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What Causes Heart Palpitations At Night Prior To Sleeping?

Posted on Tue, 3 Feb 2015

Question: Hi I have some questions regarding my PACS. I was feeling palpitations several on the ago and was sent to a cardiologist. He ran several tests including an echo, ECG, stress test, holter monitor, and loop monitor for 24 hours. The results of the echo showed a structurally normal heart with some trace regurgitation. Which he said was normal in most hearts. Every function and size of the heart was perfect. The holter monitor picked up 925 PACS over 48 hours. 2 bigamy cycles and 3 couplet cycles very short. It only showed 1 single ventricular beat. I suffer greatly from anxiety and panic especially lately. I have had episodes where my heart will race at 160 BPM through the day but very short 2 minutes or less and slows down when I do deep breathing and drink water. The PACS I feel at night before bed and when I wake up in the morning. I don't know if it's happening when I sleep. I am worried about this but my doctor says they are benign. He didn't explain anything toe which freaks me out more. Is that too many PACS I've heard people can have tens of thousands in a day but I don't know. These tests were 5 months ago. How often do I need a repeat of the tests? My cardiologist told me at least 3 years. I eat very well and have lost 75 lbs over the last 10 months.

Answered by Dr. Noble Zachariah (55 minutes later)

Brief Answer:
There is nothing to worry regarding the PACs

Detailed Answer:
Hello ,
Welcome to HCM and thanks for your query. I understand your concern.
I am glad that your heart is normal. Did your cardiologist mention MVP ( mitral valve prolapse ). It occurs in many people who have irregular heart beat (arrhythmia ) . There is no arrhythmia of concern in your Holter monitoring. PACs are benign and there is nothing to worry about them, even though they can be uncomfortable and anxiety provoking.
Did your doctor suggest any medicines to control them?
I congratulate you on losing weight. Eat healthy wholesome food, avoiding caffeinated beverages, exercise for at least 30 minutes a day, practice stress relieving measures like yoga, meditation or relaxation techniques . These would help reduce your panic attacks and arrhythmias.
For my patients who have no other illness like asthma or diabetes, I advise a simple medicine to control their PACs if they are troubled by the arrhytmia.
Relax, it is not necessary to repeat your tests now. If you practice what I have advised, you are likely to be benefited.
Take care,
Dr Noble Zachariah

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

Follow up: Dr. Noble Zachariah (6 minutes later)

Hi Doctor Thank you for your detailed answer. My monitors did say sinus rythm so no other arythmia. What worries me is my resting heart rate is around 56 is that too low. My cardiologist says it's fine. I'm not very active right now because I was worried about my heart.

Also is the very mild regurgitation anything of concern. The test results said structurally normal? I worry at night because my heart rate slows down and the PACS Start. As long as I know they are not a concern I will try stress reduction before medicine. Also someone told me to try magnesium, omega 3 and potassium. They said it can help a lot with PACS. Do you recommend that?

Answered by Dr. Noble Zachariah (15 minutes later)

Brief Answer:
Please get blood level done before taking Potassiu

Detailed Answer:
You have not mentioned your age. A heart rate of 56 is okay provided it comes up with exercise.
How low does your heart rate come down before the palpitation starts? Do you have PACs or sinus tachycardia then? Omega 3 fatty acids are fine. Please check your Magnesium and Potassium levels in the blood. You can take them if they are low.
If you can upload a tracing of the arrhytmia, I shall comment on it.
Sometimes people require electrophysiological studies.

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

Follow up: Dr. Noble Zachariah (10 minutes later)

My heart rate goes to 56 at rest at night if I'm sitting on the couch. The lowest they caught it was 50 but that was in deep sleep. I am 31 years old. When I walk around or move around heart rate goes up. It's only at rest. If I'm completely relaxed it is around 56-60 bpm

Answered by Dr. Noble Zachariah (6 minutes later)

Brief Answer:
Better to have an electrophysiological study

Detailed Answer:
There is no harm in doing moderate exercise.
You may require an electrophysiological study.

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

Follow up: Dr. Noble Zachariah (5 minutes later)

Ok I got the report here it is

Over 48 hour holter monitor
Total beats 198000
26 % of beats in bradycardia
12 % of beats in tachycardia

925 PACS

915 Single pacs
3 couplets
4 bigamy
0 runs totalling 0 beats

Average heart rate of 71

Answered by Dr. Noble Zachariah (22 minutes later)

Brief Answer:
Holter analysis is fine. Do you have the tracing.

Detailed Answer:
This is fine.
Could you send me the tracing when the bradycardia triggers the tachycardia or PACs?
If you are not able to do it through this site, you can do it through http://www.drnoblezachariah.com/home/ask-a-doctor

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

Follow up: Dr. Noble Zachariah (1 minute later)

Oh sorry doctor I do not have that. All I have is the results from holter and echo and a letter from my cardiologist stating that I have benign PACS.

Answered by Dr. Noble Zachariah (1 hour later)

Brief Answer:
Ok

Detailed Answer:
It is okay. Next time when the heart rate drops and you are likely to get an arrhythmia, try walking around or exercise mildly and see if it will avert the arrhytmia.
An electrophysiological study if possible would be helpful.

Note: For further queries related to coronary artery disease and prevention, click here.

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