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What Causes Palpitations Despite A Normal ECHO Report?
Question: I am almost 59years old i have been treated for 3 months for Acid Reflux, I have flutters/skipped beats presently which seem to start after i eat and continue intermmittently throughout the day until I go to sleep. I seldom feel them at rest unless I am laying on the left side. I have been to my cardio, who seems to be dismissive. I had an excellent echo, although that was prior to this. I had a holter monitor which did not pick up anything and all EKGs are normal. Bloodwook is normal too. I am happy about all of this, but neverless lately whenever I eat or change body positions I feel the flutters. I am not SOB and no pain. I take: Diovan; Atorvastin; Synthroid and now Prevacid - I have been under stress from the recent GERD but now I feel fine with that. If it were not for the palpitions I would feel great. No palpitions when sitting or laying, just after eating and standing/walking. The cardiologist is referring me back to the GI doc. who does not want to change the prevacid right now. Thoughts?
Brief Answer:
please provide more details.
Detailed Answer:
Dear Madam
Please provide me following details.
1. Skip beats and flutter are two different things scientifically. If you feel multiple missed beats or they are irregular beats for a considerable duration. Do you ever feel as if you are passing out during those palpitation. If you ever had a fall without explanation / blackout / pre-syncope during those episodes.
2. How much long back the ECHO was normal prior to beginning of these episodes. Did you feel any symptoms / palpitation or flutter during the 24 hours when holter monitor was on ? Can you share the report of holter?
3. When did you last get your TSH checked (that's a thyroid function test)?
4. How much is consumption of coffee/ tea/ cigarette in a given day? How much anxious you are normally as compared to an average person? Do you take any OTC drugs pertaining to common cold or flu frequently?
Waiting for your reply
Sincerely
Sukhvinder
please provide more details.
Detailed Answer:
Dear Madam
Please provide me following details.
1. Skip beats and flutter are two different things scientifically. If you feel multiple missed beats or they are irregular beats for a considerable duration. Do you ever feel as if you are passing out during those palpitation. If you ever had a fall without explanation / blackout / pre-syncope during those episodes.
2. How much long back the ECHO was normal prior to beginning of these episodes. Did you feel any symptoms / palpitation or flutter during the 24 hours when holter monitor was on ? Can you share the report of holter?
3. When did you last get your TSH checked (that's a thyroid function test)?
4. How much is consumption of coffee/ tea/ cigarette in a given day? How much anxious you are normally as compared to an average person? Do you take any OTC drugs pertaining to common cold or flu frequently?
Waiting for your reply
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Hi
1 - seems like flutters (almost like an eye twitch would feel but in the chest) No I never feel like I am going to pass out or anything like that. I stating "skipped beats" because if I take my pulse when I feel the flutters I can feel the missed beat.
2 - The normal echo was in April 2016 - prior to my illness of GERD and the palpitations The Holter monitor did not show anything at all per the cardio I do not have the report - I did feel the flutters while wearing it, just not as much. I called and requested an event monitor but the nurse said the doctor said it's not my heart.
3 - My TSH has gone from 4.7 to 2.7 in 4 weeks, since I started taking a PPI - I was going to recheck the TSH again this week to see if it went down more.
4- I do not drink coffee, or smoke I only drink chamomile tea - I have been anxious from this GERD condition even awakening me up at night shaking, but I feel calmer now since the pain has subsided. Perhaps I am anxious, I do run two businesses and work 7 days a week, but why would the flutters be more prominent after I eat and move around compared with just sitting behind my computer working? I do not take any other meds, the only new medication is the PPI.
Thanks
1 - seems like flutters (almost like an eye twitch would feel but in the chest) No I never feel like I am going to pass out or anything like that. I stating "skipped beats" because if I take my pulse when I feel the flutters I can feel the missed beat.
2 - The normal echo was in April 2016 - prior to my illness of GERD and the palpitations The Holter monitor did not show anything at all per the cardio I do not have the report - I did feel the flutters while wearing it, just not as much. I called and requested an event monitor but the nurse said the doctor said it's not my heart.
3 - My TSH has gone from 4.7 to 2.7 in 4 weeks, since I started taking a PPI - I was going to recheck the TSH again this week to see if it went down more.
4- I do not drink coffee, or smoke I only drink chamomile tea - I have been anxious from this GERD condition even awakening me up at night shaking, but I feel calmer now since the pain has subsided. Perhaps I am anxious, I do run two businesses and work 7 days a week, but why would the flutters be more prominent after I eat and move around compared with just sitting behind my computer working? I do not take any other meds, the only new medication is the PPI.
Thanks
Brief Answer:
please see details.
Detailed Answer:
Dear Ma'am
Thanks for the details.
1. If you have had flutters when you were wearing the holter and it did not show up any significant rhythm disorder, then it suggests that at time of flutter there is no serious rhythm disorder is occurring. Moreover absence of warning signs like passing out etc is reassuring further.
2. Missed beats or transient flutters or pre-mature contractions are common in general population and on a given day 2/3rd of a population will have some missed beats (recognized or unrecognized). They are most common cause of transient benign palpitations. We tend to recognize them by various methods like an ECG at time of palpitation or a holter if they are occurring daily or a loop recorder if they are occurring occasionally. Absence of serious rhythm disorder on holter or ECG when patient is saying that he or she has those symptoms, speaks against a serious rhythm disorder. First thing in work up of pre-mature contractions (missed beats) is look for warning signs which are absent in your case. second thing is to look for any structural heart disease which is again not there as your recent ECHO was normal.
3. As far as the cause of premature contractions is concerned. They can occur due to a variety of reasons or provocations or stimuli which may range from a cup of coffee to anti-flu medications to mental stress. GERD is a common causative factor. Hence we may not be able to pin-point the cause in a large number of patients.
4. For treatment, if there is no serious rhythm disorder, no warning or red-flag sign, no structural heart disease, We ask the patient to ignore them. At times we use suppressants like beta blockers or verapamil for them. We ask them to avoid common stimulants like cigarette, coffee, tea and certain medications.
I hope this provides you insight into your condition.
Feel free to discuss further.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Ma'am
Thanks for the details.
1. If you have had flutters when you were wearing the holter and it did not show up any significant rhythm disorder, then it suggests that at time of flutter there is no serious rhythm disorder is occurring. Moreover absence of warning signs like passing out etc is reassuring further.
2. Missed beats or transient flutters or pre-mature contractions are common in general population and on a given day 2/3rd of a population will have some missed beats (recognized or unrecognized). They are most common cause of transient benign palpitations. We tend to recognize them by various methods like an ECG at time of palpitation or a holter if they are occurring daily or a loop recorder if they are occurring occasionally. Absence of serious rhythm disorder on holter or ECG when patient is saying that he or she has those symptoms, speaks against a serious rhythm disorder. First thing in work up of pre-mature contractions (missed beats) is look for warning signs which are absent in your case. second thing is to look for any structural heart disease which is again not there as your recent ECHO was normal.
3. As far as the cause of premature contractions is concerned. They can occur due to a variety of reasons or provocations or stimuli which may range from a cup of coffee to anti-flu medications to mental stress. GERD is a common causative factor. Hence we may not be able to pin-point the cause in a large number of patients.
4. For treatment, if there is no serious rhythm disorder, no warning or red-flag sign, no structural heart disease, We ask the patient to ignore them. At times we use suppressants like beta blockers or verapamil for them. We ask them to avoid common stimulants like cigarette, coffee, tea and certain medications.
I hope this provides you insight into your condition.
Feel free to discuss further.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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