Really worried about irregular heart beat

[joeg]

Dear Doctor,

I'm 32, male. Four months ago, I felt sharp chest pains. I was panic for worrying about having a heart problem.

I went to see my doctor, and every test (EKG and X-ray) came out normal. He told me it was anxiety, but he would schedule me
for a stress test.  But I was still worried.  After about 2 weeks, I started to notice having early heart beats, at some time, I had about one early beat after every 5-6 normal beats.  I then went to see a cardiologist.  He also heard the early beats, and scheduled me on a Thallium and Echo tests.  Both tests
came out OK.  The report says there was RARE PVC in stress test as part of the Thallium test.  Though I did see many irregular heart beats on the screen during the Echo test, but the Echo test report didn't mention it. Why? After the tests, the cardiologist told me I should not worry about it, even though sometimes early beats may happen more freuently.  Now, after about 2 months, I have noticed I have more frequent early beats, every day, especially at night. Sometimes, there is an early (sometimes like skipped) heart beat in every 1-2 normal beats and that happens 3-4 times in a row. Whenever I have those early
beats, I would feel fluttering my chest. I am really worried.  

My question is: should I worry about those early beats even the doctors said my heart was normal after the Thellium and Echo tests?  There are times the early heart beats are much more frequent than the time I did those tests, so the tests may not catch everything. Is that possible? Do I need to see the doctor again?

Thanks a lot!

J

[CCF-M.D.-CRC]

Dear J,
Echocardiograms do not evaluate the electrical system so an "extra beat" would not change the echo report. Probably the best test to get at this point would be a 24-hour Holter monitor.  This is a 24 hour recording of your heart's electrical activity.  The number and type of extra beats can then be determined.  

In general, extra beats are benign in a normal heart.  However, if they are bothering you treatment may be indicated.  The first line therapy is usually medications such as beta-blockers and occasionally antiarrhythmics.  If these fail or if you want to avoid life-long medications a ablation procedure may be your best option.