maintaining treatment. This is done by monitoring your heart rhythm for a longer period of time. In this regard, it is recommended 24 to 48 hours ECG monitoring (Holter).

This is also valid for your recurrent PVCs.

I would explain that PVCs could not be a marker of a serious cardiac disorder as far as a normal cardiac structure and function have been concluded by the performed tests (cardiac ultrasound, cardiac stress test) and no excessive amount of them is confirmed by Holter monitoring.

So, the best thing to do is perform periodically Holter monitoring for two main reason:
1) screen for possible complex cardiac arrhythmia occurrence (including recurrent AFibs) and quantify the exact level and day-night trends of PVCs.

2) explore the effectiveness of your maintenance ahti0arrhythmic therapy (by comparing consecutive Holter tests). Metoprolol and Multaq are also recommended drugs for PVCs.

So, you should relax as your therapy is properly targeted!

But, what is important in this period is an appropriate surveillance of cardiac rhythm issues and also checking other possible triggering factors of cardiac arrhythmia, such as:

- a pulmonary disorder (it is recommended pulmonary function tests and arterial blood gas analysis),
- thyroid disorder (checking thyroid hormone levels),
- electrolytes imbalance (checking blood electrolytes level),
- inflammation (PCR, ESR),
- liver and renal function tests,
- glucose metabolism disorders (fasting blood glucose, HbA1C)

After avoiding the above prescribed triggering factors and assuring that the above mentioned imbalances are not present, it would be more easy to control the level of those benign PVCs and properly judge about the therapy effectiveness (through periodic Holter monitoring).

You need to discuss with your attending physician on the above mentioned issues.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 33 minutes later
Thank you Dr. IIiri -

So you know - I have been Holter Monitored (Zio Patch) a couple times, but will suggest we do it again so they can see if there is any Afib present during the palpitations. Also, the day to night PVC's have changed. This could be pure anxiety as well.

I have not been checked for any pulmonary disorder or inflammation PCR and ESR, but have been checked for thyroid, electrolytes, liver and renal and glucose metabolism. I will make sure though.

I don't smoke, drink nor consume caffeine. I truly try to stay away from all possible triggers as I hate these palps.

Your reassurance though with exercise and telling me to relax is very helpful. I am scared to death to exercise and always worried I should be doing, eating, taking something different. All my blood work comes back good as well. No cardiac enzymes, and nothing out of the ordinary.

Thank you
doctor
Answered by Dr. Ilir Sharka 48 minutes later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

I am glad that most of your tests have resulted normal. This is a very reassuring fact that nothing serious is going on with you!

So, just relax and don't worry about it!

You can feel free to exercise as you like. Of course aerobics, yoga and recreational sports are more recommendable. I would just recommend avoiding straining physical activity (like weight lifting or racing).

Anyway, if you wish, you can perform the additional recommended tests in order to exclude every possible underlying causes.

Hope to have clarified some of your uncertainties!

Let me know about everything!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 18 minutes later
Thank you!!
doctor
Answered by Dr. Ilir Sharka 6 minutes later
Brief Answer:
You are welcom!

Detailed Answer:
I am glad to have been helpful!

You can ask me directly at any time if your like, in case of any other questions or for a review of your performed tests.

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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