PAC's

Hi, I am a 29yr old 4th year medical student from the UK.

About 6yrs ago I quit smoking with the aid of nicotine patches. During the period in which I used the patches I noticed a strange fluttering in my chest. These quickly stopped upon ending the use of the patches. However, they quickly returned which led to a trip to the A&E department. After countless ECG's, a 24hr Holter monitor and a treadmill stress test, my cardiologist discharged me.

At the moment I take 300mg of Mg daily which seems to have stopped what I believe are premature atrial complexes. However, in the last few months I have had three quite alarming flutters in my chest. Usually I feel the flutter of the premature contraction, then the compensatory pause and finally the kick of the next contraction. On the three occasions in the last 8 months it feels as though there are many premature contractions - 4 or more maybe - in quick succession. This lasts for about 5-8 seconds before the pause as opposed to the usual 1-2 seconds. I don't experience any other symptoms during these alarming moments (chest pain, dizziness, etc) except for a thready pulse.

I have also noticed lifting my arms in the shower to wash my hair or keeping my neck tilted in a certain position can trigger these events - Vagal stimulation maybe?

Any advice would be appreciated, thanks.

[Darcy Green Conaway, MD]

The most common cause of palpitations is premature beats-- either ventricular or atrial. I would suggest an echocardiogram and an event monitor to ensure you don't have significant arrhythmias. You may also consider getting your thyroid tested. As long as your heart is healthy premature beats are not associated with a poor prognosis. They are treated when symptomatic