Heart Rhythm Expert Forum
Should I be concerned?
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Should I be concerned?

Hi, I am a 44 yo male who exercises regularly (ice hockey 3x week, weights 2-3 x week). I am concerned because the other day I noticed my heart was skipping beats after exercise before bed. My father had 2 MIs before 50, and my mother had A fib at 65.

I did see a cardiologist who did a holter, which found I occasionally get an intermittent type 1 2nd degree heart block while sleeping. I did an EKG which showed an incomplete RBBB which was not there a few years ago. I did a stress test and reached a max of 20 Mets. I had no chest pain but short of breath and he said the test was normal. He said not to worry but this does not sound normal. Should I be concerned? Will I get A fib in the future? Should I exercise less?
4610897_tn?1393869202
Thank you for your question. The symptoms you are describing are called palpitations. They are a very common reason patients seek medical evaluation.

The key to an evaluation of palpitations is put a patient in the appropriate risk category, but ultimately the goal is to capture their heart’s electrical rhythm when they are having the symptoms. This can be difficult for patients who have infrequent symptoms.

First, an incomplete right bundle branch does not infer any difference in prognosis in patient with no evidence of structural heart disease. You may ask your doctor to order an echocardiogram (ultrasound of your heart) to ensure you have no structural heart disease.

In terms of capturing the abnormal beats. Your symptoms sound infrequent if they were not captured on a Holter or not occurring with vigorous exercise (20 METs on a treadmill). I congratulate you on your excellent exercise capacity by the way! I would NOT recommend you decrease your exercise. You have no real red flag signs from what you described.
Also, if you haven’t done so already make the following lifestyle interventions. Avoid excessive caffeine alcohol. Avoid stimulants. Avoid sleep deprivation. Look into stress reduction techniques (yoga, massage, tai chi, etc).

As for your chance of getting atrial fibrillation. There is no way to tell. The fact that your mother had atrial fibrillation does not necessarily increase your risk. And the fact that you have palpitations does not increase your risk as well.

Thank you for your excellent question. You can consider asking your physician about an echocardiogram and a longer period of Holter monitoring (30 days) if you need closure for this matter. However, you should not be excessively worried about this issue.

Sincerely,
Dr. S
3 Comments
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Avatar_m_tn
The stress test was a stress echo, the echocardiogram was normal.
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Avatar_m_tn
My only symptom was on one occasion when taking my pulse I noticed a pause, ie, beat, beat, beat, pause etc, that appeared at intermittent  random moments. I assume this was the block? Otherwise I feel we'll.
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