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Can palpitations be painful?
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by Tim, Jan 25, 2001
I am a 29 year old male.  I've had palpitations for 4 years now.  There is some coronary heart disese in my family but only at old age.  I have a tendencies toward high blood pressure and high cholesterol.  I also have had undiagnosed breathing difficulty for the past 5 years.  Most of my symptoms are probably caused by my severe anxiety which I have only recently admitted to myself I have.  Until now the palpitations, breathing difficulty and blood pressure have been controlled through regular cardio vascular exercise. But recently the palpitations have been persistent and even painful!

I saw my cardiologist two weeks ago. After seeing one normal palpitation on an ekg the doctor prescribed 50 mg Troprol (a Beta Blocker).  It worked well for the first week.  I have not exercised much over the last two weeks, in part because it is during heavy exercise that the palpitations are painful.  Light exersize is not a problam.  It may be because I virtually stopped exercising, but 8 days after starting the medication my palpitations got much worse(especially in the evenings).  A couple of days ago (with the doc's permission) I increased the Troprol to 75 mg with a little success.  

The main thing that really scares me about all of this is the pain and the fact that I feel it during times of stress, whether fear or physical.  The pain is always quick (about a second), deep, moderate to severe, located behind my breastbone and is associated with pressure. There are no other heart attack/angina symptoms.  I think it is just painful palpitations, but I'm not sure.  From research on the net pain does not seem to be associated with arrhythmias.  I have not yet had a stress test, the Doctor doesn't seem to eager for this.  I will be given a heart monitor tomorrow.

Could it be a blockage(e.g. angina)?  Does anyone else get heart pain which is that quick?  Has anyone heard of this kind of pain?

Thank you so much for taking the time to read this and for any help
Tim
Answer:
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by CCF CARDIO MD - DLB, Jan 25, 2001
Short episodes of palpitations do not cause pain. While a fast arrhythmia that lasts for a long time could cause chest pain, especially if there is underlying heart disease such as due to angina, this is unlikely in your case, since you are young and presumably healthy. The heart monitor seems like a reasonable first step.
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Member Comments (11)
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by Julie, Jan 25, 2001
Tim - I have seen a few cardiologist with my palpitations but I remember that one of them once asked me if my palpitations were painful.  When I told him that my palpitations were not painful he told me that for some people palpitations can be painful.  All the same - I think you need to get this checked out.
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by Buzz, Jan 25, 2001
I have pain with my tachycardia.  Started out as short stapping pains at first.  Then over time had advance to a tighness on the left side.  At times I could feel the pain in the waist area and the inside of the elbow.  I also noticed I was not able to get a pause.  (was so very weak)  Since I started my beta-blocker my pains are almost all gone.  I also now can find my pause.  Only eating chocalate  and tons of stress will cause the pain to return.
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by Art, Jan 26, 2001
Hi Tim,

It is not always true that palpitations are not painful, even in a single PVC or short run.  I have had PVC's for almost 20 years (and it seems I have experienced almost all the sensations people have described here at one time or another).  During most of this time I have exercised heavily (at a competitive level in running), even though there is usually a little bit of fear lurking in my mind whenever I have episodes.  While I commonly had PVC's at rest, which are particularly common the day after exercising heavily following a break in exercise, I never noticed them during exercise.  About 4 years ago I noticed pain associated with skipped beats when running.  They showed up particularly at the beginning of the exercise.  It scared me because I had never noticed palpitations while running, so I saw a cardiologist.  He said he didn't think the intrusion of PVC's into exercise was a problem if my heart tests were normal, nor even the quick sensation of pain.  I suggested that the reason it was painful was that with a PVC, you usually have a longer pause than normal before the heart beats again, and the cardiologist agreed with me.  Even at rest you often note this skipped beat.  It is not the PVC but the following slightly stronger beat you notice.  When exercising hard, because the blood flow and blood pressure is high it might overstretch the ventricle a bit during this longer interval, giving a brief sensation of pain.  The fact that the pain occurs only for the duration of the PVC is suggestive.

Six months after visiting the cardiologist I trekked in the Himalayas with no problems.  Two years after first experiencing this, and having noticed it several more times, I was still running very well.  I have not yet taken drugs for PVC's, which he recommended if I could not handle the psychological side.  I was prescribed them once when I first began having PVC's 20 years ago, but they didn't seem to help, probably because the dosage was too low.  I had stopped exercising entirely at this point from fear.  Finally, I decided I could live with this fear.  I decided it was do or die and entered a track meet, running several events.  I didn't fall over dead and it was incredibly reassuring.  Been running ever since.

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by dah, Jan 26, 2001
Hello,
I suffer from frequent chest pain - the kind described above - short, quick, and painful stabs of pain, lasting only a second or two.  I get them in different areas of the chest but mostly concentration on the left side.  I've complained about them to my doctor and was evaluated by a cardiologist - all say they can't find any problems.  I am a long time sufferer of diagnosed PVCs, PACs, PATs, and occasional SVT.  My chest pain occurs at random times, sometimes associated with the extra beats, sometimes not.  It's so frustrating and scary.  If anyone knows of a chat room or message board where I can communicate with other people with similar symptoms, please let me know!
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by Scott, Jan 29, 2001
Been there, done/doing that.  30 year old male.  I get pains during episodes of either PAC's, or PVC's too (I don't know which one causes the pain.)  Quite scary at times.  Never seem to have them during exercise.  I'm pushing towards Art's solution (letter above): better to die living life than to live in fear.
Anyway, anxiety has been a big component of these episodes.  Handle the anxiety and you will notice a reduction in the episodes.  Also, that tight feeling under the breastbone, low in the chest.  I'm convinced that is the involuntary smooth muscle clenching down in the vicinity of the diaphragm in response to elevaated anxiety levels, hence the difficulty in breathing.  I've reduced my anxiety by focusing on the symptoms and willing them away.  That is, tightness in chest presents itself, try mentally willing those muscles to relax.  Anxiety medication is also an option.  Good luck.
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by ChrisMcG, Feb 03, 2001
I have to laugh as I write this:  I often get tons of PVCs while browsing this site!  It is so clear that there is a mental side to these darn things... I just wanted to chime in and say that at 34, I have also had all manner of pvcs, pacs, etc. and DO occasionally get a short stab of pain with a pvc.  It isn't the norm for me, but it certainly happens once in awhile, and I have noticed it with exercise.  I logged on here tonight because I got momentarily very dizzy and fatigued and wondered if that could be pvc related as well (that one is kind of new to me, but I think I may have had a particularly looooong pause).  Hang in there everyone:  we certainly have a burden to bear in this life with these nasty things.  But the post above which takes the "better to live life and die than..." is absolutely right.  We must make that choice.  I find that the more I do, the better I feel (not the opposite).  This little dizzy spell would have sent me into panic -- me with my fingers shoved into my neck taking my pulse on and off for the evening -- but after so many weird heart things, I have begun to relax.  Think about the stresses you are under and how they may relate to your symptoms.  There is usually a connection.  Oh, and I finally decided (a year ago now) to take a beta-blocker and find it a big help, even at a low dose.  Be brave friends!  We are most certainly not alone.
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by Mike, Feb 04, 2001
I was looking for some answers and I think I've found them!  I'm 27 years old and have recently been diagnosed with a heart virus.  I experience the same symptoms as all of you, however I do take Lopressor, a beta blocker, in order to control my PVCs and PACs.  I was hospitalized for a week, where they ran a series of tests on me, all of which came up negative.  All the doctors seem to know is that I have a blocked left bundle branch, I experience skipped beats and pauses, my heart is slightly enlarged, and the heart muscle itself is mildly weak.  Also, my blood pressure is very low, hovering around 90, and for some reason I always feel cold.

There's no history of heart disease in my family, so I've been really worried about why or how this has happened.  I do agree with the above comments that stress is a factor in the severity of the condition.  However I have noticed another symptom that I haven't seen mentioned yet.  When I feel the pain behind the breastbone it is often associated with an increasing amount of pressure in that region.  When this happens I experience an uncontrollable series of belching until the pressure goes away. This can often occurr at undesireable moments.

I hope there will be future comments on this site regarding muscle therapy.  I am eager to find an exercise program that could alleviate these annoying symptoms.  As it stands right now, I cannot run for longer than a minute without experiencing a racing heart and chest pains.  I believe that these symptoms can be overcome, I just don't know how yet.  And I refuse to believe that I'm not going to get better.   Hopefully, one of us will figure out how to beat this thing!
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by tom, Feb 05, 2001
Forgive me, I am not going to spell check this.....I know how you all feel.  I get these buggers, especially when I lay on my left side with a full stomach.  After exercise,etc. But what I am begining to believe, and I would ask all of you to think about this, is that my main problem is Panic Disorder and anxiety.

My PVC's are always more numerous and strong when I am stressed.  Especialy if my stomach and esophogus are all tore up from stress.  I think we should all remember that it is the immediate fear we have (because we have put or bodies on alert) can make you instantly dizzy, sick to your stomach, etc.  I don't hear to many accounts of people just droping dead in young and middle age, do you?  I saw a post about a guy who has a PVC every third beat, when he exercises it is for the most part normal. He bikes hundreds of miles/week.  The doctor on the post said he had nothing to worry about (I know, easy for him/her to say!).

I cut caffine out all together because I have had a relapse of panic attacks (after 12 years!).  I still get a PVC once in while and have just taken a exercise stress test that the doctor called "excellent".  But guess what, I am still thinking my heart could stop beating or I could have a heart attack at any minute!  I road my bike this morning and had some stomach pain that of course was caused by my heart (only in my mind).  I realize that some of you have real trouble with PVC's, but I just wanted to let you know that I understand the obsesion with the heart.  God bless all of you because I know EXACTLY how you feel. I think the guy who posted on diet issues might be on to something by the way.