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23 year-old Male with Arrhythmia and Palpitations
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23 year-old Male with Arrhythmia and Palpitations

Hi. Please help me out as I am very concerned at the moment.

I am a:
- 23 year old Asian male
- no family history of heart disease
-165 lbs, 5'11", BMI is 23.2, resting heart rate is 60, blood pressure is 138/86
- play 2 hours of soccer 3 times a week, lift weights twice a week
- no medication, multivitamin daily, fish oil daily, and protein shakes with 5 grams of creatine after exercise
- don't smoke and drink about 2 times a month

My symptoms are:
- occasional arrhythmia and palpitations for 3-4 years now, but recently they have become more often
- happens when I go to bed an hour after I play soccer (soccer at 10 PM, bed around 1 AM)
- characterized by extra beats, keeps me up for at least 30 mins
- sometimes extra beat will kick in every other normal beat
- very aware of it, feel like there's a pocket of air in my chest when it happens
- arrhythmia also happens after a night of heavy drinking or when not enough sleep
- hard and rapid heartbeat when I am nervous or anxious
- sometimes hard and very slow heartbeat (1 beat every 2 seconds) when I wake up from taking a nap

Cardiologist visit last week:
- normal EKG reading
- doctor detected murmurs and extra beats
- said it is possibly premature ventricular contraction, mitral valve prolapse, and mitral regurgitation
- said I need a stress test following the Bruce protocol and an echocardiogram to confirm and determine whether the condition was benign or required treatment
- because of the high deductible on my insurance, I have not gone back for those tests as I can get them done for much cheaper back in Bangkok, Thailand (including airfare)

My questions are:
1. Given that I am still able to engage in strenuous exercise without feeling pain or reduced tolerance, should I worry about my symptoms?
2. Are my symptoms serious enough that I should get these tests (stress and echo) done immediately?
3. What other possible conditions could it be?

I appreciate and thank you for your time and help in advance.
Related Discussions
Avatar_dr_f_tn
Extra heart beats are often the culprit for the symptoms you are describing -- heart skipping a beat, heart pounding, etc. They don't usually cause a sustained sensation of fluttering heart, but are more episodic. If you are having long periods of palpitations, then I would consider an abnormal heart rhythm such as an SVT (supraventricular tachycardia, which includes atrial fibrillation, atrial tachycardia, AVNRT, AVRT, and atrial flutter). If your doctor heard a murmur on your exam, then I think an echo is certainly indicated, because if one of your valves is leaky (mitral valve prolapse is common in young women and can result in mitral regurgitation), the leak can cause enlargement of the atrium (upper chamber of the heart) which predisposes to abnormal heart rhythms.

The absence of pain doesn't mean there isn't something going on. It just means there probably aren't any blockages in the blood vessels supplying blood to your heart, which is usually the cause of pain with exertion. You are young and this is not generally a concern in young patients.

The benefit of doing a stress test in addition to doing an echo is that some leaky valves don't look bad when you are resting, but when you exert yourself, they can get worse because of changes in the amount of work the heart has to do.

I would recommend proceeding with both tests, though there is not any urgency to them. You are not in danger.
5 Comments
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2027548_tn?1329031595
Are you on any anti anxiety pills? Every time my heart gets to racing. 160
s 170's i take my anxiety pill. I am also on a beta blocker to slow my heart rate down. Did he say anything about possibly checking you for sleep apnea? Also you could possibly have something called psvt. Paroxysmal ventricular tachycardia. Where your heart constantly wants to beat fast. If i were you I would continue to do more testing since you play sports and exercise alot
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Avatar_m_tn
Hi Nessajo89,

Thank you for taking the time to answer my question. I am not on any anxiety pills because I don't get anxious or nervous often. It's just that when I do get nervous (like watching the Superbowl and rooting for the Giants), my heart tends to beat very hard. The doctor did not say anything about sleep apnea, but that is something that I will definitely look into. I don't think I have tachycardia because my heart does not constantly beat fast and like I said it usually stays around 60 BPM. Rather it is beating abnormally (skipping beats, extra beats) and that's what is bothering me.
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2038046_tn?1329709665
I am into bodybuilding and sports too. I strongly reccomend that you focus upon relaxation and recovery. Make sure you are spacing your workouts sufficiently-- stress is never a good thing. Have sufficient recovery days. Occasionally just stop and take off for an entire week.  Always make sure you stop working out when every you are sick from flu or other such thing until you are completely recovered.  Take a nap once a day or more. Start meditating-- laying in bed close your eyes and think about being in a beautiful place.  You can find free programs on android -- get an android tablet that is good for bed use. These meditation programs emit regular sounds and help you to go into a  very therapeutic dream like state-- you can explore places you have not been in a while- walk around your elementary school or other place.  Also to improve sleep at night try about 4 to 8 melatonin pills (3mg each) and one valerian root pill(both available at Walmart) about 1 or 2 hours before bed.  You will get a deep sleep that also helps your muscles grow and repair better-- it will improve all systems including the heart. The first week or 2 you may be catching up on sleep as even if you feel you have gotten enough it will often not be true. Deep quality sleep is the product of these natural and non-addictive substances-- melatonin also aids in the fight against cancer and both help to normalize blood pressure (your diastolic is a bit higher than ideal).  If you are taking chromium in a supplement try to stop taking it and see if your diastolic goes down to below 80.  Also go buy a good blood pressure tester from Sams club for the best price and quality-- or other place if you know of a good source. Always rest at least 15 minutes to a calm state prior to taking blood pressure for the best test results.
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2038046_tn?1329709665
I am into bodybuilding and sports too. I strongly reccomend that you focus upon relaxation and recovery. Make sure you are spacing your workouts sufficiently-- stress is never a good thing. Have sufficient recovery days. Occasionally just stop and take off for an entire week.  Always make sure you stop working out when every you are sick from flu or other such thing until you are completely recovered.  Take a nap once a day or more. Start meditating-- laying in bed close your eyes and think about being in a beautiful place.  You can find free programs on android -- get an android tablet that is good for bed use. These meditation programs emit regular sounds and help you to go into a  very therapeutic dream like state-- you can explore places you have not been in a while- walk around your elementary school or other place.  Also to improve sleep at night try about 4 to 8 melatonin pills (3mg each) and one valerian root pill(both available at Walmart) about 1 or 2 hours before bed.  You will get a deep sleep that also helps your muscles grow and repair better-- it will improve all systems including the heart. The first week or 2 you may be catching up on sleep as even if you feel you have gotten enough it will often not be true. Deep quality sleep is the product of these natural and non-addictive substances-- melatonin also aids in the fight against cancer and both help to normalize blood pressure (your diastolic is a bit higher than ideal).  If you are taking chromium in a supplement try to stop taking it and see if your diastolic goes down to below 80.  Also go buy a good blood pressure tester from Sams club for the best price and quality-- or other place if you know of a good source. Always rest at least 15 minutes to a calm state prior to taking blood pressure for the best test results.
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