Question for the Doctors

Factual Questions
1

I’ll preface this by saying I’m not so much seeking medical advice or trying to get anyone to diagnosis me, rather I’m mainly just looking for some ideas from people that would know.

Anyways Thursday before last late at night (like 3am late) I start getting strong heart palpitations. I know they are palpitations not because I’ve ever had them before but because I’m a fairly hypochondriacal person and have read up on literally hundreds of symptoms. Everything I knew told me these were palpitations. I considered this somewhat alarming because I’ve never really had them with any regularity or for a prolonged period of time.

Anyways the palpitations are bad enough that I cannot sleep. I should insert the info here that I’ve been exhibiting some very insomniac behavior as of late (last few months) so going a night without sleep has become unfortunately common for me. Now what keeps me awake is more an anxiet as opposed to actual discomfort from the palpitations.

The next day I schedule an appointment with my physician and go over to his office. He takes my pulse, blood pressure, and listens to my heart in his examining room. He says my pulse is slightly elevated but he said it’s not at a point he would consider serious (it’s 110 bpm, which is actually what I consider pretty high because I’m in fairly good shape and my resting heart rate isn’t near 110 bpm.)

He tells me it could be stress, lack of sleep, change in eating habits, dehydration et cetera (all of those things have been going on in my life, my eating habits have changed because I’ve been busy and haven’t been able to eat my regular diet, and the business alluded to above contributes greatly to my stress, and plus I’ve drank a good bit of alcohol lately and not near enough water.)

Anyways I take his word for it and throughout Thursday night and Friday night I’m completely fine. I do have a recurrence of the palpitations once or twice but it’s minor and there is no accompanying chest pain or dizziness or anything like that (basically the list of things I’ve read that mean heart attack/stroke if they occur with palpitations.)

Well Saturday at about noon I get a very strong series of palpitations. Enough that I feel extremely worried and decide to go to the emergency room. As I walk in to the ER I can literally hear my heart pounding almost ubiquitously.

At the ER my pulse is recorded as high as 130 bpm, and my blood pressure is recorded as high as 177/(something, forget what), when it was like 122/80 when I was examined by my regular physician.

I had some electrodes on my chest for most of my four hour stay at the ER, and I was hooked up to a machine that was consistently monitoring my heart rate and breathing.

While at the ER chest x-rays were taken, they took blood samples, an EKG, and I was examined in the same way my physician examined me while I was at his office.

After about 4-5 hours the ER doctor comes in and basically says, “You want to go home?” He tells me he’s found nothing in any of the tests he’s done that point to a problem. He says these palpitations are either related to some sort of behavior I’ve been going through (stress/eating/sleep/et al.) or some kind of rare abnormality.

He then hooked me up with a little device referred to as a holter monitor and kept me on that for 48 hours, I’ve since taken it back to the doctor. Sometime at the end of the week I’m supposed to go back to my regular physician and I believe he’ll have the results of the holter monitor test.

So what I’m wondering from my Doper friends is, do any of you have any ideas as to what’s going on here? I’m still having the palpitations, almost always when I’m trying to go to sleep, much less so throughout the day (but occasionally.) They’ve never felt as strong as they did on Saturday nor have they persisted throughout the day like they did then.

It’s been over a week since I was at the ER (the Saturday I’m referring to above is the Saturday before last) and I’ve been getting more regular sleep, I have again normalized my eating schedule (I do a lot of working out and have a very regimented eating schedule most of the time), and have quit worrying about the things that stressed me. Yet the problems persist.

If I “passed” the chest x-ray, the blood exam, the EKG, what could this be? Should I be worried? Should I not? How common is it for a heart condition to be present that eludes all of those tests?

2

IANAD, but went through similar symptoms as yours more than 10 years ago and was eventually diagnosed with mitral valve prolapse, a heart abnormality which, while not dangerous in my case, was a real PITA. (It’s usually easily treated, and in my case, I’m fine as long as I’m not burning the candle at both ends. I am supposed to take antibiotics before getting my teeth cleaned, though. But in short, it’s no big deal.)

The one thing you haven’t mentioned is your caffeine intake. If you’ve been somewhat insomniac, are you trying to compensate for fatigue with caffeine? If so, that in itself might be causing the rapid heartbeat. Happens to me on as little as 2-3 cups of coffee.

3

Well, if he’s checking out okay on the physical side, there’s the possibility of anxiety disorder (panic disorder).

Nobody’s said those two words to you yet?

Read.

http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/anxiety.html

More grist for the hypochondriac’s mill, I know… :smiley:

4

I have had something like this off and on for about a year or so. I take medication for high blood pressure. I don’t know what you consider “palpitations”, but I occasionally could tell that my heart seemed to be beating harder than normal, faster, and it felt like I had a lump in my throat when it happened. It felt to me like my heart was skipping beats. It would beat fast, then stop, then start up fast again.

Usually the symptoms didn’t last more than a few minutes at one time and didn’t persist for very long. One day it bothered me off and on for several hours and I decided to drop by a “doc-in-the-box” clinic and see what was up. I had the problem while the doctor examined me and he ran some tests.

He ran a blood test because a thyroid condition can cause the symptoms, but my thyroid was in the center of normal. He ran an electrical test and said that what I thought was a skipped beat was actually the heart trying to slow down to its regular rhythym from the faster beat. He said that the heart was firing extra beats when it didn’t need to. He also said that there was different ways this happens, but that the way mine was doing it was not a dangerous form. He incresed my blood pressure medication because one of its values is that it helped prevent the extra beats from happening. He also gave me a script for Xanax to help relieve my anxiety about it. He also told me that stress (which I have had a lot of lately) could be causing it.

Sometimes I go for days with no occurances, sometimes it bothers me a few minutes a day and no more. A few times a week it hangs around for a while and I take a Xanax and it seems to go away. I can’t determine any factor that causes the symptoms to start. They just come without warning. There is no pain or discomfort other than the feeling of the lump in my throat, which I have read is a typical symptom of this condition. It is an uncomfortable feeling, and if it continues to bother me, I will go to a specialist and see what can be done.

Does anyone with medical or personal knowledge of this condition have an opinion as to what caused this problem to start at this time and what can be done to cure or prevent it?

5

The differential diagnosis would include panic disorder, stress, hyperthyroidism, mild heart arrhythmias (PSVT, PAF, mitral valve prolapse) and dehydration. The more sinister diagnoses are likely to be excluded with a Holter monitor, the tests you had and a good clinical exam. Thyroid blood tests and an echocradiogram are occasionally required. Most cases of palpitations are benign.