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Dr. Andrew Rynne

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What does heart fluttering during strenuous exercise indicate?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5760 Questions

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Posted on Sat, 2 Jun 2018 in Hypertension and Heart Disease
Question: Hello,

I'm a 24 year old weightlifter and long time athlete. I have low body fat levels and otherwise healthy. For quite a while I've had this "flutter" thing in my chest that happens sometimes. It can be once a day or once a month or in between.
I'm thinking this flutter feeling (which is sometimes very strong) is a PVC or PAC. Rarely it feels very strong (like a punch in the chest) but usually it isn't.
It happens usually at rest but sometimes happens right after doing an exercise set. For example when I do a very heavy bench press set and the bar comes down hard on my chest and I press up with extreme force - it happens (once every couple weeks) right when I stand up after the bench press set and it happens with a lot of force.

However this chest flutter is not symptomatic. I don't get dizzy or lightheaded or anything.

Usually it happens at rest when I bend over and lean forward.

2 weeks ago I had an hour where I got a lot of PVCs while sitting down but it went away a bit when I got up and walked around. But this was the first time I got them like every few minutes for an hour.

I have read these are benign but the sensation of the flip flop flutter feeling in my chest is disturbing and makes me worried and anxious.

Should I be worried about this at all? Especially the stronger PVC when I bench press (doesn't happen much).

Is there anything else it could be? My esophagus hitting the left atrium? Also my pulse is usually regular and good during exercise. No symptoms.

Thank you!
doctor
Answered by Dr. Ilir Sharka 47 minutes later
Brief Answer:
I would recommend performing some tests:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that it is necessary performing a comprehensive differential diagnosis of different possible causes that may lead to your clinical symptomatology: a cardiac arrhythmia or hypertrophic cardiomyopathy (especially considering the fact that you have been a weightlifter), gastro-esophageal reflux or a hiatal hernia, etc..

Anxiety can also mimic all this clinical scenario.

For this reason, I would recommend consulting with your attending physician for a careful physical exam and some tests to investigate for the possible underlying causes:

- a cardiac ultrasound and a resting ECG to examine your heart function and structure and investigate for any possible cardiomyopathy
- an ambulatory 24-48 hours ECG monitoring would help examine your heart rhythm trends for a prolonged time and exclude possible cardiac arrhythmia
- a chest X ray study
- complete blood count for anemia
- blood electrolytes for possible imbalance
- thyroid hormone levels for possible thyroid gland dysfunction.

I would also recommend trying an anti-acid or PPI (omeprazole, pantoprazole). If your symptoms are relieved by such drugs, it would be necessary performing a fibrogastroscopy to investigate for reflux or a hiatal hernia.

You should discuss with your doctor on the above tests.

If all the above tests result normal, you should consider anxiety as the main cause of your complaints.

Hope you will find this answer helpful!

I remain at your disposal, whenever you have any other questions.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 37 minutes later
Hello,

Thank you for the response.

I should have mentioned I've done a few tests in the past. Several normal EKGs including two which were during a time of stress, normal chest x ray, normal blood work except borderline potassium.

I have not checked thyroid function however.

I am a very anxious person though and do have high stress levels. Also I should mention I did not have any PVCs or anything when I read 2 bananas daily. Potassium maybe?

I also have a history of esophageal spasms. Could it be autonomic nervous system dysfunction?

From age 11 until now I have been a very serious athlete in track and field and weightlifting. Never had symptoms except the occasional PVC like now.

Thank you!

doctor
Answered by Dr. Ilir Sharka 6 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Thank you for the additional information!

Yes, potassium levels play a very important role in the heart rhythm.

For this reason, it is necessary checking again potassium levels.

Regarding autonomic nervous system dysfunction, it is less likely considering your symptoms. Nevertheless, a Head Up Tilt test would help investigate for orthostatic intolerance, which is a common finding in autonomic nervous system dysfunction.

Esophageal spasms usually are associated to severe chest pain, besides palpitations. Anyway, a fibrogastroscopy would help investigate for possible reflux or hiatal hernia, which can trigger this symptomatology.

Although you have performed repeated ECGs which have resulted normal, I would advice performing an ambulatory 24-48 hours ECG monitoring (Holter), which can help examine your heart rhythm for a prolonged period of time, compared to a resting ECG and investigate for possible cardiac arrhythmia.

Thyroid hormone levels should be investigated too.

You should discuss with your doctor on the above issues.

Hope to have clarified some of your uncertainties!

Let me know about everything!

Wishing all the best and a Happy New Year,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 7 minutes later
Thank you! Helpful information.

I noticed it only happens in exercise when doing heavy bench press where the barbell is putting heavy impact on my chest. That triggers it.

But would the several normal EKGs and other normal tests make it likely that it's nothing serious? I'm just worried about having something more serious. Blood pressure has always been good. The doctor who read my EKGs before said there isn't evidence of hypertrophy. So I'm hoping there's nothing serious...

As I'm in USA and live in Canada, I won't have access to medical tests for 1 month. That's why I'm worried...
doctor
Answered by Dr. Ilir Sharka 17 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Your symptoms do not indicate any serious medical disorder.

So, don't worry too much about it!

It can wait until consulting with your doctor!

I would just recommend avoiding the triggering factors (heavy bench and straining physical activity).

I would also advice trying an antiacid before training. If it helps improve your symptoms, it would be indicative of gastro-esophageal reflux or gastritis.

Hope you will find this answer helpful!

Wishing all the best,

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