Question Title: Arrytmia in Neck vs. Chest

In the past year I have developed a mild case of panic disorder that was
effectively treated with cognitive-behavioral therapy and 10mg of Prozac
a day. During the panic disorder and since then I noticed that I have
sudden strong heart beats in the chest area. I had an EKG
and wore a halter monitor for a week. The EKG was fine and the recording
the monitor showed sinus arrythmia and
my doctor said I had nothing to worry about. Since then I started
experiencing strong beats in my neck area (right where the thyroid is).
It feels as if a strong heart beat or several in a row issue from my heart
and travel up to my neck where they "explode" and that's when I feel them.
I can sometimes anticipate them by a split second.I visited a cardiologist
at UCLA who checked me thoroughly and said I am experiencing normal
irregularities and have nothing to worry about. As a side note, I've
been tested for thyroid problems and have none.

My questions are:
-Why do I feel the strong heart beats in the NECK AREA (sometimes also beneath
the shoulder blades)as opposed to the heart area? Is this common?
What does the location signify?

-I notice that while the sudden strong heart beat in the chest
area can occur out of the blue when I am resting, the heart beats in the
neck(or right under the shoulder blades)ONLY occur when I am either
very anxious (going into an important meeting) or when I am doing
physical movements that involve a lot of stooping and standing up and
down (cleaning the floor etc.) This concerns me because I know that
people with heart conditions are more likely to experience symptoms with
excercise or under stress. Any thoughts on the different onset of symptoms?

Sorry for the lengthy message. THANKS!

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Dear RH,

Thank you for your question.

Q:Why do I feel the strong heart beats in the NECK AREA (sometimes also beneath
the shoulder blades)as opposed to the heart area? Is this common?
What does the location signify?
A: The heart has no area of it's own to express itself. It therefore uses other parts of the body such as the neck, arm, jaw, chest and abdomen. Any of these areas can have symptoms due to the heart. This is very common and does not signify anything special.

Q: I notice that while the sudden strong heart beat in the chest
area can occur out of the blue when I am resting, the heart beats in the
neck(or right under the shoulder blades)ONLY occur when I am either
very anxious (going into an important meeting) or when I am doing
physical movements that involve a lot of stooping and standing up and
down (cleaning the floor etc.) This concerns me because I know that
people with heart conditions are more likely to experience symptoms with
excercise or under stress. Any thoughts on the different onset of symptoms?
A: You may have two different types of extra beats - one that occurs at a slower rate and one that occurs at a faster heart rate.

I have enclosed some general information about extra hearts beats below. Good luck.

PVC's can cause chest pain as you can see from the many other questions on this site. You can also draw comfort from the fact that so many others have the same concerns that you do. As far as specific advice about what you should do we always recommend following your local doctor's suggestions.

Below is a brief summary of what a PVC is, what causes them and the treatment (if any) for PVC's. You can find additional information in an article in New England Journal of Medicine, May 7, 1998, Vol. 338, pages 1369-1374. Your local medical library will have a copy of this. Hope this helps.

PVC's (premature ventricular contractions) are "extra" heartbeats occurring out of sync with the normal regular rhythm of the heart. PVC's may cause no symptoms at all or may be felt as a "irregular" heartbeat or as the sensation of a "hard heartbeat". PVC's are common findings in persons with otherwise normal hearts, in which case the prognosis is excellent and there is no decrease at all in life expectancy. On the other hand, they may indicate that there is an underlying abnormality of the heart muscle (from any number of reasons). If there is an abnormality, then the prognosis and treatment depends upon the specific problem of the heart. The usual evaluation of PVC's is a history, physical examination, and electrocardiogram (ECG). Also your doctor may wish to check an ultrasound of the heart. If all those tests are normal, then you would fall into the category of people who have PVC's but otherwise no underlying heart problem. In that case, treatment depends on how much the PVC's bother you. If they are essentially asymptomatic, then no treatment is required. If they bother you, then a medication called a "beta-blocker" may reduce the frequency of the PVC's. PVC's can't be "cured", but the medication can decrease their frequency. The potential side effects of beta-blockers are tiredness, impotence in men and breathing difficulties in individuals with underlying lung disease. Be sure to discuss these issues with your doctor and under no circumstance should you take medications for the heart without the supervision of a doctor.

Below are some web sites with additional information about PVCs.

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/prevent.html
http://www.nhlbi.nih.gov/nhlbi/cardio/other/gp/arrhyth.htm
http://www.MedicineNet.com/Forum.asp?li=USA&ag=Y&ArticleKey=1946

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist

• PVC

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