Question: Hi,

I am a 31 year old male with no long term health problems. About 3 weeks ago, I felt flutters on my chest that became repetitive over the next few days. These flutters would happen if I did any movement, even walking around would cause the feeling of chest fluttering and for a split second, shortness of breath. I also had very short duration chest pains, usually in the middle of the sternum, either a bit to the right or to the left. I went to my local GP who first diagnosed me with some sort of esophageal reflux, since my EKG came clean and she couldn't hear any distinctive murmurs in my heart nor I had any movement pains in my chest. A couple of days later, I had a severe onset of these palpitations and went to the ER, where I was diagnosed with extrasystoles and a possible hint of myocarditis. The myocarditis was not evident on a further echocardiogram, although the cardiologist told me that my left ventricule is slightly larger than normal (~58mm) but otherwise my heart was working fine. Over the following days, the chest pains and flutters became less common and now they are almost gone, but substituted with a constant feeling of lightheadedness/drowsiness. It is ever present, no matter which position I'm in, although it's not severe enough to make me lose my balance. There is also a slight feeling of pressure in my throat that comes and goes, along with a slight stiffness to my hands. I seem to feel better after a good night sleep, but if I don't get enough rest, like today, it gets worse. I also seem to be unable to sleep on my left side, since the pain on the chest reappears after a while - and I can pinpoint it to the middle of the sternum, slightly to the right (between ribs).

I am still holding on the results of a 24-h Holter monitor, but the dizziness is worrying me. By BP varies between 115/75 and 130/80 depending on the time of day, which I assume is normal. Sometimes I have small twitches randomly on my body (thighs, back, etc) and my hands get cold rather easily. I have no other symptoms (cough, loose bowel movements, fever, etc). I had a blood exam in the ER that found no evidence of ischemia or other apparent blood issues but since they did not control for iron or B12 levels, I wonder if I might be defficient in one of those nutrients. One of my doctors tries to make a connection between these symptoms and anxiety which I totally refute as I dealt with anexiety many years ago

Can someone point me to possible causes of this situation or further tests that I should ask my doctor to perform? I would be very appreciative.

Hello Dr Wahal,

It is a bit confusing to me that so far all heart-related exames (blood pressure, auscultation, multiple EKGs, Eco-cardiogram) revealed no hints of heart insufficiency. My ejection fraction was normal and there were no signes of exertion from my heart muscle. Plus, the pain is not constant and does not occur on exercise - I cycle somewhat regularly, as far as I can say it is rather random or slightly postural, even though the lightheadedness is constant, getting better with rest.

Can there be a motive behind this that is not heart-related? Something to do with the autonomous nervous system, nurtrient deficiency, or adverse reaction to the pronton pump inhibitor I have been taking, maybe? What other exams would you recommend to differentially diagnose?

Regards,

XXXXXX