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What is causing chest tightness and feeling like missed heart beat?

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Practicing since : 1981
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Over the past couple of weeks my husband has had chest tightness and the feeling his heart is missing beats, sometime a few beats at a time. He went to the ER, has done a EKG, Treadmill test, all tests so far have come back fine. He is scheduled to have a ultrascound in 2 weeks. The ER Dr said palpitiations and anxiety. Never had anxiety until this happened and says he doesn't get stressed. The papitations get worse at night when he lays down. Doesn't drink coffee or smoke. Is it common for them to get worse at night, any advise as to what he can do to help would be great appreciated.
Posted Sat, 24 Nov 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
Thanks for writing in.
I am a qualified and certified cardiologist and I read your mail with diligence. I will discuss your husband's problem in two parts I. Pain and chest tightness and
II. Arrhythmia (missing of beats, palpitation)
Chest pain raises the question of heart attack (Myocardial Infarction) or mismatch of blood supply to the heart muscle and its demand (Angina).
We label a patient with pain related to heart (Myocardial Infarction) when two of three of following criteria are met, according to World Health Organization Guidlines:
1. Typically, retro sternal (midline) squeezing or suffocating chest pain almost always associated with shortness of breath; usually accompanied by sweating rapid heart rate, sinking sensation radiating to neck and left arm. Pain of heart attack lasts for more than half an hour. Electric shock like pain lasting for seconds take me away from any insult to the heart as a source of pain.

2. Associated with increased in blood parameters like cardiac enzymes creatine phospokinase MB fraction (CPK-MB), Troponin T or I and serum myoglobin

3. Typical EKG changes of waves of EKG.
Your husband did not have any. Also, treadmill test would have brought about the pain of Angina. It did not
As you did not fill criteria of pain and EKG so pain related to heart attack has been excluded. As sensations carried from above the diaphragm(from chest and arms) are carried to cervical nervous system through cervical spine that is another diagnosis of cervical spondylosis which can explain this. After doctor has thoroughly examined you he/she would advise you:
1. An x-ray or scan of Cervical Spine if positive, hard bed no pillow, thin mattress, neck exercises and avoidance of jerky movements of neck is first line.
2. Some do require collar for the treatment.
Other cause is GERD:
At times your gastric contents (which are acidic) spill into food pipe esophagus, this Gastroesophageal Reflux can mimic the symptoms of heart pain. Please ask your doctor if he wants to prescribe prescription medicines for this. OTC medicines antacids one and three after meals should give you relief meanwhile.
But with age of 47 we can not run away from Coronary Artery Disease.
Let us review risk factors for coronary artery disease at any age. Seven are modifiable and for three non modifiable no one can do much:
1. High Blood Pressure
2. High Bad Cholesterol or its component that is Total Cholesterol, LDL and
3. Low Good Cholesterol or its components HDL is the main
4. Stress in fact Hypertension is stress in action.
5. Diabetes
6. Smoking
7. Obesity and Sedentary life style.
in elderly deficiency of folic acid leading to increased homocysteine and in Indians especially, Lipoprotein a (LPa) are additional risk factors.
Non Modifiable Risk Factors:
1. Family History
2. Being a man (women are protected till the age 45)
3 Increasing age

So, you may have some risk factors that is one can conclude. Please see your doctor and get the list completed and if you are lucky enough not to have any of the risk factor start taking preventive measures for unmodifiable risk factors that you are a man and age will increase only. No junk food, No Junk Thoughts, proper exercise are the key that you do not see a cardiologist as a patient in rest of your life see him only as a friend.
Normally, heart beats for about 100,000 times a day (72 x 60 x 24); one percent of these beats can be normally out of rhythm, to a sensitive and more perceptive persons these may be perceived as missed beats. At times heart can beat faster rate it can be due to rhythm disorder which can be:
1. Proxysmal Supra Ventricular Tachycardia (PSVT), comes like a bolt from blue and after few minutes to hours stops as abruptly as it came. Manifests as Palpitation. This is not the symptom your husband is having.
2. Inappropriate Sinus Tachycardia: Similar to above but gradual set in and set off also manifests as palpitation that is not the situation with your husband.
3. Irregular beats inappropriately timed ventricular or supra ventricular ectopics which may manifest as missed beats or at times as palpitation. If ventricular function is normal (as determined by clinical examination, echocardiography or when there is normal ability to perform adequate exercise in form of stress test it is normal) then these ectopics are of not much significance except a little apprehension for the person who perceives them. All of us are exposed to stress, how we react to that is what counts. Once investigated and declared normal heart I assume anxiety will also be alleviated. Personally, I feel the planned ultrasound of heart that is echocardiography which is scheduled later will confirm normal structure and function of heart.

Modifying life style to avoid I & II
And finally to counter these risk factors you must aim for doing adequate exercise which is brisk walk at the speed of 5 KM/Hour for forty minutes a day is sufficient cardiac exercise. The diet depends upon you are vegetarian or non vegetarian. If you have any question for me I will be happy to answer however in health care magic drugs are not prescribed only recommended. If your doctor feels, you can be prescribed anxiolytics which are not OTC drugs. Good luck.
With Best Wishes. If you have any further query I wll be most happy to answer it.

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: What is causing chest tightness and feeling like missed heart beat? 3 hours later
Thank you XXXXXXX for your quick and detailed response.
I need to ask, is it normal for someone to general feel unwell when this palpitations occur. My husband says that it is really hard to explain but when they occur he doesn't feel great. There is also a feeling of apprehension, waiting for them to start, would this make you feel unwell. He's knows so far the tests have been fine but still feels something is not right.
Thank you
Answered by Dr. Anil Grover 34 minutes later
Thanks for writing back.
For normal person if arrhythmia produces symptoms it is abnormal when apprehension of heart disease is not there. Severity and consequeces are explained by the doctor and this is absolutely benign, as confirmed by doctor. You need to see a cardiologist and that after echocardiography (which has been advised) and Holter (24 hour recording and analysis- this I am suggesting) before any cardiologist can declare these to be absolutely benign with almost 100% certainity.
Thanks for asking this question.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: What is causing chest tightness and feeling like missed heart beat? 11 minutes later
Thank you again, you have been most helpful and very informative. I will share this information with my husband. I wish the echocardiography was tomorrow, 2 weeks seems forever.

Answered by Dr. Anil Grover 1 hour later
Thank you XXXXXXX I appreciate your words of kindness. It was a pleasure interacting with you. Kindly close the query with remarks and stars. Regards
Good Luck.

Dr Anil Grover
Above answer was peer-reviewed by
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