Hi doctor please help as i am significantly depressed and despairing about this. I am male, 47 and a light smoker (started smoking in 2005). I was diagnosed with mild to moderate sleep apnea in 2005 in Canada but did not want to use a CPAP machine. At the time, i could not accept that i had sleep apnea as i could not sleep during the sleep study, which apparently showed an AHI of 16. I went for the sleep study because i was having very noisy rumbling chest sounds that continued through the day and night. This had been ongoing for about one year. After seeing 16 doctors (in the UK and in Canada) and a few Cardiologists, i was told nothing much was wrong. But doctor 17 in the UK said she could hear a systolic murmur, and put me on Propranalol 120 mg a day. I was on this for five years and it dampened the symptoms, to the point that in 2007 i was able to taper of the drug and had no more symptoms. But, while working in Singapore and then in China from 2008 - 2011, going through two deaths of close family members in Canada (my parents -- my Mother last year) and a very stressful relationship, the symptoms came back suddenly in May 2011, when i was on 40 mg Propranalol a day. Since then i have been through a terrible Hell as something is quite wrong. When i try to rest or sleep, i have a strong vibration in my chest, followed by a strong fluttering which is then followed by an increased heart rate. The fluttering at first was low-level and occurred mainly during the night but it has now started to go on through the day. Propranalol 40 mg in the morning dampens it significantly. I had a stress echo in July 2011 which showed structurally normal and so far, no evidence of heart disease. About a week ago, i had a 24h Holter which also showed good rhythm with no AF or flutter and no arrythmia. But the strong fluttering sensation especially when i am woken out of my sleep has not gone away. It is frightening me to death. I am so exhausted trying to resolve the actual cause of this. I am certain it is a slightly floppy valve (mitral, tricuspid; or both). A 2005 resting echo showed mild mitral leakage and a 2009 Stress Echo showed mild mitral and mild tricuspid leakage. In 2011 i also had a sleep study at a specialist Singapore clinic (Dr Kenny Pang) (but only using a PAT which i think is not detailed enough) which cost me $1200. I was diagnosed again with sleep apnea (AHI 21). I have found it extremely difficult to use the CPAP consistently (I bought a BiPAP machine) but when i do use the BiPAP mode, it does seem to stop the flutter. My question: will i get better using the CPAP. I am frightened the flutter will become AF or a worse arrythmia. Most of the docs i have been speaking to are against any kind of intervention, especially surgical. I am extremely worried that curing the sleep apnea (if possible) will NOT cure the heart issue. But arranging a valve repair (mitral/tricuspid or both) seems to be my only hope to completely cure this flutter. It is damaging my life completely and i cannot think of anything properly. I am still working (high-stress software job in Shanghai) but my mind is being destroyed by fears. My recent visit with a new Cardiologist was very positive but he put me on 5 mg of Nevibotol and some Xanax and just encouraged me; he expressed that any heart surgery (for anyone, not me specifically) is palliative in nature and that current technology is inadequate to improve outcomes at all. I certainly do not want to get heart surgery (i have no insurance and would be forced to exhaust my savings; but i am close to cheaper centers here in Thailand or India, for example). What on earth shall i do? The good news is that i am able to get by on 40 mg propranalol in the morning and 5 mg of Nevibolol in the evening; but if i forget to use the CPAP and fall asleep, i get such a frightening flutter. The flutter definitely affects my heart because instead of LUB dub it becomes VERY STRONGLUB-dub; VERY STRONGLUB-dub which goes on for about ten minutes after i wake up with flutter. Should i go for a voluntary subcutaneous valve repair? If i wait until i am symptomatic i am afraid it will be an unmanageable acute situation from which there will be no recovery or a very poor prognosis.