Palpitations (AF, gastro issues)

[DT9954]

Hi,
     I've got a question about palpitations and I guess I just want some clarification reassurance. A bit of background:

I've probably been a bit anxious/stressed for the last couple of years and have occasionally had skipped beats/flutters in my chest. This has also been accompanied by some chest discomfort at times and muscle twitching. I've also have issues with Crohn's, gastritis and acid reflux - which has flared up with stress.

I initially saw a cardiologist re: palpitations - I've had an ecg (a few times) and wore a monitor for 7 days + had an echo scan... everything came back fine. I wore a monitor a second time after being admitted to hospital by my GP after presenting with a rapid pulse (140 - albeit in sinus rhythm throughout) - nothing found on the monitor and the rapid pulse put down to dehydration as I'd also been ill that day (D&V).

I later got diagnosed with crohns, I had more incidents of palpitations and started having further chest pain - went back to see the cardiologist  - he decided it would be worth doing another test because there can sometimes be issues with inflammation etc..(?) - had a Stress Perfusion MRI - test came back fine and the cardiologist assured me there was nothing wrong with my heart - we'd covered all bases with the test. Chest pain put down to anxiety and/or acid reflux.

then a couple of months later I woke up with my chest pounding erratically and my heart racing - went to the local hospital and after an ECG the said I had atrial fibrillation. They gave me a beta blocker and flecainide via IV which brought me back into sinus rhythm.

I was initially worried at first and the incident caused a lot of stress but I've learned that AF is treatable and not particularly dangerous in someone my age (34) - I've got flecanide pills and bisoprolol to take if it happens again.

With that background in mind I'm still slightly concerned about the palpitations and probably just need some reassurance/clarification - I'm satisfied that there isn't anything structurally wrong with my heart, I'm not overweight and I have a good diet. I'm now just slightly paranoid about dangerous arrhythmia - I understand what PVCs are and I've felt them in the past after consuming alcohol.... I'm very conscious of my pulse when falling asleep on my front and can feel a pause (which I understand is actually a premature beat) and then a thump. The palpitations that bother me though are rather infrequent - I'm not sure they got captured on the holter monitor - they're more of a flutter/spasm for a second or two... then my heart goes back to normal. It has once happened after a large meal, once when I was sitting on a sofa after a phone call where I learned a former army buddy had died, once when I'd finished lifting some heavy boxes for a neighbour...

I realise it is hard to give me any real diagnosis over the internet but I just wanted to ask in general whether a brief flutter/spasm as opposed to a pause/thump is anything to be concerned about? Secondly, after a bit of googling (which I wish I hadn't done) - would the tests I've already had rule out most dangerous arrhythmia (I understand some of these can occur in structurally normal hearts) - things like the MRI stress test - would that also rule out the sort of arrhythmia looked for on a treadmill test as my heart was also under stress in the MRI, and presumably as I've had an ECG after being given flecanide in hospital then something like Brugada syndrome which I understand is tested for by administering flecanide would likely be ruled out? Sorry I'm just slightly paranoid after being told that my heart is perfectly fine and then a month or so later waking up with it not being quite so fine.

[MichelleP_3811]

That is correct.  It records constantly in a loop for a certain amount of time though I am not sure how long but it drops off the oldest data to allow the new data to be captured.  One you hit the record button it will back track for maybe 30 seconds to capture the possible start and then record for a little while to see if it stops.  There are ones that do self trigger but most only hold a few records before you have to send in the information.  I think some may do it automatically over wifi but mine didn't.  I had to use an analog phone to call it in.  I have to suspect in this day and age they would have advanced the technology since people do not have landlines.  When I did this in 2011 I still had a land line but have since done away with it.  

[DT9954]

thanks, these are rather short episodes and very infrequent... they last a couple of seconds or so at most - with an event monitor would it only start recording when I press a button (in which case I'd likely miss these) or does it continually buffer the recordings so that if I say press the button it will also save the data from moments before the button was pressed?

[MichelleP_3811]

Possibly but the only way to know for sure is to get a monitor to catch what is going on.  You might want to consider it just for your peace of mind.  Ask for a 30 day to give you more time to catch the symptoms that are concerning you the most.

[DT9954]

thanks for your answer, I have checked on my blood pressure and it is normal... my pulse is normally a little high during the day but comes down to 60 or so at night (I'm assuming this is probably anxiety).

I did read this on wikipedia:

https://en.wikipedia.org/wiki/Palpitations
"Vagus nerve induced palpitations are felt as a thud, a hollow fluttery sensation, or a skipped beat, depending on at what point during the heart's normal rhythm the vagus nerve fires. In many cases, the anxiety and panic of experiencing palpitations causes a sufferer to experience further anxiety and increased vagus nerve stimulation."

which might explain the fluttering/brief spasm feeling as opposed to pause/thump... I've certainly experienced palps after a heavy meal in addition to times where I've been stressed and so I guess vagus nerve irritation is a possibility - especially with the additional gastro issues - crohns.

I've also woken up several times feeling my heart beating heavily and a twitching sensation over my left chest - muscle twitching which leaves me with a bit of pain in that area - I'm guessing this muscle twitching could be anxiety related too.