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.

[ireneo]

I would advise at least getting the echo done. In my opinion (not a medical one at all), the fact that you can play strenuous soccer without symptoms of chest pain or unusual breathlessness, that would be as good as a stress test. But an echo will clearly show if you have any serious valve problems or abnormalities with the heart muscle. If all that is normal then most likely you have a common electrical problem in your heart, PVC's. Many people have those and although annoying, they are not life threatening. I've had arrhythmias all my life and am still going strong at almost 60. For some people the frequency of the premature beats is too much and they will take medication to ease the sensation and frequency of them. You also know certain things will trigger them (drinking, fatigue, stress) and you can take action to avoid those things as much as possible. But again, for peace of mind, an echo would be helpful.