Criteria for echo

Hello,
I have had palpitations for several years.  When I lay down they are strong and I'm a little breathless, but it will go away after about a minute.  Now I am having trouble laying down at night, because they won't go away.  It has also changed from just feeling my heart beat to feeling my heart constantly flutter and some brief, intermittent chest pain.  It happens during the day also. I have had an EKG, a chest xray, and some blood drawn.  
Also, I have discoid lupus, sjrogen's, and chronic reactive arthritis (20 yrs), and maybe mild AS.  I am not taking any medicine except for Black Cohosh for hot flashes after my hysterectomy.  
Since the EKG (emergency room visit) came back okay, I don't know if it would help to go to my PCP at the VA.  I don't have high blood pressure, but strokes and aneurysms run in my family.  I have been having some discomfort in my left shoulder and squeezing pain near my wrist, but I don't know if it's related to the arthritis or what.  I am only 46 yrs old.
I've read that an echocardiogram is more specific than an EKG.  What is the criteria to request an echocardiogram?
Should I not worry if the EKG' was okay?

Thank you very much!

[CCF-M.D.-KE]

Dear Hayley,

Sorry to hear about your recent episodes of palpitations. Given your past medical history and the symptoms you have been experiencing I think it would be a good idea to have an echocardiogram along with a holter monitor study. I would suggest making an appointment with a cardiologist who will acquire more information about your medical history and order further tests.
The echocardiogram is an ultrasound of the heart, which is able to detect and characterize problems with the heart valves and the heart muscle. The holter monitor is  a device worn for 24 to 48 hours which records the electrical activity of the heart in an effort to detect rhythm problems. Hope everything goes well.


Thanks for your question,

CCF-MD-KE

[hayley3]

Thank you very much for your time and expertise!!