1242443 tn?1268371732
Palpitation Concern

First of all I would like to thank any anyone who does take the time to answer my question regarding what I believe is my heart. I apologize in advance for the length, and have provided a “tl;dr” at the end. I've tried to be as detailed as possible. Any insight or comment is most appreciated.

I am a 28 year old male, 5'10 and about 205 pounds. I am uninsured. I do not smoke, do not use recreational drugs, and only drink either water or orange juice. My last visit to the doctor (today) revealed my blood pressure being 112/78 I believe, or a number around that. I lead a mostly sedentary life style. I personally have not been diagnosed with any heart disease. I believe one of my uncles died of a heart attack in his sleep, however. My mother has complained of some heart issues when I was a child, but because it was so long ago she doesn't remember what was wrong with her heart. She since then sought some treatment and hasn't complained about it since.

In November, 2009, I started, on occasion, to become consciously aware of the beating of my heart. I would be doing something or nothing in particular, when suddenly my focus would just shift to my heart. I would ask myself, “is it just me or is it beating oddly?” At first, it sort of felt like the occassional random skipped heart beat. Then I wondered if it was beating too slowly. I learned to measure my heart rate, and calculated it was beating in the 60 range. Prior to this I was not ever aware of my heart rate unless I had did something strenuous like running. My heart rate was noth something that occupied my daily waking thoughts.

Then one evening, after having taken a shower and having finished dinner, I felt my heart start to race. It was to the point where it felt abnormal and I had to lay down and try to calm myself down. Given the amount of practice I have taking my own heart rate now (after the incident), I believe I might have been tachycardic during that evening. I seriously considered going to the hospital, but I did not. My heart felt like I had run a considerable distance nonstop, and I feared it would stop.

When it happened again about a week or so later, I decided to visit the Urgent Care. The doctor there informed me that the palpitations (as I had learned that's what people called them) were caused by my use of the medication advair (It is also the only medication I was taking at that time and nothing else) He then prescribed me asmacort. I went to get the asmacort but was informed it was no longer on the market, and so I was prescribed pulmicort flexhaler.

While the incident that happened twice in November and December respectively, has never repeated itself again, at least not with the same intensity. I have felt on occasion since then an elevated heart rate, which does not seem to consistently come about from physical exertion, although that does seem to be the trigger about maybe 1/3.

Fast forward to January, February, and March 2010. Nearly daily, with occassional breaks inbetween days, (moreso in February and March) I find that my heart rate will suddenly become elevated. While I understand that this is a normal occurrence for people, I find that my heart rate elevates even when I am doing nothing particularly stressful or when I do something non strenuous like washing dishes. I understand that elevation is normal, but for me it elevates to the point where I become consciously aware of it. What makes me take notice of it is the fact that I'm not doing anything that warrants the elevation. The same actions prior to November, would not cause me to become consciously aware of my heart being elevated.

To summarize, I believe that there might be something wrong with my heart because doing something not physically strenuous like washing dishes or standing up after sitting down for a long period, raises my heart rate to the point it feels as if I had just run some significant distance. These same actions prior, did not cause cause my heart rate to elevate to the point where I became aware of it.

This leads me to conclude that my heart is elevating beyond what my body considers normal or what was typical for me in the past, and hence why I become aware of it in the middle of an activity.

I went to a primary care physician finally, and she checked my heart with a stethoscope and said she did not hear any clicks or gurgles. She ordered an EKG, and found it was normal. She had me wear a holter monitor for 24 hours, and she concluded from the results that my heart was normal. She then concluded today that I was fine, and that the palpitations which I had claimed to experience were benign in nature. I did not have blood tests done, and because I am uninsured stress + echo is financially not feasible. She suggested stress + echo, by the way.

I told her that I did not feel any sort of chest discomfort during the ekg or any real discomfort during the 24 hour holter monitoring. I then proposed that the data did not accurately reflect my potential condition since I did not experience any symptoms during the examination time. She was persistent in her conclusion that my heart was fine given the results from the ekg and the holter. I asked her what she would suggest if I felt my heart rate being elevated once again, and she replied that I should go to the ER or simply ignore it. To me it sounded something like a cop out answer.

To add more to the list symptoms, shortness of breath rarely accompanies my heart rate elevation. In fact, sometimes, it helps bring down the heart rate a bit. I do sometimes feel physically weak during the heart elevation. Sitting or laying sometimes alleviates the symptoms. Also, sometimes, getting up and walking will alleviate it too. However, sometimes, physical activity does the exact opposite and causes the symptoms to present itself.

Tl;dr Is there something that could be causing my elevated heart rate? How probable would it be something like mitrial valve regurgitation or such? (I have done amateur research, by the way) Do my symptoms warrant those conclusions? Is it serious or should I be concerned? Furthermore, were the actions of my doctor appropriate given the circumstances?

Thanks, and again sorry for the long post.
1 Answers
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612551 tn?1450025775
You didn't give any numbers, let me offer a few.  If when you are fully at rest you HR is in the 60-70 range (that's a nice range, but anything under 100 could be acceptable) and it goes to 90+ when you stand, and do light work, maybe it goes up to 100+ I'd not be concerned.  

As for a stress test, that is mostly to check for oxygen to the heart muscles, and a blockage would be very unlikely at your age.  Also, given you good results from you doctor visits I think there isn't much to worry about.

As from Mitral Valve problems, if it were anything significant the doctor could likely hear it with the stethoscope.  It appears she did not hear anything abnormal.

If your stomach isn't troubled with a aspirin a day, with a meal to help protect the stomach lining, I think taking one a day would add a small measure of heart/stroke protection without high cost or side effects.  Of course, if you have a sensitive stomach, then aspirin may not be the right home treatment to use.

I take an aspirin a day, usually a full strength 325 mg dose, not the 81 mg low dose some people take.
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