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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Irregular Heartbeats With Right Side Chest Pain?

59 yo female; Have intermittent upper right chest pain, irregularly irregular heartbeat, skipping 10-12 beats per minute, pulse 68-70, 10 yr hx hypertension - controlled. Has been happening off and on today. and intermittently over past week. ER or Urgent care
Mon, 29 Jun 2015
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Cardiologist 's  Response
Hi. Thank you and welcome to HCM. I read your query. I will try to be thorough with my answer.

If this is really an irregularly irregular heartbeat, combined with your description, there is a good probability this a supraventricular arrhythmia, called atrial fibrillation. It can have various origins, which act on atrial chamber by enlarging it.

First, I would recommend an echocardiogram, to assess the valvular function, as well as to measure the atrial chamber by area and volume. Concomitantly, I would also recommend you to be put on 24-hour Holter rhythm monitor, to assess how often do these episodes occur in a day. If the are paroxysmal, then you should start treatment with a drug that controls the rhythm and prevents other episodes from happening, such as a beta-blocker (atenolol 50 mg x 2 tb/d) or a calcium channel blocker (verapamil 40 mg x 3 tb/d). If from the 24-hour registration results that this arrhythmia is persistent, then factors from echocardiogram should determine whether to try converting into sinus rhythm or not. If yes, since this would be an atrial fibrillation not know for how long has been there, proper anticoagulation should be initiated (I would suggest low-molecular weight heparin) and conversion to sinus rhythm should be tried (pharmacological or electrical). In case that, after assessing all the factors, this atrial fibrillation is declared chronic, then a rate-controlling drug and proper anticoagulation with acenocoumarol or warfarin, should be instituted. My opinion is that all these maneuvers should be undertaken in a healthcare facility, where proper monitoring is readily available.

I hope I was helpful. Take care.
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What Causes Irregular Heartbeats With Right Side Chest Pain?

Hi. Thank you and welcome to HCM. I read your query. I will try to be thorough with my answer. If this is really an irregularly irregular heartbeat, combined with your description, there is a good probability this a supraventricular arrhythmia, called atrial fibrillation. It can have various origins, which act on atrial chamber by enlarging it. First, I would recommend an echocardiogram, to assess the valvular function, as well as to measure the atrial chamber by area and volume. Concomitantly, I would also recommend you to be put on 24-hour Holter rhythm monitor, to assess how often do these episodes occur in a day. If the are paroxysmal, then you should start treatment with a drug that controls the rhythm and prevents other episodes from happening, such as a beta-blocker (atenolol 50 mg x 2 tb/d) or a calcium channel blocker (verapamil 40 mg x 3 tb/d). If from the 24-hour registration results that this arrhythmia is persistent, then factors from echocardiogram should determine whether to try converting into sinus rhythm or not. If yes, since this would be an atrial fibrillation not know for how long has been there, proper anticoagulation should be initiated (I would suggest low-molecular weight heparin) and conversion to sinus rhythm should be tried (pharmacological or electrical). In case that, after assessing all the factors, this atrial fibrillation is declared chronic, then a rate-controlling drug and proper anticoagulation with acenocoumarol or warfarin, should be instituted. My opinion is that all these maneuvers should be undertaken in a healthcare facility, where proper monitoring is readily available. I hope I was helpful. Take care.